Sad question about end of life and vets' responses

I'm about to call a friend who is struggling with (and emailed me to ask my opinion) about her very old and ailing dog--who has been ailing for quite awhile. She took her to the vet the other day, and tried to broach the questions of quality of life and end of life with the vet (I don't have specifics about how the conversation went), and her email to me said the "vet wouldn't go there," and that her mother told her that some vets just don't "support the option."

Is this true? I haven't had to deal with this since my last family dogs left us over 14 years ago, and I can completely understand a vet not saying, "you should do this," and wanting to make it the owner's decision, but I thought, even though it's a very sad question, I'd ask what your experience has been or what you know about this. Will some vets not even entertain the discussion and force an owner just to make a demand? Are they opposed to it?

Thanks.

I'm not sure if this surprises me or not. I was trying to think about my response. I would expect the vet to be willing to discuss the subject, at the very least.

If the dog still has some quality of life, I can see where a vet might question the decision. If the dog is suffering, in pain, or can't do the daily activities (eating), I would expect the vet to respect my decision to let it go.

I guess my response is this: I'd expect the vet to discuss all of the options, the prognosis for the ailment, any treatment options (or none), and finally to respect the decision of the owner. Just as I'd expect a medical professional to do if it was MY care and condition in question.

Can she consult another vet in the practice? Or worst case scenario, get a copy of the records, and go to another vet who will discuss it with her?

Thanks, Allie. I agree. I thought I'd call her after getting a few responses here to see what peoples' experiences have been. When we let our last lab go, I remember the vet saying, "Well, we can do x," and I asked (my mom, really), "Why? If he's in so much pain, are we doing this for him or for us?" And then the vet acknowledged my question, which seemed appropriate, and we had the conversation.

Maybe a meeting with the vet, without the dog present? Or a phone call?

That's just weird, all the vets that I known have been willing to discuss when it's time and have been very helpful about quality of life decisions. That's just sort of creepy that this vet wouldn't. You would think that any vet would want the end of the dog's life to be as
pain-free and comfortable as possible. I think everyone's suggestions about talking to another vet are good ones.

I've gone through this a few times . All of vets were willing to discuss quality of life but I was the one to bring it up. It was kind of like they talked around the subject like an unfinished sentence and then I finished it to continue the conversation.

In fact, there's one vet in particular that I consider my "go to" person if I need to make difficult decisions. She very compassionately will over over all the options.

I've only had 2 experiences with this. One was our family's cat, she was almost 24 years old, and our vet (who knew her almost her entire life) gave my parents good advice on what to watch out for, and when they might want to make that decision. Muffin ending up passing on her own, but I know our vet really helped us out when we were all struggling on "when would we know" type of questions.

My other one was a rescue pug that had advanced cancer. I was with her, and it was clear she was starting to suffer. Our rescue vet (who we love) is the one who told us because it had spread to her lungs, her breathing was compromised and the kindest thing to do would be to let her pass peacefully.

That is odd to me. Since we began dealing with Kayla's illness in November, I have been extremely open with all of our vets regarding her quality of life and end of life options. And they all have been very willing to talk about it with me whenever I bring it up. I trust their judgment and guidance in helping me make the right decision and I also trust them as an outsider that they will tell me when it's time, if it seems I'm not yet seeing that.

I would most definitely recommend your friend talk to another vet. It's hard enough on us as owners to talk about the subject at all - having to talk to a vet who's uncomfortable talking about it seems like it would only make the entire situation more difficult to deal with and face.

TxAllieGrl wrote:.....I guess my response is this: I'd expect the vet to discuss all of the options, the prognosis for the ailment, any treatment options (or none), and finally to respect the decision of the owner. Just as I'd expect a medical professional to do if it was MY care and condition in question.

This would be my response, too. In fact, my vet and I HAVE discussed all options about my elderly pugs of the past. I've gone both ways, too. Some were ready, others weren't and we didn't put them to sleep at that visit.

Quality of life is how I determine who is ready. My vet agrees with me.

