Euthanasia Part 3b.

We own animals.  That’s how the law sees it, anyway.  There are some (in the US at least) who would change that and have us be animal guardians.  In a legal sense this would imply or perhaps confer more rights on the animal.  At the moment the animal has few rights – certainly fewer than you or I.  Which is why it is legally OK to consider euthanasia as part of our list of options in veterinary medicine.

If you clicked through to the animal guardians link just now you will have some idea of what a complex issue it is, and also that it has the potential to be quite emotive.  Maybe I’ll look at it in another post, but for now I’m going to accept the status quo in this country, where it is legally OK to euthanise your dog,  cat, chicken, cockatiel or carpet python.  But not your grandmother.  Nor your boss I’m afraid.

In this last post in this series on animal euthanasia (which of course, follows on from the previous, last post in this series) I’m going to think out loud about whether there might be a right time, and if so, how will you know?

My simple answer to this is to say that the right time for euthanasia is when it is in the animal’s best interests, and the obvious problem with that answer is in determining what exactly is in his or her best interests.  Broadly I think it means that when the negative stuff outweighs the positive stuff, then perhaps it’s time to call time.  But everyone will interpret things differently, so where does that leave us?

We often talk about “quality of life”, which is also suitably vague and hard to pin down.  What is “quality of life”?  It’s like asking ‘what is art?’, or ‘what is pornography’?.  The answer is “I don’t know what it is, but I know it when I see it.” (Which, by the way, is apparently a good enough argument for a Justice of the US Supreme court.)

Quality of life implies something more than just existing, more than breathing and digesting.  To me it means some kind of engagement with life and with the world.  To exist we need oxygen, water, food and shelter, in that order.  To live and to enjoy life we need to be able to engage with the world, to interact with it, to love and be loved.  When these things are missing and all that is left is existence, maybe then it’s the right time.  Or maybe just a bit sooner than that perhaps.

Thinking about air, food and water is not a bad starting place.  If an animal can’t eat, or can’t drink – oral tumour, oesophageal cancer for example – then there is an obvious case for euthanasia.  If an animal doesn’t want to eat or drink because of nausea or some other reason – advanced renal failure, liver disease for example – then again we have good grounds to consider that quality of life is diminished enough to warrant euthanasia.  Of course you could set up some other way of getting those nutrients in – tube feeding into the stomach or intestines, IV nutrients and so on.  But maybe that would impinge on some other aspect of quality of life.  Like the not being stuck in a cage aspect.

Can the animal breathe normally?   This is obviously important, and anything that causes prolonged shortness of breath or respiratory distress is clearly going to effect quality of life.

Can the animal urinate and defecate normally?

Can the animal stand and walk normally, or normally enough to get through the day?

Is there constant pain that can’t be adequately relieved?  Might there be pain but you can’t tell?  Some animals are very stoic, and won’t let on if they are in pain.

These are harder questions because they are either subjective, or dependent on owner interaction.  For example, some owners have the time and the willingness to devote many hours per day to nursing a non ambulatory dog, washing him and helping him toilet, where others do not.  As a kid I knew an old farmer whose old dog was paralysed in his hind legs.  Many farmers in a similar situation would have given up on their old dog, but Skipper got wheeled about the farm every day in a wheel chair.  He ate, he drank, he barked at the other dogs and seemed to enjoy his life.

So, the prime consideration should be the animal’s quality of life, tempered by the owner’s understanding of that, and the owner’s ability and willingness to be nurse, and also by the owner’s quality of life.

And who assesses quality of life?  This has to be a partnership between the animal’s owners, or family, or carer or even guardian if you prefer, and the vet.  Preferably the vet has an existing relationship with both the animal and the people.   The vet’s role is to make quantitative assessments of wellbeing – monitoring those things that are measurable, minimising pain and discomfort, managing symptoms and so on.  The owners’ role is more qualitative, to monitor the animal’s level of engagement with the world, the animal’s level of happiness or lack thereof.

It’s rarely easy.

It’s especially easy to figure out when is the right time, and that’s because perhaps there really is no right time.  The right time might be able to be determined in retrospect – “we should have done this last week” – but it’s not so easy to figure out in prospect.  Maybe the words of that US judge are not so far off the mark.  To paraphrase him, it’s impossible to know when the right time will be, but you’ll know it when you see it.

I started this series of posts a few days ago, hoping to make some sense of this issue.  I’m not sure that I’ve made any progress in that regard.  Maybe I need to start again.  Feel free to comment.  Add stories, personal experiences, philosophies, dangerous ideas, challenges and more.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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2 Comments (+add yours?)

