"When is it time?"
This the most common question people ask, maybe next to "Do you think he is suffering?" (also a loaded question, which is usually really asking many other things, and maybe we'll talk more about that another day). The answer
is there is no right answer. It depends on each animal's constitution and personality, and the ability of the family to provide, financially, physically, and emotionally, adequate care and support for their pet as their needs increase. It is murky and more like a moving nebulous cloud then a specific point or line. There is no "right" answer to this question, but we can try to make an educated decision based on what the animal needs and what the family needs, and feel at peace knowing we've honored their life as best we could.
But I think veterinarians and families need to ask this question in reference to hospice and palliative care sooner than we do. We wait until we've tried the chemo, the surgery, the 7 medications and the weekend in the critical care hospital to admit
it's time for hospice or palliative care.
In reality, hospice and/or palliative care should be offered and recommended when we first receive a terminal diagnosis. We should start to talk about palliative care and our expectations and goals early, before we don't have any more time and emotions are running high. As the veterinary field becomes more and more advanced and specialized medically, we can offer so much in the way of treatment and diagnostics. Our pets have the best of oncology and cardiology and surgery and internists available to treat their disease, and they are living longer and longer. Sometimes, however, we become a little like the Buddhist story of the blind men and the elephant, in which each man thinks he has something different based on which part of the elephant he can feel. None of them realizes they are touching an elephant.
Palliative care looks at the whole elephant. It gives the oncologist the space and time to focus on the cancer, and takes care of the other parts of
the pet and family. Things like, the anxiety and fear your dog has from having to go to the hospital to get treatments or to have blood work done. The worries you have over money and finances and how you are going to make time for appointments and home care and medications. The nausea and diarrhea that comes 2-3 days after the chemo, on a Saturday when the oncologist can't be reached, and it's the emergency room and a 2-4 hour wait. The questions the family has about what happens if and what happens WHEN, because honestly, even the best medical care often can't cure cancer. The sadness and grief you feel every time you realize, again, you're going to lose your best friend, eventually. Palliative care is so much more than pain management, although that is part of it. It is the part of your care that sees you and your pet's needs, and helps to support the human-animal bond through their illness or death. The focus is on the family and the animal, not on the disease. And last, but not least, it is finding the things you can still enjoy with your pet, and the things your pet loves, and learning to live with no regrets. Starting now.
Additional reading on palliative and hospice care: