Tuesday, May 15, 2007

End of Life

A fact that needs discussion
There are precious few moments in a veterinarians career that has such profound significance. Assisting in end of life decisions for ones beloved pet companion is heart wrenching. This is a time in the animals life stage that demands of the veterinarian roles of physician, counselor, death facilitator, and friend. Each one of these are critical and require profound prudence, gentleness, and most importantly genuine caring. They become a permanent part of that person and companions last interaction and experience. Most veterinarians take this charge very seriously.

Personal companion animal euthanasia is difficult to describe in words. It is a roller coaster ride full of emotional extremes reflecting, in an instant, innumerable memories for the owner and doctor. The veterinarian often has had the honor of being that pets pediatrician, dentist, advisor, surgeon, geriatrician, and finally sometimes the facilitator in a process that culminates in a humane, dignified, and gentle end to a fulfilling life. Often veterinarians and their nurses also find themselves taking on the owners role for ill and dying homeless animals. Should that we all be so lucky.

That is why today's grand rounds discussion at Pallimed is so important. This is an area that needs to be discussed much more in the human medical arena. Whether we like it or not, it is a topic that will not go away and requires that people take a deep breath, listen, and engage in discussion civilly and respectfully.

The most recent End-of-Life Practices in the Netherlands Study published in the New England Journal of Medicine is a way of broaching this important and taboo subject here in the US. It provides interesting information and addresses some concerns. Among the studies findings are:

"1) No slippery slope. A major finding was the absence of the 'slippery slope' that many fear may come with the public/legal acceptance of physician-assisted death.

2) Less evidence of hastened death without explicit request. One of the major safeguards against the slippery slope and hastened death of those who society may no longer find 'useful' is to ensure that E/PAS is voluntary/autonomous and without coercion."

That end of life occurs is not the question. It seems we will acknowledge and face the possibility of end of life situations for our companion animals, yet seemingly ignore the crying pleas of so many people. I realize this is a sensitive subject full of deep and complex societal and religious overtones, pressures, and mores.

Still, it is critical that we acknowledge this is a common and deeply personal experience fraught with unanticipated considerations and profound impacts. Countries such as the Netherlands that openly deal with this inevitability gives us the opportunity to learn how it might work here. We need to find a way to develop a framework that helps physicians and families better navigate these difficult moments so that they can make their own informed personal choices.

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