Trading Places

A hospice veterinarian spends a day with the humans

Posted Mar 01, 2016

As the population of companion animals has swelled over the past several decades, and as more and more animals receive a lifetime of good food, safe shelter, and veterinary care, more of our companions will live long enough to be diagnosed with a terminal illness. The options for providing care for terminally ill animals have also expanded. One of the most important of these options is hospice care for animals. Hospice offers an alternative to immediate euthanasia, and seeks to manage the symptoms of disease and maintain quality of life so that animals can have more time to enjoy life and be with their families.

I’ve been very interested in the similarities and differences (both practical and philosophical) between human hospice and animal hospice. The field of animal hospice in many ways tries to model itself on human hospice. This is most evident in the basic philosophy behind both: seeking to offer care rather than cure, working to maintain quality of life, treating the patient as part of a family unit, and attending not only to physical pain but also to emotional and spiritual suffering.

PJ Johnson, Flickr
Source: PJ Johnson, Flickr

Nonetheless, stark differences remain. The biggest difference, of course, is that within animal hospice euthanasia is always an option, when suffering can no longer be adequately addressed or when palliative treatments exceed the financial resources of the pet owner.  Which leads to the other main difference, with huge practical ramifications for pet owners: animal hospice is almost always funded entirely by the animal’s human family. Very few people have pet insurance, and even for those who do, coverage of hospice therapies is spotty and incomplete. The government doesn’t provide a safety net for patients whose families cannot afford treatment or hospice care, again leaving the financial responsibility solely in the hands of the pet owner.

A friend and colleague of mine who works as a hospice veterinarian told me recently that she had spent a day with a human hospice physician and his staff at a hospice facility. I was intrigued and asked if she would share some of her reactions. Beth Marchitelli DVM owns 4 Paws Farewell, a mobile pet hospice and home euthanasia service in Asheville, North Carolina. She spent a day at Care Partners Hospice and Palliative Care center with Dr. John Langlios, a physician who specializes in hospice and palliative care medicine.

Beth Marchitelli

Here are my questions (in bold), with Dr. Marchitelli’s responses.

What prompted you to ask a human hospice physician if you could shadow him/her for a day?

I thought it would be very insightful to learn how human hospice physicians manage the care of their patients.  I was curious about how specific disease states and clinical signs were typically managed and how this may apply to veterinary hospice and palliative care medicine.  I was also curious about how care is facilitated between members of the human hospice care team including the hospice care nurse and social worker. 

What differences did you most notice, compared with your experiences of ushering animals through the final stages of life?

The most obvious difference is the absence of the legal option for humane euthanasia for humans in most states.  Although this is the most identifiable difference, there are more subtle differences also.  The structure of human hospice appears to have the hospice nurse as the pivot point, reporting changes in clinical signs and in the emotional stability  and wellbeing of the patient and the family.  In veterinary hospice at this point in time, most veterinarians are the pivot point as often times we do not have the benefit of having a veterinary technician or social worker as part of our staff directly. These individuals are vital and can provide indispensable ancillary care.  There are also differences in the management of disease states due to overt differences between animals and humans in disease progression.  These differences are also affected by the level of medical sophistication that is possible in home care for humans whereby we may not always have such options in veterinary medicine. 

What similarities?

The goals of care are identical in avoiding suffering and to providing as much comfort and care as possible during the transition to death.  In both human and veterinary hospice this care and comfort are for the patient and the patients loved ones.

Will you change anything you were doing, based on your experiences?

I learned a great deal about how specific disease states are managed that may be directly applicable to veterinary medicine. 

What sorts of questions did the hospice doctor as you about your veterinary practice? (What were they curious about?)

I was asked about the management specific disease states and how we incorporate the process of humane euthanasia. Dr. Langious and I discussed the differences in how dyspnea (difficulty breathing) is managed during end of life for animals versus people.

Are there problems with animal hospice trying to model itself on human hospice care?

It seems to me that because we do not have universal health care for animals that includes subsidies for veterinarians, veterinary technicians and social workers we may have financial constraints and challenges that are not present to the same degree as in human hospice. We also have the fundamental difference of having the legal option for humane euthanasia.

They asked you to come give a talk… what do they want you to talk about?

The staff at Care Partners Hospice and Palliative Care were incredibly welcoming and have a sincere interest in sharing thoughts and ideas between the two disciplines.  I will discuss the history of veterinary hospice and describe how veterinary hospice and palliative care are practiced in the home setting. In collaboration there is  much to learn and benefit from for practitioners who care for beloved human family members as well as those practitioners who care for beloved family members with fur. 

My final thoughts: I think this kind of cross-talk is really important. Clearly human hospice has a lot to teach those who are caring for animals at the end of life. The fact that euthanasia is not an option means that human hospice practitioners are skilled at managing symptoms, controlling pain, and addressing the emotional needs of patients and families. These are areas in which animal hospice is still learning. Human hospice physicians are familiar with the natural dying process--something that veterinarians often know little about, since nearly all animals are euthanized. It may be that veterinarians also have something to teach human physicians (and politicians) about allowing death to come more easily to those experiencing unrelenting suffering.