6 myths of veterinary palliative care
"They don't deserve to hurt." This serves well as a motto for caring for pets throughout their lives, particularly as they approach the end of their lives. Our obligation as veterinary healthcare providers is to advocate on behalf of beings that cannot advocate for themselves. Dr. Lloyd E. Davis once said of pain in animals that "[o]ne of the psychological curiosities of therapeutic decision-making is the withholding of analgesic drugs because the clinician is not absolutely certain that the animal is experiencing pain. Yet the same individual will administer antibiotics without documenting the presence of a bacterial infection. Pain and suffering constitute the only situation in which I believe that, if in doubt, one should go ahead and treat."1 When a pet develops a terminal disease and is approaching death, this obligation becomes even more important.
A common misconception both within veterinary medicine and among pet owners is that when a veterinarian renders a terminal diagnosis, all care options are exhausted. Often veterinarians advise immediate euthanasia because, as they will often state, "There is nothing we can do." In many cases this is wrong. While there are patients that present at the practice in distress that truly need the compassionate release of euthanasia as soon as a terminal diagnosis is rendered, these patients are in the minority. More commonly, the veterinarian discovers a situation that may require immediate treatment or intervention to relieve clinical signs but does not require immediate euthanasia. In the space between the diagnosis and death, the patient needs and deserves palliative care and hospice services.
A look at the team's roleVeterinary technicians and assistants can and should participate in delivering palliative care and hospice services. To be effective in this role, training is critical. This includes a team-wide understanding of pain pathophysiology and pain evaluation and examination techniques and a general understanding of how pain is treated. Even though diagnosis and prescribing medications are the veterinarian's responsibility, the technical team can serve as a critical link between the veterinarian, the palliative care or hospice patient, and the client.
Once a pet is deemed a palliative care or hospice patient, ongoing evaluation and fine-tuning of care focuses on managing signs rather than on curing a disease process. Palliative care embraces a wide scope of activities that can be accomplished in the home easily. The core competency of veterinary palliative care and hospice is appropriate, comprehensive pain management. Pet owners' biggest fear is that their pets will suffer. We can effectively prevent and relieve suffering. Clients need the veterinary team's support as they embark on this unique journey with their beloved companions.
Team training must include these skills: