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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

Palliative Care ≠ Murder

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April 26, 2012 / (10) comments

I talked yesterday about compassion fatigue, which often develops when caregivers focus primarily on others while ignoring their own needs. Sometimes, however, a caregiver’s negative emotions are a direct result of the words or actions of others.

 

I have found that stress seems to bring out the best or the worst in people. I am constantly amazed at how gracious and kind the great majority of my clients are when we are making end-of-life decisions regarding their pets. Of course, I’ve met a few bears too, but they are the exception that proves the rule.

I recently ran across a story about an especially egregious account of malice directed at a medical doctor. You can listen to the whole story at Colorado Matters, but here is an excerpt:

 

It was one of the darkest days of Daniel Matlock’s medical career. Dr. Matlock specializes in older patients and end-of-life care. He’d been summoned to the case of a woman who experienced a massive stroke. The woman had spelled out her wishes in an advance directive and she did not want any form of life support. Matlock saw the woman was getting intravenous hydration and asked that it be removed. That was when another doctor essentially accused him of murder. Turns out, this isn’t unusual. A recent report in the Journal of Palliative Care finds that one in four doctors who work with patients at the end-of-life have experienced accusations like these. Dr. Matlock, who’s a geriatrician at the University of Colorado, started blogging about his experience. It was picked up by the New York Times.

 

I’ve never had an owner or another veterinarian accuse me of "murder" when I’ve discussed palliative care, or even the euthanasia, of one of my patients, but I commonly come across very different points of view about what is appropriate treatment. I’ve dealt with a few clients who are morally opposed to the euthanasia of animals and in those cases we’ve developed a plan for hospice care that helps the animal die as peacefully as possible. Other people are adamant in their desire to prevent suffering and will request euthanasia at the first sign that a pet’s quality of life is starting to decline. Most owners fall somewhere in the middle, wanting to maximize the good times and minimize the bad. I work with each client on their own terms, always trying to be the animal’s advocate and remembering that there usually is more than one right way to handle a difficult situation.

The New York Times recently ran a group of editorials called One Sick Dog, One Steep Bill. In her commentary, Dr. Louise Murray, vice president of the ASPCA’s Bergh Memorial Animal Hospital in New York City stated:

 

In situations in which euthanasia would once have been the only option, pet owners may now need to make tough decisions about the best course of action for their pets and themselves … I reassure them that for an animal that is lucky enough to be a beloved pet, there are no wrong answers as long as the focus remains on minimizing suffering. In a world in which too many dogs and cats find themselves homeless, an animal in a loving home has already won the lottery. Beyond that, the choices become personal to each individual or family, and are not for others to judge.

 

Amen.

 

 

 

Dr. Jennifer Coates

 

 

Image: We all get old by kgantz / Flickr

 

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COMMENTS (10)
1
End Of Life Decisions
by TheOldBroad on 04/26/2012 07:05am

End of life decisions are difficult for everyone involved.

Unless it's my decision for my critter, it's not my place to agree or disagree with the decision to euthanize (out loud anyway).

It's impossible to imagine being in the vet's position when he/she disagrees with a client's decision for euthanasia.

2
by Grevillia on 04/26/2012 09:33am

I've had to make this decision with my husband twice, most recently last November.

In the first case our dog, Molly, was diagnosed at 8 1/2 with a brain tumor. We were told it was inoperable but that it would not be fatal. Over time, however, Molly's quality of life would deteriorate & we would have to make the decision to let her go. My husband & I really struggled to come to a joint decision. He felt she was allowed to go for too long whereas I felt pressured into making a decision that I did not feel comfortable about.

Our 2nd dog, Ghillie, had heart surgery last November for pericarditis at the age of 11 1/2. We were warned that this might be caused by cancer & we agreed that when the surgeon opened him up, if he was riddled with cancer, we would come in, say our goodbyes & not wake him up. Thankfully this didn't prove to be the case & the surgery was completed. For 3 days he was great & for a while I had my bright-eyed, handsome dudie boy back. Sadly 4 days post-op he contracted a pseudomonas infection, which he couldn't fight. When he got to the point were his blood wasn't clotting, we made the decsion to let him go - he was dying in front of our eyes.

Almost 3 years on & I still find Molly's death incredibly traumatic. Not only did I feel pressured to make the decision but it was also the first time I'd been present at the moment of death & although Molly's euthanasia went smoothly it was not at all what I expected. I'd always thought that, like on TV, the eyes closed naturally when someone died. I still remember the shock I got when Molly's eyes remained open & I saw her glassy eyed face staring up at me. Until then I'd never realised how "dead" someone looked when they died! By comparision the decision to euthanaise Ghillie was easy - there was no other choice to make - he literally could not fight any longer. Ghillie was also already sedated, so he looked as if he was sleeping even before he was given the final needle.

I can't say that the pain I felt at losing Ghillie was any less than losing Molly but 6 months on I am certainly more at peace with his death than I was 6 months after losing Molly. I'm just thankful they had caring vets who were able to help them take their final journeys in a gentle way & that I was able to be by their sides as they slipped away. After all the joy they each gave throughout their lives it was absolutely the least I could do for them.

3
This is a hard-one
by kay morris on 04/26/2012 10:02am

We are Blessed to have our Pet-Doctor and his wonderful Staff...Our Sweet Daisy had a Brain Tumor, could no-longer walk..had to let her go at 9 yrs. of age...yet our Fitisy...left us in his sleep, age 22, at home..He was not sick, just old and tired....both are loved and missed...Love is Love and always a Gift.

