Quality of Life Part 111th August 2019
Dr Lennon’s Sunday Musings
Last week, I had to euthanase a 17 year old cat with kidney failure. The owners had been caring for him for 18 months since it was diagnosed. They made sure the food was wet and fluids were always provided, keeping him hydrated. They invested in diets that were kinder to the failing kidneys. They provided supplements to support the insufficiencies of those important bean shaped organs. They did all they could to make their pet as comfortable as possible. In the end, they monitored his quality of life very carefully and when they felt it was compromised, they requested the needle of no return.
Discussing about quality of life is something that we do on a fairly regular basis. There are multiple situations when this topic is brought up. Some examples include after the diagnosis of a terminal condition (like cancer, organ failure), when an animal is slowly but surely showing signs of being affected by a chronic condition (like osteoarthritis, failing sight), after a traumatic incident that has affected multiple organs or just simply caused vast amount of damage that will require intensive medical care and recovery.
In my experience, these discussions are all different to each situation as each circumstance is unique. There are no set parameters that we measure or philosophies that are imposed simply because every single pet has a different lifestyle and their owners a different set of beliefs.
For example, I once treated a 2 year old Labrador that suffered a spinal injury which meant that she was doubly incontinent. She belonged to a young childless couple who absolutely doted on her. Apart from her double incontinence, she was as right as rain, running and jumping like any other dog would do. So, for 4 years, her owners used nappies and changed them religiously two to three times daily. Their commitment meant that not only their beloved dog was kept clean; their house was not subjected to soiling too. It was only when she unfortunately contracted cancer, did they make the hard decision to put her to sleep. This may seemed like a fairly extreme case (to apply multiple nappies daily for years) but it is true. Now, this arrangement may be suitable for these owners but could you imagine if the same dog (with the same issues) belonging to a family having young children, toddlers or babies? It probably meant a different outcome for the dog.
There was another case where I was treating a blind cat. He was an indoor cat that had no interest on roaming the streets like his feline counterparts. So being blind was of no consequence to him as he had memorized the layout of the entire house and also relied on his other senses to carry him along. However, the considerations would be different for an outdoor cat that would be miserable if kept indoors.
Every discussion about quality of life for pets is different. We have to consider the temperament of the animal itself (what he likes to do, what are her habits), the exact consequences of the present condition (how exactly the present condition is going to affect the pet) and the owner factor (their beliefs, their lifestyle, their expectations, how much can they cope/adjust to the situation). There are never set rules on this wide discussion and there never should be. In these potentially emotion charged situations, we, as veterinary professionals, need to help our pet owners to understand the thoughts behind quality of life. It starts with actually finding out more about the owner’s expectations and beliefs before even giving any advice.
Only by understanding what our pet owners are thinking of, can we give the most suitable advice. If done properly with compassion and without compromise on the pet’s welfare, we are more likely to achieve a result that will not entail guilt, confusion but actually encompasses understanding and the feeling that we (pet owners and the vet) are doing the right thing and everyone (including pet) will benefit from the outcome. It is not easy and in my experience, usually when there is a negative outcome from any party (pet, owner or vet), it is usually some form of communication breakdown and misunderstanding.
Comment below on your criteria for quality of life for 1) yourself and 2) your pet.
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