Navigating End-of-Life Care and Decision Making

At the Dog Aging Project, we’re trying to learn about all stages of a dog’s life. There is so much we don’t know but want to explore. One area that needs more study is end-of-life care. How do various health conditions impact a dog’s final days? What influences quality of life? How do dog owners navigate the complicated decision-making on behalf of their beloved dogs? At the Dog Aging Project, we believe that these issues are a really important part of the human-dog story.

The End of Life Survey is a new research tool designed to understand what happens when the end of life draws near. This survey collects information about the circumstances surrounding a dog’s death. When the data collected by this survey are combined with the information we collected about canine health and life experiences through our other surveys, it will help inform our understanding of the aging process and identify key targets to improve the quality and length of life for future generations of dogs.

For this blog post, we asked Dr. Lisa Moses, VMD, DACVIM, a veterinarian and the chair of the Dog Aging Project Animal Welfare Advisory Board, to discuss the End of Life Survey in the context of her years of experience improving aging dogs’ quality of life and helping families navigate decision making near the end of their dog’s life. We’re incredibly fortunate to have a team member of her caliber leading our Animal Welfare Advisory Board!

For the past fifteen of my thirty years in practice, I specialized in veterinary pain medicine and palliative care. Nearly all of my patients were elderly dogs with layers of chronic problems affecting their ability to comfortably function and enjoy life.

People often assume that palliative care, whether the patient is a person or a dog, is the same as hospice care, but it’s not. Palliative care focuses on making the quality of life as good as it can be, regardless of how much life is left and even with intensive treatment for diseases like cancer. In contrast, hospice care aims to make the very end of life, and death itself, as peaceful and comfortable as possible.

Even though the care I gave my patients concentrated on managing their comfort as they aged and got sicker, discussions about death and when to stop aggressive veterinary care were part of nearly every appointment. Over the years I learned a lot about what life is like for elderly dogs and which problems are the hardest to manage. I also learned more than I ever expected to about grief in all its complexities.

When I first opened my palliative care practice and wanted to make sure I was properly trained, I quickly realized that there was very limited information available on geriatric veterinary medicine, about why dogs die, what motivates people choose to euthanasia, and how families make end-of-life decisions. In fact, there is so little information available about most of these subjects that I ended up pursuing training in human pain medicine and palliative care so I could help my elderly dog patients. This gap in knowledge is exactly why I volunteered to help the Dog Aging Project. Veterinarians (including me) desperately need real answers so we can do a better job helping older dogs.

The End of Life Survey is going to fill in a lot of those gaps. This survey focuses on two areas: what diseases and health problems were the cause of death and whether euthanasia was part of that.

Even though these questions may seem simple, my experience has taught me otherwise. I know how deeply families agonize over what is the right thing to do when their dog’s health is declining. After thousands of these conversations, I’ve come to realize that there are many highly personal influences on end-of-life preferences. Veterinarians could do a better job guiding families through this difficult time if we knew more about what most people want and why. We also need in-depth, clear data on what problem or problems most affect quality of life in senior dogs and exactly how those issues make daily life hard.

Let me be clear about something. The Dog Aging Project wants to understand how people come to a decision about euthanasia, and the team supports the decisions of dog owners, regardless of the path chosen, without judgment or reservation. Veterinarians know there are many reasons why euthanasia is or isn’t chosen. I know that those reasons are very personal, often connected to people’s experience of aging and death. In my experience, dog owners usually know what is best for their dog. I also know that people frequently feel judged about those decisions by their family, friends, and sometimes even their veterinarian.

The Dog Aging Project team, including me, feels strongly that judgment has no place in end-of-life decision-making. The End of Life Survey is meant to collect data about euthanasia-related decision-making (among other end-of-life issues) so we can help other human-dog families as they navigate what is arguably the hardest decision anyone ever has to make. Making your way through the end of your beloved dog’s life is tough enough. We need your help, but we never want to make this transition harder.

I mentioned before that I learned a lot about grief as a result of my work in canine palliative care. I’m not trained as a social worker, but some truths about grief became obvious. Everyone “does” grief in their own way. Grief often starts when loss is anticipated, but not yet here. There is no single, “normal” way to grieve. An extension of this idea is that you have to find what comforts you when you are grieving. Many of the dog owners I worked with found that doing things to help other dogs and other grieving people helped them. I sincerely hope that some of you will find solace in helping us understand dogs as they age.

The team and I are so grateful to all the Dog Aging Project Pack members whose devotion to their dogs will live on in the Dog Aging Project work. It’s an honor to work with each and every one of you.

Photo credit: Eric Ward