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Decision-Making
Compassionate Care for Companion Animals at the End of Life
A new book offers a guide to hospice and palliative care for diverse species.
Posted April 20, 2023 Reviewed by Michelle Quirk
Key points
- The editors incorporate advances in the science of animal cognition and emotions, particularly through their discussion of quality of life.
- The main message of the book is that animals with life-limiting illnesses deserve compassionate and thoughtful end-of-life care.
- Guardians—who are going through one of the most heart-wrenching experiences of their lives—also deserve empathy and support.
Almost everyone who chooses to live with a companion animal (a.k.a. "pet") of any species will, at some time, face having to care for a sick, terminally ill, or dying individual. There are better and worse ways to do this, and a new book edited by end-of-life experts Drs. Amir Shanan, Jessica Pierce, and Tamara Shearer titled Hospice and Palliative Care for Companion Animals: Principles and Practice (2nd Edition) covers all of the ways to offer compassionate care for companion animals who need all the love they can get. Guardians—who are going through one of the most heart-wrenching and challenging experiences of their lives—also deserve empathy and support.
I found some of the "what to do" summary tables to be extremely valuable, having been a guardian for many animals in need. I'm pleased that Jessica Pierce, one of the editors, could answer a few questions about their landmark, wide-ranging, book.1
Marc Bekoff: Why did you and your colleagues edit an updated edition of Hospice and Palliative Care for Companion Animals: Principles and Practice?
Jessica Pierce: In the second edition, we incorporated advances in hospice and palliative care medicine and practice and added chapters on caregiver burden, factors in euthanasia decision-making, and recognizing distress in animal patients. We also incorporated advances in scientific understanding of animal cognition and emotion, particularly through our discussion of quality of life, and we centered decision-making around what animal patients want and need. In other words, we are trying to focus attention on animal-centered care, within the context of interspecies families.
MB How does your book relate to your background and general areas of interest?
JP: My background is bioethics, and one of my key areas of professional interest has been improving end-of-life care for companion animals. I spent the first part of my career doing “normal” bioethics work, teaching in a medical school and working with doctors, nurses, and medical students. The core issues of concern—and the issues that really gave birth to the field of bioethics in the 1960s—revolve around death and dying: Is hastening the death of a suffering patient ever morally justified? How should we balance quality of life versus quantity? How can we compassionately navigate medical decision-making for those who cannot clearly articulate their own wishes? These questions became overwhelmingly personal when my beloved dog Ody, at age 13, entered a period of significant decline, and when I realized that I, alone, was responsible for life-and-death decision-making on behalf of my best friend. I turned my professional interest to ethical issues in animal end-of-life care.
My two co-editors are both veterinarians who specialize in end-of-life care, and both were instrumental in the founding and development of the field of animal hospice. This book is a culmination of their decades of combined work.
MB: Who is your intended audience?
JP: The book is written primarily for veterinarians, veterinary nurses, and other professionals who provide care for animals facing life-limiting disease or advanced age-related decline or who offer support to human families facing the loss of a beloved animal companion. Although some of the chapters are quite technical (e.g., those that focus on specific disease processes such as cancer, kidney disease, congestive heart failure, and gastrointestinal conditions), I think guardians who are caring for an ill animal may find the information useful: It provides a framework for understanding the physical processes and symptoms of disease, common trajectories of illness (e.g., should you expect slow but steady decline over an extended timeframe or should you expect a long plateau with rapid decline right at the end?). Armed with information, caregivers can be prepared, can make more-informed choices, can have access to a greater span of treatment options, can engage more actively in shared decision-making with a veterinary team, and can feel more confident that they are supporting their animal effectively, providing the best possible quality of life given the circumstances.
MB: What are some of the topics you weave into your book and some of your major messages?
JP: The main message of the book is that animals with life-limiting illnesses deserve compassionate, thoughtful end-of-life care. Their human guardians—who are going through one of the most heart-wrenching and challenging experiences of their lives—deserve empathy and support. Our goal is to help veterinary professionals and individual caregivers provide the best possible care for dying animals. We hope to expand the range of options and possibilities for animals at the end of life and embrace hospice-supported natural dying and hospice-supported euthanasia as equally viable trajectories.