  1. Adam
    Oct 03, 2011 @ 23:58:22

    This is something which I confronted recently, and which you would be aware of (in reference to our kitten, Pippa, who had rapid onset FIP). The option of euthanasia never became available to us, simply because the diagnosis on a Friday afternoon was cautiously optimistic and her death was on Sunday evening, before Veterinary hours recommenced in order for us to make any practical decision. So, by perhaps a process of fate, we were forced into witnessing a process of degeneration over 36 hours which was painful, heartbreaking, frustrating, and inevitably, incredibly natural. It can only be described as natural, really, because in the end there were no medical interventions, no attempts at palliative care, no options for surgery…it was simply the onset of deterioration and death. Which is not to say that enduring that, and watching a small loved one endure that, wasn’t horrible.

    What I gained from this was a profound exposure to the realities of death, and more explicitly the helplessness that I felt when watching a small creature die in front of me. I remember thinking on numerous occasions that here I was, with a world of technology and science before me, and I was impotent, incapable of doing anything which would assist her in any meaningful way. I think when you refer to our previous generations and their exposure to death on a more frequent and tangible basis, this is what you mean (though I’m not stating that the death of a child would be comparable to the death of a kitten). Or actually maybe I am, given that in relative terms my exposure to real instances of death is so minimal that the profundity of its occurrence cannot be diminished by making cheap comparisons to the woes and tribulations of generations past. But that’s another point I suppose.

    I wondered over that weekend if I would have euthanised Pippa if the opportunity presented itself to me. The answer for the most part was always ‘no’, and this was primarily driven by a self fulfilling and self motivating belief that her condition might improve. I suppose I knew fairly quickly this wasn’t the case but I nonetheless felt compelled to hold onto the hope that things might look up. I knew that this wasn’t going to happen when she began to protest heavily at my attempts at feeding her water through a syringe. On Sunday evening, in my last attempt at feeding her, she let out an enormous meow which resonated from a very deep place, it was an empowered sound, a desperate plea that my actions were not welcomed anymore, that she simply wanted to be with us, in our company, and to pass from this world in whatever peace she could find. To obey her command, her only real request, felt counterintuitive initially, I felt I should take the position of the ‘superior being’ who knew best, who knew she needed sustenance to prevail, who would continue to force feed her water no matter what. But, in the end, I acquiesced, I surrendered to her will. It was that simple. It was the will of this beautiful creature that she be allowed to die on her own terms. Her meow and her stubborn refusal was simply her expression of existential will, ‘I am going to die here, I don’t want you to try and control that anymore’. Surrendering to that was philosophically challenging for me. She died about an hour later, her eyes closed, resting her body by the fire, with my partner’s gentle and caring hands warming her body. She surrendered to the inevitability of nature, and in the end, so did we.

    Euthanasia would have changed this, it would have altered the course we took and altered the manner in which she died. Despite our deepest respect for you and your practice, the idea of her passing away from a needle in your brightly lit operating theatre, the barking of strange dogs and the noises of strange bodies surrounding her, distresses me deeply. Letting her pass at home was unquestionably more powerful, more natural, and felt resoundingly more right than choosing the time and manner in which she would die. It is a power and a responsibility which I would not have carried lightly. I am reminded of Camus’ work ‘The Myth of Sisyphus’, where he argues that the greatest philosophical question is that of suicide; when do we decide that the good is simply outweighed by the bad, and forfeit our experiences on this mortal coil? It is a timeless and perhaps unanswerable question. I feel the question of euthanasia is similarly subjective, and it is impossible to crystallise an answer which is universally applicable. I am happy that my kitten passed away on her terms, and whilst it was an incredibly painful journey to share with her, I think it was the right one. But then again, we didn’t choose euthanasia because the option wasn’t available. I don’t know if I was in a similar situation again what I would do.

    You propose a very difficult question John, and an incredibly valid one. I am enormously relieved to know that Veterinarians are contemplating these issues, it shows me that the brevity of your actions is not lost on you in the day to day running of a business. I cannot but sympathise with the difficulty of the task you must face, and I doubt I could undertake it. You are faced with the difficult role of being healer, and thus giver of life, and subsequently at times the taker of life. What a challenging philosophical position…I’m not surprised that it irks you.

    I’m not sure my story has expanded upon the discussion previously entered into, but I wanted to share my personal experience. There are no real answers here, just more questions, and in the end we must settle on a position, our only confidence coming from the knowledge that, if need be, we can reconsider it.

    Reply

  2. bikenarian
    Oct 04, 2011 @ 09:59:49

    Thanks Adam.
    It’s a hard topic to think about, and harder to write about, and you’re absolutely right about there being no universally applicable answer.
    I also agree that being truly present at the death of a loved one (be it human or animal) is, whilst painful, a unique opportunity to get in touch with some deeper aspect of ourselves and to connect or to re-connect with those we love and to the world around us. Perhaps this is why the issue is so challenging, and especially why it challenges someone like me, trying to write about it from an objective and scientific standpoint. That connection, that love that we feel, that time of death that cries out to be labelled as spiritual and brings us face to face with issues of death and mortality, that connection is special and deserves to be recognised and cherished.
    Of course there are no hard and fast answers here, I think. So we just keep pushing our little stone up that hill.

    Reply

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