The Good Death

From: https://melnewton.com/2019/the-good-death/

The Good Death

November 14, 2019

A good death.

That is our responsibility to the animals under our care, if we can possibly give them one. It isn’t always possible – they get lost, hit by a car, burned by a fire, swept away in a flood, poisoned by contaminated feed. It’s a dangerous business – this thing called living.

Sometimes we get lucky. Those under our care live a full and happy life until they drop dead seemingly out of nowhere – an undiagnosed heart condition, an aneurysm. It’s over so fast that it leaves you reeling. Just yesterday they were fine! I never knew anything was wrong.

Other times the choice is clear. Your horse is writhing on the ground in pain from a colic episode. Surgery isn’t an option and medical management has failed. Euthanasia is the only option so you give your partner the relief they need. 

This post isn’t about any of those deaths. This post is about when we have to do the agonizing job of choosing the time of death after receiving a terminal diagnosis, or trying to decide when to call it quits after a long gradual decline of chronic illness. Or maybe it’s a younger animal with a disease that won’t hasten their death but calls into question of what the “right” decision is moving forward – life or death?

Of course we want the decision taken out of our hands. “I want them to die in their sleep, at home.”

Yeah. You, me, and everyone else. 

I can practically guarantee that if we are having this conversation, they won’t and they don’t. 

I’m sorry. Really sorry. 

It really sucks and don’t let anyone, including me, tell you differently. These are the hard cases. 

“When will I know?” is the most common question I get from clients and friends who want to talk to me about it. Is it when they stop eating? Get down to a body condition score of a 1 out of whatever number scale you want to use? Can’t stand? Can’t get up the stairs? Don’t want to  go on walks? Is it the look in their eyes? When they are so confused they are head pressing in the corner of their stall or their living room? Or is it the day before you leave on a long vacation because you can’t stand the idea of getting a phone call from the pet or ranch sitter in a week and having to make it happen when you aren’t there?

When do you make the decision to end a life that has nothing to do with putting food on the table or war?*

*the only other culturally acceptable times I can think of  to end a life, with the exception of a few states where there is an end of life dignity laws. 

People want me to give them the formula. “When they stop eating for X days it’s time,” or, “body condition score of 1 means it’s time.” Or maybe it’s when various body fluids are pouring out of various orifices with varying amounts of control. 

The problem is, every animal is an individual, has different priorities in life, and deals with the suffering and limitations of old age or their condition differently. 

Here’s the thing. 

Most people wait too long. 

Concerned with cutting a life short unnecessarily, or guilt-wracked with should-of’s and could’ves, they hang on to their pet’s continued existence as proof that this is not a convenience euthanasia.

But, we need to remember that animal cares nothing for our intentions, or whether there is some small hope of a better future. An animal lives in the present. Any decision to prolong suffering should be because there is a significant hope that a life that can be well-lived on the other side of that suffering. 

So, let’s set aside the guilt, sadness, and all those other complicated human emotions that are important and real, but don’t matter to the animal in front of us. 

When is it time? 

Let me ask you another question. 

What are you waiting for? 

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..

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Are you waiting for them to not be able to get up, to be found 6 or more hours down in the mud with signs of struggle as they tried again and again to make their arthritic joints obey their still young-at-heart spirit? 

Are you waiting for your dog to take one last swim in the swimming pool, the love of their life, and not be able to get out this time because their hopes just can make that last leap? 

Are you waiting for them not to eat for a couple of days? 

Are you waiting for there not to be any more good days? 

Are you waiting for the day they can no longer rise to relieve themselves and your once fastidious animal soils itself for a couple of days while you wait to make sure it’s time? 

I know these are upsetting to read. They are hard to even write. The thing is, I’m not making any of these up. These and more are actual scenarios I’ve personally been a part of. 

I think considering the question “what are you waiting for” instead of “when is it time” clarifies a lot of things. It often brings to mind the scenarios that we don’t want our animals to experience if it is in our power to prevent it. 

I can’t think of anything more awful than waiting to euthanize my arthritic old horse until they are down in the cold mud, struggling and panicking for hours.

I will gently put her to sleep on a warm day when the sun is shining, while she is standing and her last hours will be filled with love and gratitude for the years of service she gave to me.

I will I will not wait until the bad days have squeezed out all the good ones until there is only suffering. That isn’t fair and that is as selfish as euthanizing too early. Somewhere between convenience and a love too great to let them go is a happy medium where the needs and suffering of the animal are considered independent of the human’s needs.