The book is divided into three main parts. The first part, Core Concepts, describes the field of animal hospice and palliative care (its history and its philosophy), explains the concept of the interdisciplinary team (where caregiving is a team effort of veterinarians, nurses, mental health professionals, spiritual counselors, and guardians), and goes into depth on quality-of-life assessments, how to recognize distress in animal patients, balancing efficacy of treatments against the burdens of care, and ethical decision-making (including how to support the autonomy of animal patients).
The second part of the book focuses on patient care. We have chapters on providing palliative care for animals with cancer, kidney disease, cognitive dysfunction, gastrointestinal conditions, congestive heart failure, and musculoskeletal disorders, among other things. We also have chapters on the use of integrative therapies and physical medicine and rehabilitation and a chapter on euthanasia techniques and best practices.
The final section focuses on supporting the needs of caregivers and includes chapters on the physical and emotional burdens of caregiving, addressing the spiritual needs of caregivers, and providing aftercare options.
MB: How does your book differ from others that are concerned with some of the same general topics?
JP: Our book stands alone. It is the only complete guide to animal hospice and palliative care.
MB: Are you hopeful that as people learn more about this sort of care they will take better care of their companion dogs and other animals?
JP: Greater knowledge about and deeper insight into caring for dying animals can help us all navigate this difficult terrain with increased compassion for animals and for ourselves. Nearly all veterinary professionals encounter and care for animals who are dying. And nearly everyone who lives with and loves a companion animal will be faced with the profound challenge of ushering this animal through their final months, weeks, days, and hours of life. The goal of our book is to support animals and their human caregivers, medically, practically, and emotionally, as they make this sacred journey.
References
1. In conversation with Dr. Jessica Pierce. About the editors: Amir Shanan, DVM, is the founding president of the International Association for Animal Hospice and Palliative Care and a founding partner of the Animal Hospice Group. He owns Compassionate Veterinary Hospice, a veterinary practice dedicated to end-of-life care, in Chicago, Illinois. Jessica Pierce, BA, MDiv, Ph.D., is a bioethicist and faculty affiliate at the Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, in Aurora, Colorado. Tamara Shearer, DVM, CCRP, CVPP, CVA, MSTCVM, owns Shearer Pet Health Services and Smoky Mountain Integrative Veterinary Clinic in Sylva, North Carolina, and serves on the faculty of Chi University.
The book's description reads: "A thoroughly updated and expanded new edition of the only book providing comprehensive treatment of hospice and palliative care in veterinary medicine. Animals with life-limiting illnesses deserve compassionate, thoughtful, end-of-life care. Their caregivers and families, faced with the loss of a beloved companion, deserve empathy, support, and education, to guide them through an emotionally wrenching period and provide their companion animals with the highest possible quality of life. In recent years, the ethics of care and service to sick and dying animals and their caregivers has been the subject of considerable attention. Hospice and Palliative Care for Companion Animals, 2nd Edition provides a thorough update to the first and only complete guide to this field of service, its foundations, and its applications. It addresses the needs of pets, caregivers, and veterinary professionals alike, including fundamental ethical and emotional principles as well as detailed discussion of specific illnesses and life-limiting conditions. The expanded second edition incorporates cutting-edge research into animal behavior and cognition to enrich the reader’s understanding of companion animals’ emotional needs and their experience of illness and death."
Do Dogs Know They're Dying? What Citizen Science Tells Us
Dogs, Dying, and Death—and How to Help Them Cope
A Last Goodbye: A Kid's Book About Animals, Dying, and Death
What Do Animals Know and Feel About Death and Dying?
Pet Loss, Animal Spirituality, Earth Ethics, and Celebration
Why Blind Dogs Can Play Fetch, Find Toys, and Stay on Track
A Salute to Senior Dogs: Elders Can Teach Us New Tricks, Too
Special Needs and Senior Dogs Rock: They, Too, Need Love
My Old Dog: Rescued Seniors Show that Old Dogs Rock
When Dogs Need Help to Say Goodbye (Are veterinarians adequately trained to cope with emotions evoked by euthanasia? Data show that most veterinary colleges do not train their students effectively to deal with the emotional consequences of euthanasia.)
