Letter to the Editor: Hospice care needs rational debate

When a review on veterinary hospice and palliative care was published in the Veterinary Record,¹ Professor Emeritus and Mrs David Noakes wrote a letter to the editor stating that when they saw the article they thought that the meaning was to provide canine companionship to human patients in hospices.

When they realised the article referred to hospice care for animals they wrote “surely the establishment of veterinary hospices only panders to misguided anthropomorphism” and “we note that most of the publications cited in the review emanate from the USA. In the interests of animal welfare in the UK, let us keep them there”.

Professor Paul Flecknell wrote a letter of support for the Noakes’ letter and added that rather than scholarly research in this area, there needs to be a careful consideration of ethical issues and the question asked, “Who benefits most from hospice care – the owner or the animal – or perhaps the veterinarian?”

In human patients, hospice care generally means going off to a hospice, but in animals the distinction between hospice and palliative care has not been sharply defined. Palliative care is a complex issue and depends on individual cases, but hospice care refers to terminally suffering animals and not those that would benefit in the short term from palliative care to maintain quality of life. Hospice care has been described as management of palliative care patients who have progressed such that death will likely occur within a period of days to weeks. A newly published book on the subject defines hospice care as “A philosophy and programme of palliative care aiming to improve comfort and reduce suffering for pets with terminal illnesses with the end goal being euthanasia.”²

Whatever our feelings are on the development of hospice care as a separate entity for terminally ill animals, there is no doubt it is a growing trend and it seems to me that there needs to be an ethical discussion about providing this care. Is hospice care really in the best interests of the animal?

As far as we know animals live in the here and now and, unlike humans, can’t express a desire to stay alive and certainly can’t express a need to see their long-lost Auntie Ida before they die. As philosophers put it, “as many animals have no conception of themselves as distinct entities with a past and a future, then it is difficult to believe that they would choose any suffering, if they could not imagine a future where the suffering has ended”³ and “in the case of animals…there is no evidence either empirical or conceptual, that they have the capability to weigh future benefits or possibilities against current misery. To entertain the belief that ‘my current pain and distress, resulting from the nausea of  chemotherapy or some highly invasive surgery, will be offset by the possibility of an indefinite amount of future time’ is taken to be axiomatic of human thinking.”⁴

We, as general practitioners, have long been giving compassionate and appropriate advice and need to accept that death is not a bad welfare outcome. It is more challenging these days for owners because there are so many options given and it is often up to the owner to wade through the choices. Veterinarians may be tempted to abrogate their professional responsibility onto an owner who does not accept when it is time to euthanase a pet and, in their desperate attachment, they may put animals through meaningless procedures. However, as a veterinarian, whose first priority is the care of the animal, it is a privilege to be able to humanely end a terminally suffering animal’s life. At my practice I have found that the vast majority of pet owners know when it is ‘time to go’ and most are appreciative of the support we give. That is why we have an ample supply of gifts of alcohol that we conveniently store next to the euthanasia solution just in case of a need for a glass of a good red in memory of a departed four- legged friend.

Is hospice care misplaced anthropomorphism? And/or just another way to enhance practice profitability? A niche market in the face of declining pet numbers and increasing numbers of veterinarians? In any case, haven’t practitioners always provided end-of-life care without putting a label on it?

Before hospice care of animals takes off in Australia there should be a rational debate on what is in the best interest of the animals in our care and who hospice care is really ‘treating’. The animal, its owner or the veterinarian?

Tanya Stephens BVSc MSc IAWEL MANZCVS Dr Stephens  is a small animal  practitioner  and researcher,  a Category A member of a number of animal ethics committees, Honorary  Consulting  Veterinarian  for the Children’s  Medical Research  Institute,  and a published  author and presenter on veterinary ethics.

This article appeared in the Australian Veterinary Journal: Aust Vet J 2018;96(3):N19

References

  1. Goldberg KJ. Veterinary hospice and palliative care: a comprehensive review of the literature. Vet Rec 2016;178:369–374.
  2. Shanan  A, Pierce J, Shearer T. Hospice and palliative care for companion animals: principles and practice. John Wiley & Sons, 2017.
  3. Singer P.Practical ethics. 2nd edn. Cambridge University Press, 2010.
  4. Rollin B. Ethical  issues in geriatric feline medicine. J Feline Med Surg 2007;9:326–344.

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