A Good Death
One of my patients died last night. I am sad that she is no longer with us but nonetheless at ease with her passing.
As many of you know, I work in a practice dedicated to end-of-life care. Most of our clients call us for our in-home euthanasia services. Our "typical" patient (if there is such a thing) has been diagnosed with a terminal condition and was treated appropriately for a period of time, but with quality of life declining, the owners eventually opt for euthanasia.
We also offer hospice services. In truth, most of these cases are not all that different from what I just described, we just get to the patient a little earlier in the course of their disease and institute whatever palliative measures are necessary to keep them comfortable and enjoying life for as long as possible. Many of our hospice clients eventually elect to euthanize, looking at hospice as an alternative to premature euthanasia, not to euthanasia in general.
But this patient, I’ll call her "Reba," and her owners were different. Reba had been diagnosed with oral cancer and was probably affected by canine cognitive dysfunction as well. Her owners were ethically opposed to euthanasia, feeling that her entire life had value. As one of them said, "Either she has something to learn or something to teach us even in her last days."
This family had been through hospice with another dog before, but "Champ" had died just a few days after the decision to switch to a palliative approach was made. Reba was different. My first appointment with her was on New Year’s Eve. I certainly didn’t expect her to live for another two months and neither did her owners. We talked on the phone frequently during that time, adjusting her medications and other forms of care based on her condition, and I visited her at home for a recheck a couple of weeks ago. She had her ups and downs of course, but through it all I feel like we did a good job of keeping her comfortable and content.
Hospice care with the goal of easing a pet through death that does not occur through euthanasia is definitely not for everyone. It is often time consuming, exhausting (physically and emotionally), and can be expensive. What sets Reba’s owners apart is their willingness and ability to support her day and night, and their attention to detail. When an aspect of Reba’s condition changed, it was addressed in a timely and appropriate manner. She was never left to suffer.
Reba’s case helped me gain a greater appreciation for what people are willing to do for their animals and reinforced the idea that euthanasia is not the only way to ease a pet through the dying process. Reba died last night, in bed with her owner asleep on the floor beside her. Her passing was so peaceful that she did not even wake her owner. From the description I was given, I believe she simply took a few last breaths and then was gone.
Thank you, Reba. You certainly taught me a great deal in your last days.
Dr. Jennifer Coates
Image: Laura Billings via Flickr