In 1998, Dr. Kathryn Marocchino of Vallejo, CA founded Nikki Hospice Foundation for Pets, the nation’s first nonprofit devoted to home care of terminally ill companion animals. This is how the foundation defined animal hospice: “Animal hospice means seeing through the veil and viewing death not as an enemy to be feared but as a doorway to other states of being. Animal hospice means accepting that we have done our best with what we have been given during a specific moment in time but never feeling regret. Animal hospice means being willing to give death a chance without allowing fear, apprehension of our own discomfort to guide our decisions. Animal hospice means accepting death as a moment of grace and coming to realize that we are still learning, every step of the way. Animal hospice means allowing our animals to teach us what they know about death—far more than we can ever hope to know.”
For many people, most veterinarians included, this flies in the face of conventional wisdom; if an animal is terminally ill and begins to fail, euthanasia is commonly thought to be the next step. A growing number of determined veterinarians and animal caretakers are working to shift the conventional paradigm toward conscious end-of-life care for companion animals. These individuals are raising awareness about the availability of palliative care for dying animals and focusing their practices on end-of-life care to more actively provide supportive care for devoted caretakers and pets during the transitional period.
Stamford veterinarian Mary Craig began her mobile veterinary practice Gentle Goodbye three years ago specifically to serve the needs of families and animals nearing the end of the journey together. “Many vets don’t believe in hospice care for pets because they think they should euthanize the animal if suffering is occurring,” she says. “I don’t think the two are mutually exclusive or the same thing.” She refers to the hospice or palliative care phase as the time “when we don’t necessarily have to euthanize, but we have to do something to maintain some quality of life for the animal. In many ways, it’s the gap in time between when the animal is ready and the owner is ready.”
The American Veterinary Medical Association (AVMA) has issued guidelines on veterinary hospice care, defining it as care “that will allow a terminally ill animal to live comfortably at home or in a facility, and [AVMA] does not believe that such care precludes euthanasia. The comfort of the animal must always be considered when veterinary hospice care is provided. As in the case of human hospice programs, patients must have a terminal illness with a short life expectancy.”
The International Association of Animal Hospice and Palliative Care (IAAHPC) was founded in 2009 by a small group of veterinarians concerned with the lack of preparation veterinarians are given to deal with death and the dying process. The group’s focus is on educating veterinarians and gathering research to help support the creation of better training in veterinary schools for this subspecialty. The association holds an annual meeting once per year and draws increasing numbers of curious vets each year to discuss end-of-life topics which may not be taken seriously by the majority of the profession.
Dale Krier of Creature Comforts Mobile Veterinary Service in Sherman attended the IAAHPC meeting last fall and it was a watershed event for her. She has maintained a successful full-service mobile veterinary practice for 19 years, but is now shifting her focus to specialize in hospice and end-of-life care. “What I’ve realized over time is that while I love working with happy, healthy animals, there are plenty of vets available to take care of them,” she explains. “In general, we as vets have been poorly prepared to help our clients when they get to the later stages and fewer people call when they’re in the palliative phase because they’re unaware that there might be support available. So the call we get is usually when it’s at the end. It’s my goal to help change that and make the last days or weeks better for the animal and the family.”
Krier cites the example of a client whose son has Asperger syndrome and was extremely connected to the family dog who was nearing the end of its life. “Every client has unique needs and challenges,” she says. “In this case we had a lot of conversations about all the intricacies of the family dynamic and how to help the son deal with the impending loss. There is a lot of planning and sensitivity to apply in these situations which can be missing in the conventional approach.”
Craig points out that many veterinarians already deliver palliative care in a clinic setting, but may call it something different, like geriatric medicine. She and Krier agree many times a client loses touch with their regular vet when the point is reached that there is nothing else curative to be done or when the recommended protocol is not chosen by the client. That’s when a client might think next of euthanasia, unaware that hospice care might represent a viable step in between.
“If someone has a cat or dog with cancer and they’ve reached the point where they don’t want to or can no longer do medical intervention, then they take their animal home from the hospital and have lost their connection to the vet and the support staff there,” Krier explains. “There may be many things the client can do for their animal at home, but because nothing is being pursued medically, they lose their guidance and support system.”
In this area some of the local veterinarian hospitals are beginning to tap into their colleagues’ expertise; a third of Craig’s patients now come from referrals from other doctors. When she is called in, Craig will conduct a medical assessment and create a care protocol with the family, using subjective measurements on objective scales to gather data which will be useful in assessing the patient’s state of being. The length of time she works with the
family and animal might be brief—days or a few weeks, but the period is emotionally intense for all involved. This is also when ordained animal chaplain Barbara Richards of Paws Prayers n People in Newtown might be found visiting with a family and their animal. “Most of my sessions are with people who know the end is near but need help dealing with that,” Richards explains. “Our connection to the animals and our pets is so deep. The reactions of people and their animals to this time of transition can be very profound. What I do is help to guide them through the process, through prayer, ceremony, energy work, whatever they need.”
As Craig notes, the journey for animals has changed significantly over the past few generations; they have come out of the fields and barns as workers and into houses, bedrooms and even under the covers as cherished companions. The deep relationship between many people and their pets now requires an honoring which may be unprecedented in human history. Richards, who is also a certified pet loss grief counselor and Reiki practitioner, focuses her pastoral work on animals; alleviating their suffering and that of people connected to them is her calling. “Much of it is the animals,” Richards says. “Much of it is the relationships we form with them. There is also the fact that we mark the years of our lives by the pets who share them. Honoring those connections and life chapters is very important and necessary in order for there to be closure and peace.”
Veterinarian Kristen Klie of Monroe-based Final Journey took a pastoral care and counseling course at a seminary in Hartford which she applies in her veterinary practice providing at-home euthanasia services when the time finally comes. “How different things could be for vets and so many other people if the vets were taught how to really listen and relax with the process.” She sees the change happening in her profession and welcomes it. “As vets, we’re becoming more aware of the need for this. It is important and necessary to provide comfort and more gracefully follow the steps of the death and dying process.”