December 13, 2017

Reader Feedback: End-of-Life Care

A letter from one reader regarding a previous article on end-of-life care, and a response from the author.
By
KUDOS AND CONCERNS
I read with interest the interview by American Veterinarian® with Dani McVety, DVM, and Mary Gardner, DVM (“End-of-Life Care at Its Best,” June and August 2017). I’d like to thank Drs. McVety and Gardner for their dedication to veterinary medicine and for helping bring end-of-life care to the forefront of our profession. Their revolutionary business model for Lap of Love is an extraordinary gift to clients and to many veterinarians as well. I wholeheartedly agree with many of the points they made.

Their description of budgets was excellent. I often talk to people about these areas (financial, emotional, physical, and time). It is a good reminder, for both veterinarians and clients, to remember that none of us are without limitations, or limited budgets. In terms of convenience euthanasia, I stand with them as well. It is very important to work toward finding the intersection where we find a way to be helpful. As Drs. McVety and Gardner said, judgment is not helpful here; they are absolutely right that in the long run it will harm our profession.

Whose Decision Is It?
Although I agree that as veterinarians we have the right to refuse to perform any euthanasia we are not comfortable with, I am not sure I am being helpful if I insist on euthanizing even if suffering is sustained. The reality is that we cannot legally euthanize without the client’s consent. I have had clients come to me because they refused to allow another veterinarian to euthanize their pet because that person felt there was an unacceptable level of suffering. The client disagreed and, in these cases, so did I. Suffering is subjective, so how do we reconcile what is too much suffering when 2 professionals cannot always agree? As a profession, we should be very careful about believing that our perception of reality is the right one because we are the experts and that clients must follow our direction.

In my experience, the most serious conflict arises when the client doesn’t 100% own the decision. Yes, there is grief and there is often guilt. We really cannot take the guilt away, but we can educate and help the client see that this is a compassionate, realistic, logical, understandable decision. We can explain that we fully support the decision instead of characterizing it in more judgmental terms of right or wrong. We can reassure clients that doubts are normal. And we can remind them that their furry loved one absolutely trusts them and knows their decision is made of love.

Providing Support
Our clients don’t need us to take care of them. They don’t need us to treat them as children who must do as we say. They need us to support them and trust that they are capable of making these difficult life decisions. If they ask for reassurance we can offer it. We serve them best if they reach a place where they can feel a deep sense of peace in making this decision. Holding both guilt and grief is something the heart knows well how to do. It is the head that sees conflict. This is all part of this journey. If we remind clients that self-forgiveness is the healing salve for guilt, we do not have to try to insert our expert opinion as that salve.

Some clients have told me they just knew when it was time. I believe this statement to be true at a very deep level. While it may not resonate with some people, I don’t feel it is fundamentally harmful, at least in my hands. I often say this along with a reassurance that I can be that sounding board if they are not sure. Ultimately and ideally, these clients reach a sense of grounded acceptance and alignment within themselves. The decision regarding euthanasia is not simply a medical one. It is a much more profound existential journey, and most of the time we don’t know even a small portion of the story that is unfolding. We are but supporting actors. What happens if we offer our medical expertise and compassion as partners (rather than the ultimate authority) with our clients while trusting, honoring, and acknowledging that ultimately the decisions are theirs?

I recognize that there is not one best way to do any of this. I also understand that different cultural norms, how well you know the client, personal style, and more will color our experience and our approach. Sometimes it may not go as planned. We too are human, and practicing self-forgiveness is also healthy for us. It is good to continually be willing to question what and how we are bringing ourselves to our work and to life. This is the real, meaningful stuff of life. As Ram Dass said, “We're all just walking each other home.”

Liz Fernandez, DVM, CVA
Acupuncture for Pets Newbury Park, CA

Continue to the next page to read Dr. Dani McVety's reponse.

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