While never having had to decided end of life decisions for a dog, I have had to make them for 4 cats. And in only one case, have I had a problem with the vet. With Miss Molly, it was clear she wasn't going to be going on too much longer, she had renal failure along with a host of other senior cat problems. When Dr. White diagnosed her with the renal failure, she said anytime you decide she doesn't have a quality of life, I'll be here. We had an extra two weeks because of Dr. White. With my other cats, 2 of them almost the same speech. Only with one cat, my heart cat unfortunately, did I have a vet question my decision, he thought I was getting rid of a pain in the a** cat. I dismissed his opinion since he wasn't my regular vet, and didn't know Lucie was suffering. I knew she was and it was my decision to make.

Since I will have to make the decision sooner, rather than later, with Winston, I have already told my vet that when Winston has not got the quality of life left that I want him to have and if he's suffering from these damned neurological diseases, I'll let them know it's time. And again, it's my decision, no one elses.

Thank you all for your input. I just had a long conversation with her, and we both agree with what has been said here--this vet failed her in not being open to discussing quality of life, and indeed, making her feel worse at an already very trying and sad time.

She's having a vet who makes house calls come over next week, and hopefully this vet will be more supportive of and open to discussing all sides. I appreciate your input, since it has been a long time since I've dealt with this, and at that time, it was a family pet, not just *my* pet.

Well, having JUST done this with my vet around Lola, I will say that my vet always honours my decision, but I'm not always sure she agrees with me on when. She did alot of talking while I was there with Lola and while she never said that she didn't agree, she talked for a long time about being sure and what her life was like. I value that in her, frankly, but it does often leave me thinking "Was I wrong?". I think it's hard for vets to deal with it, especially when there's not an obvious ailment. In Lola's case, clearly she wasn't well, but there wasn't any prior indicator of a "disease" per se.

But I knew that she was done. I knew it. And I would always rather let them go a day too early than a minute too late. And, of course, my dogs almost always rally at the vets and look better while they are there, but I know that as soon as we return home--if I chicken out--that I see again the very behaviours that worry me to begin with. As I said to my vet, "Yes, she can rally for an hour in a high stress, high excitement environment. It's the other 23 hours I have to worry about".

Thank you, Blanche. Her Rosie is in much the same situation as your Lola was; if you don't mind, I'm going to share your words with her, since you just went through this. I appreciate your words at such a sad time, especially.

Blanche raises a very good point about a dog looking and acting better when they are at the vet. They don't see the suffering that goes on the rest of the time.

I hope the other vet is more compassionate with your friend. Our vet is an old country vet. He's more into the large animals, and if I have anything serious, I take My Boys elsewhere. But he's a great guy for minor things and shots. He's also been very compassionate the 2 times I've had to make that horrible decision. He actually comes out to the house while I lay with my baby and he administers the shot(s). It's a bit more peaceful to be at home and not in the sterility of the clinic, but it's never easy.

I think here's the other thing that makes it hard for my vet, in particular. I don't drone on and on about my dog's struggles and I don't run them in for every thing that I see. I will initially, but once it's clear to me that there isn't anything more the vet can do than I do, I don't do it. Lola has had off and on vomiting for several months--even the last year. This improved after the enucleation, but re-appeared in the last 6 weeks. She'd eat, throw up, not eat, bring up bile or foam. We know her blood work was good in April so no indication of anything obvious. As we went along, I did take her in and we put her on tilosin and famitidine. That's all that could be done. I've used both over the last several weeks with little to no effect really other than to give her a day or two of improved gastric health. But she began to refuse even the cream cheese with the pill or would promptly throw it back up and then she refused to eat at all. She began to have trouble navigating even the sidewalk and was falling back into her excreta. She was lying around refusing to engage. That's all I needed to see. I wasn't going to start a bunch of invasive tests on her. She was dead terrified of the vets in any case.

As I said, I'm not sure Judy thought the time was right and I am sure that the fact that I mull this stuff over in my head for weeks and only discuss it with a very few people doesn't help--especially since once I make the decision to end it, I move quickly. It doesn't give Judy much time to absorb the fact that I think we're done. But I'll be damned if I'm going to make my dogs linger on so I can make anyone else but me more comfortable with the decision.

