Pets: New Guidelines for End-of-Life Care

When faced with the impending death of a pet, everyone reacts differently based on their personal experiences, beliefs, and emotional sensitivity. To find the right solution for each individual case, the American Animal Hospital Association (AAHA) and the International Association for Animal Hospice and Palliative Care (IAAHPC) have just published guidelines* on end-of-life palliative care for dogs, cats, and exotic pets. These guidelines provide veterinarians with the framework and tools needed to develop a detailed, collaborative end-of-life plan and to better recognize the needs of animals, clients, and members of the care team during this critical phase of the veterinary care relationship.   The AAHA/IAAHPC guidelines compile the most up-to-date information on end of life care to help the veterinary team navigate this difficult stage and improve the quality of life for animals nearing the end of their lives. The roles of all members of the care team are detailed so that, together, they can provide the best palliative care and optimal support to preserve the human-animal bond. For many pet owners, end-of-life care and the associated decision-making process—which mark the final stage of their pet’s life—are just as important and meaningful as the entire course of care leading up to it, according to the two American associations. In practice, according to the proposed guidelines, it is important to note that:

• end-of-life care and the decision-making process leading to a choice between euthanasia and natural death are medically, emotionally, and ethically challenging for everyone involved;
• studies show that 30% of animal owners experience immense grief following the loss of a pet, and that 50% of them will second-guess their decision after euthanasia;
• Members of the veterinary team face an increased risk of compassion fatigue when caring for animals nearing the end of their lives. Along with the animal owners, they are immersed in a context of intense emotional and physical suffering, often over a long period, without receiving sufficient group support.

  Veterinarians are, in fact, regularly confronted in their practice with the death of the animals they care for. End-of-life care is an integral part of the therapeutic journey and the care agreement. It aims to maximize the animal’s comfort and minimize its suffering while offering support to the owner—who is an active participant in the treatment—through communication grounded in empathy and free from judgment. When faced with a prolonged, agonizing illness with no possibility of remission, it is essential to develop a treatment plan in collaboration with the owner and to discuss the option of euthanasia with them, in order to do everything possible to alleviate the animal’s discomfort and the owner’s distress until the inevitable outcome. Furthermore, the way the care team responds to an owner’s grief following the loss of their pet is a key factor in building client loyalty. Thus, these guidelines have multiple objectives:

• to raise awareness among practitioners and their teams regarding the scope and importance of palliative care;
• to provide the foundation for empathetic communication about end of life care to help team members confidently address the topic with affected pet owners;
• to define and clarify what palliative care entails; to provide a framework for developing a collaborative treatment plan with animal owners for animals nearing the end of life;
• emphasize the importance of recognizing anticipatory grief in pet owners and providing emotional support following the loss of their pet;
• emphasize the importance of a holistic clinical approach and the role of a dedicated end-of-life support team;
• discuss considerations regarding euthanasia versus natural death and palliative care;
• encourage veterinarians to refer cases when they cannot provide adequate palliative care themselves.

  Thus, the recommendations address palliative care or long-term care in animals versus humans, its importance for the animal, the owner, and the veterinarian, the roles and responsibilities of the care team, the identification of candidates and the development of a personalized treatment plan, its implementation through to the end of life, the effective management of this terminal phase, and more. An integrated approach to treatment is proposed, using a pyramid of care model. As in human medicine, the physical, social, and emotional well-being of veterinary patients are closely interrelated. Veterinary palliative care can thus be divided into three complementary levels. At each level, key issues must be addressed and managed to ensure dignified care at the end of life and a satisfactory quality of life. The base of the pyramid consists of physical care (management of pain, clinical signs, hygiene, nutrition, mobility, etc.) provided by the veterinarian. The middle level focuses on animal welfare, centered on interactions with other animals and with humans. The top of the pyramid focuses on the animal’s emotional well-being (preserving dignity, maintaining the will to live, reducing stress), which includes meeting its individual needs and receiving attentive care from those around it. When the veterinary team, in collaboration with the owner, successfully meets the animal’s physical, social, and emotional needs—which correspond to the three essential aspects of its well-being—these best practices ensure the animal experiences maximum comfort and reduced suffering during the end-of-life phase. This is, ultimately, the goal to strive for with every animal at the end of life. In the final hours, pain management becomes a priority. Ultimately, navigating the complex medical and ethical realities alongside intense human emotions is one of the greatest challenges of veterinary end-of-life care—and a central theme of these guidelines. A “satisfactory” decision regarding euthanasia therefore depends heavily on open, honest, and empathetic communication with the animal’s owner. * https://www.aaha.org/professional/resources/end_of_life_care_guidelines.aspx