Saturday, November 1, 2008

Veterinary hospice & palliative care

I've had an interesting email conversation with a veterinary radiation oncologist who is involved in the nascent pet hospice/palliative care movement, Dr. Lillian Duda. She was kind enough to say I could share some of her comments on the blog (slightly edited for flow):

Yes, there is a small but growing veterinary hospice/palliative care movement. There is even one pet hospice foundation that is an associate member of the National Hospice and Palliative Care Organization.

It is an interesting topic of discussion for several reasons. Obviously, euthanasia has always been a part of veterinary medicine and a mainstay of veterinary "palliative" therapy. However, as some pet owners demand ever increasing levels of high-tech medicine for their pets (pets that are often treated as nearly human members of the family), veterinary specialists have dealt increasingly with issues of futility and aggressive treatment efforts at the end of life. These efforts can be significant--specialty hospitals and tertiary care/academic centers have the capability of 24 hour ICU, ventilator support, hemodialysis, stereotactic radiosurgery, etc. etc. There are also a group of owners who decline euthanasia, and veterinarians must either provide palliative care (for which we have little training and some degree of ethical quandry) or leave owners to do what they can and watch and wait for their pets to die "naturally" at home.

There is talk about making palliative care a veterinary specialty (meaning board certification), although I think this is unlikely to happen any time soon. I serve as the veterinary editor for OncoLink. A veterinary page was started because a significant number of pet owners were contacting them with questions about cancer in their pets. There was a heated discussion amongst the editorial board early on, because a number of people protested vehemently against having information about animals on the same site as information about people. Some felt it was demeaning and insulting to so closely equate dogs and cats with people. The decision was to maintain a veterinary page, and an article was posted to help explain this decision. It can be found at: if you are interested.
She recommends this site for further links as well:

If you're interested in the topic I suggest reading the oncolink page above - it's quite illuminating.

What struck me most about Lili's comments, and the reason I decided to post them, is just how familiar all those problems/concerns/tensions sound to us in the 'human medicine' world: all this technology which can prolong life but with major costs (both financially to be sure, but also emotionally, and to quality of life), providers struggling with ethical and professional dilemmas about if doing all this stuff makes sense and worrying about causing needless suffering for out patients, as well as providers feeling unprepared and poorly trained to deal with all this as well as to simply care for patients as they die. In addition, it's notable that access to euthanasia, and even broad cultural and professional acceptance of the practice, has not prevented this from becoming an issue - just as the practice in humans (in the Netherlands) has not at all slowed down or changed the acute need for palliative care-competent physicians and services there....

Thanks Lili.

While I'm here, and while we're posting lighter weekend fare, I'll tell my own story about pet hospice. One of the friends I did residency with was very much a pet-person (several dogs and cats). She told me that she got one of her cats from her vets office: it was dying, family had abandoned it, a lot of symptoms (I don't remember what was wrong with it or why it wasn't euthanized), and she agreed to take it in to care for it with the expectation it'd die within a few weeks. She took it home, fed it, gave it meds, and several years later the cat was alive and well and still with her. Another story familiar I'm sure to all of our readers who work in hospice!

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