4
ADD-ON
by kay morris on 04/26/2012 10:25am

To say the word Murder, This is sad, Some Folks can not deal with death, we would all like to avoid it, this is Life, Those of us who believe in God, it is easy for us. Now at times Medical mistakes has taken a lifes, more with People than Animals, This is were my Faith comes in, God is the judge, not me.

5
Euthanasia
by mairs on 04/26/2012 11:18am

Veterinarians are individuals. Some are very forthright about the need for euthanasia and don't sugar-coat it when they think the end of the line is near, and some want to keep trying something else even when I've felt that I've gotten the sign from the pet that it's time to let go, which I've yet to be mistaken about. I'm sure it's not an easy job to help an owner make these decisions.

I also feel for the vet techs who sometimes cry as well when the animal is being put down, even when they don't know the pet personally. My hat is off to all of these good people.

6
Palliative ~ Compassion
by BeeBo on 04/26/2012 01:52pm

Thank you so much for sending me this article, today ~ at this time. How would you know that I am going through many tribulations at this point in my life. I have a 15 y.o. torti who is taking daily doses of the topical thyroid medication and who is not allowed to live with me while I am looking after my 92 y.o. Mother in her own home. My 15 y.o. baby lives with her two brothers, also rescues in my home in another town not far away from my Mom. Every couple of days, I am allowed to visit my animals making sure that their care is adequate, feeding, emptying litter boxes, playing and loving them. Then it tears me up inside to leave them to go home to my Mom to look after her and her illnesses.

Thank you for letting me vent and again, THANK YOU for this wonderful article which I will keep with me to refer to daily.

7
palliative care
by lefty on 04/26/2012 02:01pm

I couldn't agree more. I am currently going through this with an elderly and much loved cat. He is not in distress, and I am following vet's directions about his care. This animal is not ready for euthanasia, but that time is probably not far off. Meanwhile, each day is a gift. It is true that an animal in a loving home has already won the lottery. I praise my vet for her knowledge and empathy. This is also not the first time I have lost a cat, and while I shall grieve, I shall also rescue another cat from the Humane Society or the shelter. I have a commitment not just to this particular cat, but to cats in general. And, life does go on.

Thank you, Dr. Coates, for your post.

8
Still grieving...
by VetsRock on 04/26/2012 05:23pm

Thank you for this post. I am still grieving after having to make the difficult choice to euthanize our dog just a couple months ago...

Our 4-year old female dog suddenly started showing uncharacteristic fear and aggression toward one of our other female dogs. She had lived in our home since she was 3 months old and had lived with this dog, 2 other dogs, and a rabbit without any problems.

We consulted a behaviorist and put all the recommendations into place and when the management plan didn't work we consulted with another specialist who diagnosed her with siezures. The siezures themselves were so mild we didn't notice them. We tried several medications and management changes. After a year and a half of treatment we had a dog who was suffering from side effects from siezure medication and who was still fearful most of the time and would be aggressive toward the other dog with very little warning. (We still aren't sure why she only showed aggression toward one dog and not the others.)

We blocked off areas of our home and used crates to try to keep them apart. Our rehoming options were limited because the other dog also had medical issues. When I was bitten while breaking up the fourth fight in two weeks we made the difficult decision to euthanize.

We have had to make this decision in the past when a pet's illness had become terminal... This was the first time that we have had to make the decision seemed to be more about the behavior than the illness. I know in my head it was the right thing to do - We didn't realize how the stress had been affecting the other animals until afterward - But it will probably be awhile before I am truly at peace with it in my heart.

I am very thankful for my vets compassion and willingness to walk beside me through this. It has made a huge difference...

9
Always tough on both
by UFOH1 on 04/26/2012 06:31pm

the vet and the owner. Most people know in their heart when it's time to let go. I find it reassuring to have the vet reaffirm my feelings especially in an aged pet.

In some instances there is a gray area of indecision. This is especially true when the cause is unknown and you have a bunch of symptoms requiring extensive diagnostic procedures.
When do you stop...........

Quality of life is extremely important to me for all my animals. I would suggest you talk with your vet about euthanasia before you have to make that final heartbreaking decision. Make sure you and your vet are on the same page!

10
My best friend :-(
by NvonS on 04/26/2012 08:30pm

At almost 14 years old my buddy Sam stopped eating and started to have bloody diarrhea. His old body was covered with tumors large and small. I took him to the vet knowing that he probably wouldn't be coming home with me. When the vet said he could run a bunch of tests but that he probably had a tumor that had invaded his intestines and surgery would be our only choice. We decided that he had lived a long and happy life and it was time for him to go to the Rainbow Bridge. I miss him every day and can still feel his coat in my memory. His breed has just been recognized by the AKC so I know I will start to see more dogs just like him in the years ahead. Although they are our furry children they are still animals. When I hear about people who spend thousands of dollars on treatments to give their pet a few more months I think about children who go without surgeries because their parents can't afford to pay and I know that my money needs to go to hospital charities to help children instead of fighting a loosing battle for a beloved pet. It's a tough choice but I know the children I help go on to have a chance at a long and productive life.

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About fully vetted

Jennifer Coates, DVM

Photo of Dr Coates

Image credit: Jim Piraino

...graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999. In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado. She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-Speak Deciphered for the Non-Veterinarian. Dr. Coates also writes short stories that focus on the strength and importance of the human-animal bond, and freelance articles relating to a variety of animal care and veterinary topics. Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and various species of pets.

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