I always, always feel a mixture of guilt and relief when I let one of them go. Did I try hard enough? Should I have waited? Would she have rallied? I feel this alot with Lola given that Judy droned on and on about her--so it made me question myself. So I'm not sure where Judy was with this and I'm not sure if I'm projecting. In the end, she did as I asked. And agreed that if not Tuesday, then probably within the next week or so I'd be back with the same request.

I will fight hard to save my dogs, but not against unwin-able odds and I won't make them suffer needlessly so that I can have closure and clarity. There often isn't any closure or clarity with some of the old dogs who just start to fail. I've learned to live with it, but it's damned hard and a vet who won't talk to you about it makes it very difficult indeed.

Blanche - I just want to say thank you for sharing all of those thoughts and what happened with Lola.

I know Angel's time is coming, and you sharing what you went through will help me deal with it when the time comes.

Gretchen - many good thoughts to your friend.

Again--thanks to ALL of you. I knew this vet's response just wasn't "right," but it helps to have people with more recent experience share theirs and their thoughts.

northernwitch wrote:
As I said, I'm not sure Judy thought the time was right and I am sure that the fact that I mull this stuff over in my head for weeks and only discuss it with a very few people doesn't help--especially since once I make the decision to end it, I move quickly. It doesn't give Judy much time to absorb the fact that I think we're done. But I'll be damned if I'm going to make my dogs linger on so I can make anyone else but me more comfortable with the decision.

I always, always feel a mixture of guilt and relief when I let one of them go. Did I try hard enough? Should I have waited? Would she have rallied? I feel this a lot with Lola given that Judy droned on and on about her--so it made me question myself. So I'm not sure where Judy was with this and I'm not sure if I'm projecting. In the end, she did as I asked. And agreed that if not Tuesday, then probably within the next week or so I'd be back with the same request.

I will fight hard to save my dogs, but not against unwin-able odds and I won't make them suffer needlessly so that I can have closure and clarity. There often isn't any closure or clarity with some of the old dogs who just start to fail. I've learned to live with it, but it's damned hard and a vet who won't talk to you about it makes it very difficult indeed.

Thanks again, Blanche--my friend will appreciate these words, too, as you've aptly described her situation, esp. in that final paragraph, and also what we had to deal with with our labs, and what many of us will face one day.

TxAllieGrl wrote:Blanche - I just want to say thank you for sharing all of those thoughts and what happened with Lola.

I know Angel's time is coming, and you sharing what you went through will help me deal with it when the time comes.

Gretchen - many good thoughts to your friend.

Allie--did you mean me? Thanks. :) And good thoughts to YOU and your Angel.

Eph91 wrote:

Allie--did you mean me? Thanks. :) And good thoughts to YOU and your Angel.

oops, YES. sorry Lex!!!!

Lex:
Feel free to give your friend my email. I'm no expert, but I've lost alot of old dogs in the last few years. They have all been hard losses--but Lola and Maude have been the hardest for different reasons.

Thanks, Blanche. I'll let her know. I know your words have helped me in retrospect, and I'm sure, for the future, and I especially appreciate them at such a sad time for you.

I was just reading an article in the NY times I think about how we are overmedicating and over treating people-basically we have become so concerned with "living" that we forget about the quality of that life. We have made so many advances in medicine and vet care, but that doesn't necessarily translate to a better life in some cases.

Well put. And I talked to my friend about how it must be hard for a medical person to euthanize, but I guess I've always assumed that vets (unlike human doctors--which is an entirely different discussion not for this thread), while not the ones to broach the subject (unless the animal is suffering terribly and the human is clueless or in severe denial), would certainly discuss it when the time comes, and yes, probably know you well enough if you've been going there for years, you're not just getting rid of a PITA animal.

I can't believe (well, o.k., I can--I know there are extremists everywhere), but am sorry to read you got nasty emails about your other dogs, Blanche. Nothing like hitting someone when she's down. How can people not see that at that point, it's selfish to force a pet to hang on just because we can't bear the thought of them dying?

Oh nothing surprises me, Lex. Most of the folks I got nasty emails from are/were Right to Lifers or Religious right wingers who defend life at all costs and feel that me making a decision to end my pet's life was playing God--a being I don't happen to believe in in the Christian incarnation of it, anyway. What I always find interesting about these folks is that they are almost universally pro death penalty. Never makes any sense to me.