Last week one of my nineteen year-old patients died. Or rather, as the euphemism goes, I put him to sleep. In truth, it was a race. If I’d been a few seconds slower he would’ve beat me to it. Such was the extreme of his advanced decrepitude.

Foxy had been blind, deaf, chronically disoriented, episodically anxious, unable to walk without assistance and periodontially challenged in the extreme. What finally did him in, however, was heart failure.

One of Foxy’s heart’s valves had been on the fritz for a decade or so—since about the same time his owner decided he was too old to risk the anesthetic complications of dental anesthesia. Hence the horrific mouth I’d been treating at arm’s length for years now. Hence the probable valve infection that led to last week’s race to bring on his demise.

You might think the owner of such an animal a tad off—or even cruel—for keeping him alive in spite of what most of us would consider “apparent misery.” And you might be right—or not—depending on a variety of hard-to-assess variables. In any case, it’s a lot more common than you might think.

I’ve learned to reserve judgment when it comes to these cases—and not just because I have a thing for working with geriatric patients. It’s also because the owners of these older, decrepit animals often find themselves isolated from their families (at least on the subject of their pet) for choosing to keep them alive. It must be terrible to be have your human alliances suffer over the life and death of your beloved pet.

Additionally, owners of the furry living dead (as I lovingly call them) are almost uniformly willing to do anything necessary to improve their pet’s healthcare situation—well, OK, there are limits, financial and otherwise (reference Foxy’s teeth). But above all, they truly believe that their pet is NOT suffering. Not any more than the rest of us do in our advanced age.

If I, as the pet’s healthcare provider and advocate, can even remotely believe that this is true—then who am I to judge?

And yet I hear the buzz in the waiting room when these clients exit. “How can she…?” “Why would anyone want to…” and other versions of the riff my staff goes off on behind closed doors: “It’s sick, keeping him alive like that when he’s nothing but skin and bones and rotten teeth.”

And they might be right. But after Foxy’s demise I had to admit that apart from his advanced dental disease (which we managed with pain relievers, brushing and antibiotic therapy—absolutely half-assed given the state of his mouth, I’ll confess), this dog was well loved and arguably quite comfortable (as long as he was with his owner, at least).

In fact, I’ve had cause to know plenty of younger dogs who were pushed well beyond comfort simply because of their chronologic age. Who’s to say whether a deaf-blind-demented-lame 19 year-old dog is any worse off than a seven year-old hip dysplasia patient whose owners know they can’t afford the surgery but want to keep him going as long as they can?

Ultimately, the only ones who can make these decisions are their owners. Is it procrastination? Sure it is. We’re all putting off he inevitable when it comes to death. Is it potentially selfish and cruel? Yes, potentially.

It’s my personal opinion that it’s better to make the decision for euthanasia weeks too early than one minute too late. But, as with making medical decisions for our human family members, it’s a verdict best left to those who are closest to the patient—for better or…worse.