Posted on 10-13-2011
Things Death Has Taught Me
Perhaps one of the toughest lessons that every new veterinarian learns, usually within the first day of work, is that veterinary medicine is often the business of death. We enter our profession to help animals and yet very often we are only helping them to leave this earth with some dignity. Euthanasia, like it or not, is an integral part of the daily job. To work in this profession you need to develop some coping methods and, I hope, you can find something positive even in this, the grimmest of services.
The first thing I have learned is that there is never a "good" time to euthanize a pet, there is only a right time to let them go. In the end it is not about what we, as owners and veterinarians, want, it is about what the animal needs. I hate to use the term, but it really is about "Quality of Life". It is about extending life, not dragging out death.
So that begs the question: what defines "quality" for a pet? Can or should we put human values on animal life? What does an animal really want from life? I believe that this cannot be a universal definition; a dog is different from a cat and a horse does not even understand anything about fish. Each species and each individual has its own basic needs. On the other hand, over the years I have formed a list of "basics" that I think are essential for "quality living".
The first basic I think every animal should have is freedom from chronic suffering. Notice that I defined the suffering as "chronic", as in "lasting" or long-term. Certainly, if you could ask your dog, he would tell you that he can endure the pain of a broken limb for a short period as long as you plan to fix that limb in a timely fashion. On the other hand, he would probably ask you to end his suffering if the cause of that pain was a growing cancerous bone tumor with little hope for lasting relief.
The second basic I believe is important is freedom from hunger and a consistent appetite. I pair these two things for a reason. The first is obvious, the second not so obvious. One of the things that I always ask my clients is "how is your pet eating"; if they tell me that the pet has to be coaxed to eat and hand fed every meal, then I know that the animal is likely chronically suffering (and we are back to my first point). I also pair this with drinking, though I probably do not have to, since I have never seen a pet eat but not drink. Drinking water, of course, is essential to life and any animal will be in deep trouble after three days without water.
The next pair of "essentials" I check for is urination and defecation. As tasteless as it is to talk about "poop", the voiding of wastes are mandatory for continued health. In the case of a pet it is also important that they void appropriately: defecation and urination inside the house, on bedding or in their living area, is highly unnatural for most pets and, again, is a sign of a chronic disease (and we again return to point one). In fact, inappropriate voiding is likely a clear sign of chronic discomfort because it often stems from lack of mobility. And that finally brings me to my last essential quality: mobility.
Your pet needs to be able to get up without help, get to his feed and water bowl, meander outside to void, and then wander over to wherever you are at the moment to get some love and attention. So here is my final list: eating regularly and happily, voiding regularly and appropriately, and mobile enough to do both and still enjoy the company of the family.
There are a few obvious things left off that list. Many owners think it is a real tragedy if their pet goes blind or deaf. Certainly I have had owner's who insisted on euthanasia when "Rover" goes blind. I don't agree with that approach simply because I am not sure the dog or cat cares if they can no longer enjoy the sunset or watch the football game. If it does not affect their ability to get to the food bowl or the back yard, in the immortal words of Rhett Butler, I don't think they "give a damn". I have owner's who euthanize simply because the family is moving and they are sure the pet will "be stressed out". Now I am not even sure what the heck that means, but I can tell you that dying is probably worse than stress. Then, of course, there is the old "my dog is arthritic" reason. This might be a valid reason to let a pet go: if the old geezer is at the high end of pain medication and still obviously painful, then we are back to chronic suffering. On the other hand, if you have not even started to medicate with anything, then I would bet that "Rover" would prefer a little white pill over a syringe of "blue juice". Even severe arthritis is usually responsive to balanced pain management. In the end, the one thing I know for sure about every animal on Earth: death is inevitable, but it is always better tomorrow than today, on any day of the week. As long as I can be assured that the pet still has some quality of life, then the pet should live at least one more day.
I have to emphasize that natural death is never peaceful. Hollywood has given us all the sanitized version of death where Grandfather just closes his eyes and falls asleep….for a really long time. In truth, the majority of us fight death right to the end. We gasp for air as we thrash out our final moments on Earth. We void, we seizure, we cry out in anguish. With very rare exception, we never "just fall asleep". While a human doctor cannot legally give his patients a "true death" (though there certainly are many examples of very liberal pain management that led to a permanent rest), it is the duty of the veterinarian to give his patient a peaceful passage to the afterlife. As a veterinarian my primary commandment is to alleviate suffering in my patients; sometimes that means I need to kill them. All I can offer at that point is the quickest, most peaceful and painless transition I can formulate. It is my responsibility.
Over the years I have developed a few personality quirks from all the death I have witnessed. I now look at death quite clinically. Life and death are like the opposite sides of a single piece of paper; opposites but unbreakably linked and separated by the thinnest margin. I have no idea if there is anything on the side of that "life" sheet of paper, but I never rush to flip that sheet over for any animal. I won't hunt and I even avoid killing an insect. I even have trouble weeding my garden; I just cannot see how those "weeds" are of any less value than the flowers my wife waters and fertilizes all summer. I always remove the collar on all euthanized pets. In fact I cannot leave a collar on any pet that dies in my presence; it seems just so wrong to "yoke" an animal for its entire life and then send it into the after-life still chained to the human mill wheel. Finally, one thing I know for sure: there are no "lesser lives". We humans are pretty arrogant animals, but we still are just animals; of no greater or lesser value than the simplest of creatures.
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