Monday, January 21, 2013

Choosing Euthanasia: A technician’s perspective


Orange and white cat sleeping in the sun
 How do you know when the time is right to say goodbye to your cat?

Due to the advances in veterinary medicine, the average lifespan of the cat has increased significantly over the years. Once upon a time, a typical backyard cat could be expected to live about 4-5 years. Now, pampered felines average about 14 years of good life, and a good number of our patients are seeing the other side of 20 years! Our own hospital cat, Ginger, was 22 years old when she developed an inoperable squamous cell carcinoma in her mouth, and we had to say goodbye.

How did we make that decision? How do you know when the time is right to say goodbye? Sometimes the choice is easy, or there is no real choice – if your cat has a traumatic accident or rapid organ failure that medicine cannot treat, it is kindest to end his or her suffering and pain. However, if your cat develops a treatable or manageable but incurable disease, knowing when to make the decision to euthanize can be hard.

I recently posted about my cat, Curie, who was being treated with chemotherapy. Just before Christmas, I had to make some decisions about her further care, and after considering her quality of life and weighing the options, I came to the decision to euthanize her. It was no easy decision, and I cried all day on the day I made the decision. I also cried on subsequent days, after we had euthanized her. However, I stand firm in my belief that it was the right decision for her. What follows are some of the factors that I considered when making my decision.

Sunset cat silhouette


Deciding how to feel about Euthanasia
One thing to keep in mind is that, as a pet parent, you are your pet’s caretaker, their champion, and their advocate. Your veterinary doctor and staff, your friends and family, your breeder – they can all offer advice to you, but ultimately, the decision is yours. No one can make the decision to euthanize for you, and it is both a terrible and wonderful power to have.

Being able to make the decision to euthanize your cat is a huge responsibility because, even though you are not making decisions about a human being, you are still making decisions about life and death. Perhaps the decision is even harder than if it were a human being, because your cat can’t tell you what their wishes are. This is a very emotional and sensitive decision for most people. In my experience, as a caring human being who loves their cat, you will almost always second-guess your decision – no matter what decision you make - even if you know it is the right thing to do. Did I wait too long and let my cat suffer needlessly? Did I make the decision too soon? Would a little more time have made a difference? You wonder and worry simply because you care about your cat, and take your responsibility so seriously.

The power to decide can also be a relief, because when you know your dear friend is failing and there is nothing more that can be done, you can release them from suffering and spare them the misery of crippling pain, slow starvation or mental distress. I think most people know in their hearts when it is the right decision, even though it is not a decision they want to make. Once you have made the decision, you have to be firm with yourself that the decision was the right one - made with compassion and love.

As much as we may hate to admit it, for many of us, financial concerns may come into play. We may wish in our hearts to run every recommended diagnostic test, or try every possible treatment, no matter how new or experimental, but for most of us, a wall of dollar signs will eventually rise up. There is no reason to feel guilty that finances come into the equation. What good is it for you to have a kidney transplant performed for your cat if you cannot then afford to buy a high-quality, kidney-protective diet to feed her?

At some point, we may need to try to distance ourselves from our cat and pragmatically ask questions such as – What will continued treatment gain my cat? Am I continuing to treat her for her benefit or for mine? What is my cat’s current quality of life? Will continued treatment improve her quality of life? What is the likelihood of relapse? What kind of post-treatment care will be required at home? We may hate to ask these questions of ourselves, or of our cat’s veterinarian, but they can provide helpful decision-making information.  

Your veterinarian does not offer up euthanasia as an option lightly. The veterinary oath stresses that top priority is animal health and welfare, and their goal is to diagnose and treat your pet to the best of their ability. However, most veterinarians also know that there must be a balance between quality of life and quantity of life. What good does it do to have extra time with your cat when you can see that your cat suffers every day? In the veterinary office, we can only evaluate your pet based on a snapshot in time – the visit to the office. Ultimately, you know your cat better than we do, and are best equipped to make the final decision – based on the scientific, objective information that we veterinary staff can provide, and the contextual, subjective information that your cat displays at home, as well as your own emotions about your cat’s health and well-being, and any religious beliefs that you hold or financial factors that may affect your decisions about your cat’s care.

Assessing your cat’s Quality of Life
Many animal welfare organizations abide by rules called “The Five Freedoms”. These guidelines were developed in the UK for farm animals, but are applicable to any animal living under human care.

The Five Freedoms:
  1. Freedom from hunger or thirst by ready access to fresh water and a diet to maintain full health and vigor
  2. Freedom from discomfort by providing an appropriate environment including shelter and a comfortable resting area
  3. Freedom from pain, injury or disease by prevention or rapid diagnosis and treatment
  4. Freedom to express normal behavior by providing sufficient space, proper facilities and company of the animal's own kind
  5. Freedom from fear and distress by ensuring conditions and treatment which avoid mental suffering
Evaluating your cat with these guidelines in mind can help make your decision less complex.

Ideally, if you are preparing for the eventual need for this decision, you should set aside some time each day or every few days and evaluate your cat’s quality of life. Does your cat still enjoy the Five Freedoms? Does he or she get a passing grade on the Quality Of Life scale (shown here: http://aplb.org/resources/quality_of_life.html)? Does your cat seem to feel “good” more than 50% of the time or have more “good” days than “bad” days? If so, you can relax and enjoy a few more special days with your furry friend. If not, then you should call your veterinary office. You may be able to ask your veterinarian for alternative methods of medication or treatments that would allow you to delay your decision to euthanize, and keep your cat comfortable longer.

The most important thing to realize about the decision to euthanize is that there is no one “right” decision in all cases. Each case has special considerations and is the “right” decision for the cat and the person or people involved.

If I Should Grow Frail
-         Author Unknown

Orange and white cat in the sunIf it should be that I grow frail and weak
And pain does keep me from my sleep,
Then you do what must be done
For this – the last battle – can’t be won.
You will be sad I understand
But don’t let grief then stay your hand.
For on this day, more than the rest
Your love and friendship must stand the test.
We have had so many happy years,
You wouldn’t want me to suffer so.
When the time comes, please let me go.
Take me to where my needs they’ll tend,
Only stay with me till the end.
And hold me firm and speak to me
Until my eyes no longer see.
I know in time you will agree
It is a kindness you do to me.
Although my tail its last has waved,
From pain and suffering I have been saved.
Don’t grieve that it must now be you
Who has to decide this thing to do.
We’ve been so close – we two – these years,
Don’t let your heart hold any tears.