I told you, this “right time” stuff is tricky.

Here’s what I’ve learned in my very short five years of being a veterinarian and listening and seeing clients talk to me about death and wrestling with this question.

You know when it’s time.

Your gut is very intuitive.

Your job is to listen to your gut. It starts with a small voice. “Someday,” it says. Not today, not tomorrow, and not next week. But it’s coming.

I look at Farley, 21 years old in a couple of months, a tad stiffer than she was a year ago. Still maintaining weight despite crappy dentition that’s barely kept in check by regular dentals. Her death at my hand is a long ways off (unless she makes some uncharacteristically poor life decisions…always a considerations with horses) but at 21 it’s unlikely she has more years left than what we’ve had so far. I can’t afford to get complacent. Do what I can to mitigate the decline and give her a pat on the nose knowing that I’m unable to see the future and she could have a decade left, or (probably, statistically) a lot less.

At some point “some day” turns into “soon.” Not today, not tomorrow, but it’s time to turn a critical eye towards the question of “what are you waiting for?” That will help define the end markers.

Maybe it took an extra try to get up in soft footing after that roll. During turn out she falls. She’s never done that before. Now when she runs in the arena there are no wild gallops.

How long do I wait? Depending on circumstances I try controlling the footing, medication, management, but at some point all that can be done in the specific circumstances has been done (which doesn’t mean that everything has been tried because time and money is never unlimited, at least in mine and my client’s lives. And that’s OK too.). Now there’s evidence that one night she struggled for a prolonged time trying to get to her feet.

But she’s fat and shiny and nickers at me when I go out to the barn.

Is it time?

Your gut hurts. You can barely think through the decision and your mind slips off sideways when you think about doing it even as you try to grab it with both hands you can turn it over and see it from all angles. You think about the judgement of social media and others looking in from the outside. “You could have….”, “You should have….”, “Why didn’t you just…” Will others think you euthanized for because it was easy? You just bought a new car and your new baby is taking up a lot of your time. You have a big vacation planned and you fly out next week.

Folks, these decisions aren’t easy.

I can’t give you an algorithm where you plug-in numbers and it gives you a result.

Here’s what I can offer for comfort.

I’ve done literally hundreds of euthanasia’s as a vet so far in almost every species imaginable. Only twice have I turned someone away and said “no, I will not euthanize your animal.”* That’s because you, as an owner know your animal well. Sometimes you need me to chat with you about your decision, but usually I’m able to validate your gut feeling. Most of the time, it was time to make the decision to let them go a week ago, but you couldn’t bring yourself to do it and waited.

*These “no’s” were people who insisted that I euthanize their animal and I refused to do so, believing based on a lot of different factors that the requested euthanasia had nothing to do with the well-being of the animal, and everything to do with being asked to euthanize under false pretenses. One I believed was a vindictive family member, the other was a breeder who had gotten a new male and didn’t want to her older male for breeding purposes any more. I very much doubt any of my readers fall into either of those categories. Other’s have come in for a euthanasia, only to find out there was some cheap and easily controlled disease to treat. It doesn’t happen a lot but it does happen sometimes and every one definitely goes home happy when it does! I don’t count those as euthanasia failures, those are just joyful misunderstandings!

For all of us, including our pets, life is always too short. It doesn’t matter if you squeeze another week in. If it’s a week of suffering it doesn’t mean anything. If there’s a terminal diagnosis and quality of life will only get worse, it’s OK to say goodbye now while life is still good. It will never be enough time, you will always wish there had been one more ride, one more picture, one more walk. There will always be regrets. Don’t make holding onto an animal longer than what is fair to them be one of them. Under the guise of “life” there are things worse than death. Give them the gift of a good death.

If you are struggling with the decision and evaluating quality of life, here are some good resources:

How Do I Know it’s Time? Ohio State University

Quality of Life Scale Quiz from Journeys Home Pet Euthanasia

Welfare of Aged Horses – Chapter 5 is especially relevant

Time to Say Goodbye from the Horse.com

It goes without saying that your veterinarian can be a good (and necessary) resource. If at all possible, chat with your vet about their philosophy of end of life care prior to having to make a big decision like this. Veterinarians are individuals and we hold varying opinions on the giant grey area of the timing of a good death. Your vet can be an ally in this situation and help shoulder some of the stress of deciding when it’s time to say goodbye.