Hospice has taken many forms throughout history—from places of respite for the sick or dying to rest stops for travelers and pilgrims. Hospice started to take today’s meaning when care for the terminally ill began evolving in the mid-19th century, with The Lancet and British Medical Journal publishing articles pointing to the need for good care and sanitary conditions for the impoverished.1 By the turn of the 20th century, dedicated facilities provided sanitary conditions for patients with tuberculosis and other terminal illnesses. These facilities helped shape the hospice movement that exploded in the 1980s.
Hospice: Veterinary & Human
For humans, hospice care is available in hospitals, nursing homes, and dedicated hospice facilities but is usually provided in the home with a family member as the caretaker. The home is where people are generally most comfortable, a point that applies even more strongly to hospital-phobic pets.
Veterinary hospice is a “family-centered service dedicated to maintaining comfort and quality-of-life for the terminally ill pet until natural death is achieved or the family elects euthanasia.”2 In human medicine, terminally ill is generally used to refer to patients who are given about 6 to 12 months to live or who have a condition that is deemed life-limiting. In small animal medicine, we could argue that the phrase terminally ill is appropriate when the pet’s life expectancy is considered to be 1 month or less. For the sake of emotional, physical, and medical preparation, however, veterinarians should use hospice for any pet that could reasonably have 3 months or less before quality-of-life, not imminent death, becomes a serious concern.
Veterinary hospice is distinctly different from human hospice because veterinarians have the ability to perform humane euthanasia on animals when medication is no longer adequate and quality-of-life is questionable. This distinction should be made when a family is faced with a terminally ill or senescent pet, regardless of life expectancy.
Veterinary Hospice Services
Just as a bed of hay for the backyard dog has been replaced with orthopedic memory foam for the indoor pampered pet, so do clients continue to seek more personalized and human-like medical care for their pets. As a result of the exceedingly positive experiences families have had with human hospice, owners are actively searching for similar care for their aging and/or terminally ill pets.
Although hospice care can be provided as both a stationary and mobile service, few veterinarians dedicate their practice strictly to hospice care. The frequently incurable nature of cancer, coupled with highly attentive clients seeking specialized treatment, commonly places the task of palliative care in the hands of oncologists.
General practitioners forget, however, that they routinely provide some level of hospice or palliative care for their elderly or terminally ill patients. We have the unique privilege of treating our patients from cradle to grave, and we need to nurture the end of this spectrum as much as the beginning. Just as there are “puppy packages,” there should be “hospice handouts.”
Our knowledge of disease processes and progression of signs places us in the role of advocate. A detailed explanation of the disease process, including the possible mechanism of death, is information that clients likely desire most during hospice discussions. Although we cannot predict with certainty when or how a patient may die, we can offer a “perhaps” scenario of what the end-of-life experience may be.
Quality-of-life and planning are essential hospice topics to discuss in order to help pet owners decide whether to medicate (provide palliative medical care), meditate (make an educated decision about what is best for the pet), or mitigate (end the pet’s suffering).