“When I was growing up, people had pets, and everybody loved their pets, but there wasn’t like a ‘You’re my child’ associated with it,” says Juliette Simmons, a pet guardian who has been through the process of making end-of-life decisions for family pets on several occasions. She believes the growing treatment of pets as members of the family has led to increased pressure for veterinarians — and families — to “try everything.”
And try everything these days we can.
While the number of people keeping pets is on the decline, the veterinary profession is experiencing significant growth. Did your vet recently diagnose your pet’s terminal illness or complex condition? With huge technological and medical innovations, there’s plenty of options for treatment.
You could be referred to one or more specialists who can provide cutting-edge care. A forest of medical specialties has expanded the choices available to pet guardians: chemotherapy, radiation, kidney transplant, drug trials, and much more.
Sinking tremendous resources into veterinary care is often the route some pet guardians choose, especially those who want to prolong and improve quality of life. Others also feel tremendous pressure to do so. The implication, if they don’t pay for advanced care, is that they don’t love their pets enough.
But saving your pet’s life comes at more than an economic cost.
While end-of-life care options can be extremely expensive, the availability of such treatment options is sparking an increasingly fraught conversation about “how much is too much.” When does medical care for pets cross the line, doing more harm than good?
More importantly, how can guardians know when care is actually prolonging pain — especially when they’re faced with a beloved pet in crisis and surrounded by a family who may be deeply, emotionally attached?
This may seem like an abstract question for people with younger, healthier pets. But those pets will eventually age. And with age comes the increased risk of painful health issues or sudden, terminal conditions.
"I don’t think I regret putting him down, but I do feel like I failed him." – Katherine Locke, on the experience of her cat’s death
The mindset ‘pets as family’ may lead to mismatched, undeliverable expectations
“In humans,” says Dr. Jessica Vogelsang, a San Diego veterinarian who provides palliative, hospice, and euthanasia home care, “you get a terminal diagnosis, and the question is: ‘How do you treat it?’ If you’re lucky and you work with the right people, palliative care comes up.”
This mindset has also bred an expectation that end-of-life illnesses like cancer in pets are curable, when they’re more often manageable.
“We overestimate the number of people who would make that choice if they understood what [treatment] meant,” Vogelsang says. How far people are willing to go to manage a terminal condition is up to them, but sometimes there’s a gap of understanding what might be involved in the long term.
Author Katherine Locke is acutely familiar with this experience after the death of her cat, Jupiter, who had cerebellar hypoplasia and feline lower urinary tract disease. “No matter what we tried, including crating him, locking him in a bathroom or small bedroom with a litter box, his litter box habits remained hit and miss. It was something that I managed and lived with, but it went from about 75 percent use to about 25 percent use, and then to none,” Locke says.
After years of struggling, she made the decision to euthanize. “I don’t think I regret putting him down, but I do feel like I failed him,” she says.
Some pet owners do have a background to feel reassured about their decisions during their pets’ end of life. Shayla Maas draws upon her nursing background and personal experience with chronic pain when she cares for her senior cat, Diana. Diana has arthritis and seizures, which Maas helps treat by delivering medications and fluids at home. Maas also believes her nursing history helps her make more informed decisions. She knows, for example, how grueling surgery can be, especially for a senior cat.
“The kind of anesthesia that would be required… that alone might kill her,” she says, adding: “I don’t want to put her into more misery for my benefit. I can understand my pain. I know what’s happening and how to minimize it. All she knows is that she can’t jump up on the desk as easily, she can’t get comfortable.”
But what if you don’t have medical experience or confidence?
One of the challenges with end-of-life care is that the decline in a pet’s health is often unanticipated. Often, pet guardians have to rapidly make hard decisions in the midst of panic and trauma. Sometimes it’s a serious injury that requires some immediate decision-making — to pursue surgery or not, to proceed to euthanasia.
Sometimes there’s an abrupt diagnosis of cancer, heart failure, kidney disease, or another condition after a mysterious decline. During this crisis, pet guardians may be faced with three choices: throw everything at the problem, hospice, or euthanasia. All choices come with their own pitfalls. And guardians, in the midst of chaos, sometimes make poor choices, tinged with regret.
And some feel that a late diagnosis of a terminal illness can be the result of compounded failures on the veterinary end, that they missed signs of serious illness during routine examinations.
While the American Veterinary Medical Association recommends that senior pets see a vet every six months, it’s not uncommon for a seemingly healthy pet to go several years without seeing a vet… until an unexpected problem develops. The result may be a delayed diagnosis of a serious health problem, narrowing treatment options.
The emotional toll of aging petsAnd sometimes the question isn’t “How much is too much for Fluffy?” but “How much is too much for me?”
Veterinarians also struggle to communicate with guardians about death and terminal illnesses
Sometimes there’s blame on the veterinarians for “missing” a diagnosis, sometimes from a sense of misplaced guilt. But it’s not that your vet doesn’t have the information about the risks and benefits of treatment. There just hasn’t been a conscious choice to teach veterinarians how to have that conversation, says Lynn Hendrix, a veterinarian and the founder of Beloved Pet Mobile Vet in Davis, California. She also adds, “We’re not comfortable talking about terminal illness in this country.”
