"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 role
Veterinary 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:
- Performing a pain evaluation on both dogs and cats—and understanding differences between species
- Using a pain scoring system or scale
- Offering wound care
- Developing communication skills to enhance technician-client interactions
- Learning the delivery of medications and other home care techniques. (See the recommended resources at the end of this article.)