What if we set out the time to thoroughly process what we might want for our pets before a crisis point arose? If veterinarians and guardians had frank conversations about common complications a pet could have, it would present both with a blueprint for dire situations.
This blueprint can provide pet guardians the confidence they need when making their decisions. For example, they can opt to refuse a surgery they feel isn’t beneficial, drawing upon decisions made when they were feeling clearheaded. Proceeding directly to euthanasia is also an option when people feel they can’t afford treatment or care, or if they feel a diagnosis means an animal may experience intractable pain and suffering.
Rather than prolonging the inevitable, some guardians believe it’s better to provide a humane death. Pain in particular comes up as a recurring theme in decision-making for pet guardians.
“We make sure they are comfortable as possible. But the minute they begin to suffer, it’s done. Part of being a responsible pet owner is knowing when to say ‘Enough!’” says Victoria Howard, who thinks of her pets as part of her family and has experienced several pet deaths.
Advance preparation for euthanasia, if that’s a route one wants to consider, may help with the emotional transition. Vogelsang says some clients are curious and want more details, while others don’t. Some may find it reassuring to ask for information about the process, and, in a clinic setting, to find out if they do appointments during “quiet hours.”
And yet there’s a powerful middle ground not many pet guardians, and not all veterinarians, are aware is an option: hospice
Here animals are provided with palliative care — including not just pain management but antibiotics for infections, medications to manage disease progression, fluids, and other options — while their families are also supported. Many hospice cases ultimately lead to euthanasia, but may follow a gentler trajectory.
"Delaying the inevitable is not fair to the animal. I was aggressive in the treatment of Gilda, and it cost us money and emotional costs." – Victoria Howard, on delaying her cat’s death
Driven by her hospice experiences, in part by the death of her own mother and how human hospice providers treated her, Vogelsang feels lack of awareness about hospice is a larger failure of the veterinary profession and one she’s working to counteract. Hospice, for some, can be the start on the path to a “good death” — not just for pets, but for their humans as well.
But it still requires care and planning. Caregiving for pets can be grueling for humans. For Howard, symptoms like leaking urine can become deal breakers, because she knows animals will be uncomfortable and unhappy during this time. Is changing diapers or pads, administering medications, and other measures around the clock a deal breaker?
Knowing what your pet’s baseline before illness looks like can have a profound impact. How active is your pet? Which foods do they like? How much do they interact with humans around them? Having these constellations of questions can help paint a picture of what “happy” looks like — and when an animal hits the tipping point.
Emily Rhoads, a physician assistant in California, recommends a “rate your day” concept. This concept is rooted in her own orthopedics experience. Day rating can help people make decisions about which procedures are right for their pet, as well as helping them measure surgical outcomes. Looking back on each day and assigning a rating may help one avoid making impulsive decisions.
If Fido has five good days in a row, that’s a good sign. But what if those days are all negative, and the number of good days are dwindling? All of these metrics can help people develop treatment plans rooted in their values, rather than sudden grief, fear, or guilt.
Pet guardians should be unafraid to consider factors like breed complications, age, and medical history — a urinary obstruction in a 2-year-old cat is very different than one in an 18-year-old cat with a history of urinary tract problems. And while it’s painful to calculate financial considerations, it’s better to do so in advance, when pets start aging, rather than in the moment. “Delaying the inevitable is not fair to the animal. I was aggressive in the treatment of Gilda, and it cost us money and emotional costs,” says Howard, speaking about the death of a beloved silver and white tabby who developed kidney failure. After costly care that included EPO shots to stimulate red blood cell production, subcutaneous fluids, and other treatments in the hopes of prolonging her life, Gilda ultimately passed away.
Thinking ahead will help you avoid unnecessary pain for you and your pet
The most powerful way for guardians to answer the “How much is too much?” question is to acknowledge the conversation about death in advance so they’re prepared with the information they need. All of these decisions are difficult to make, and they shouldn’t be made lightly.
Advanced questions to consider
- What are the specifics?
- What’s the outlook?
- What treatment options are available, and what will my pet experience in the days, weeks, or months to come, depending on the treatment we elect to pursue?
- Can you refer me to a specialist?
- If I decide to pursue hospice treatment, is that something you provide, or is there another vet in the area who offers this service?
- If you disagree with my treatment plan, can you refer me to a colleague?
Even in the most perfect of circumstances, end-of-life decisions can be traumatic and intense. There’s no one right, simple answer — how much is too much may depend on the guardian, the pet, and the context. And sometimes the question isn’t “How much is too much for Fluffy?” but “How much is too much for me?”
Thinking about the answers in advance can prepare you to answer them in the moment. Maas encourages people to ask questions about every aspect of care and every option throughout an animal’s life, not only when they receive a diagnosis.
Giving yourself the permission and time to consider these deeply intimate and personal answers ahead of time is building a powerful support system for yourself as well. These aren’t questions anyone else can answer for you, but ones you need to explore on your own.
s.e. smith is a Northern California-based journalist with a focus on social justice whose work has appeared in Esquire, Teen Vogue, Rolling Stone, The Nation, and many other publications.