Page 1618 - Clinical Small Animal Internal Medicine

1556 Section 14 Social and Ethical Issues in Veterinary Medicine

interventions with little hope for success on animals While the original hospices were places for the dying,
VetBooks.ir who are approaching their end of life. Finally, it is also a it is important to understand that hospice is a philosophy
of caring that “affirms the concept of palliative care as an
veterinarian’s obligation to the pet, the pet owner, and
the precious human–animal bond not to force or rush
… quality of life … When cure is no longer possible, hos-
euthanasia on a patient whose care has shifted from that intensive program that enhances comfort and promotes
of curative to palliative. Ours is a delicate balance to pice recognizes that a peaceful and comfortable death is
negotiate. an essential goal of health care…” This commitment to
In addition to drawing palliative care strategies from quality of life and comfort care brought to the patient
the disciplines of pain management, physical rehabilita- lends itself well to the veterinary profession. Animal
tion, behavior medicine, and oncology, it is to the disci- patients can be seen and cared for in many settings,
pline of clinical bioethics that the veterinary profession including the clinic and the home. The emergence of
should turn for guidance when evaluating the applica- ambulatory companion animal veterinary practices
tion of interventive, palliative, or hospice techniques clearly demonstrates the response of the veterinary pro-
in end of life care. The foundational principles of bio- fession to the demand for veterinary care provided in the
medical ethics – respect for autonomy, nonmaleficence, comfort of the animal’s home. This paradigm of sophisti-
beneficence, and justice – all have a role to play during cated in‐home care further reinforces the opportunity to
the decision making that occurs as an animal approaches provide palliative and hospice care to pets who are
the end of its life. Before exploring the application of approaching the end of their lives.
the principles of biomedical ethics in end of life clinical The first formal discussion of hospice for animals
veterinary medicine, it is appropriate to consider the was presented at the Delta Society’s 10th Annual
development and evolution of veterinary palliative medi- Conference in Portland, Oregon by Drs Guy Hancock
cine and hospice care, as well as the many techniques and James Harris, and Ms Bonnie Mader. The presen-
that can be used to sustain a life‐limited pet’s comfort tation, “The hospice concept for animals,” was deliv-
and quality of life until the time when humane euthana- ered at multiple regional, national, and international
sia becomes the most reasonable choice. conferences by Dr Hancock between 1995 and 2005.
Dr Eric Clough, a veterinarian in New Hampshire,
alongside his wife, June, a registered nurse with exper-
tise in human hospice, were also pioneers in apply-
Veterinary Palliative Medicine ing the concepts of animal hospice and palliative care.
and Hospice Care In 2001, the American Veterinary Medical Association
approved the first “Veterinary Hospice Care Guidelines,”
Veterinary palliative medicine and hospice care derive an open‐access document available at www.avma.org.
their basic principles from human palliative and hospice In 2003, the Pet Hospice Volunteer Student Outreach
care, both directly and by analogy. Historically, hospices Program was launched by the Argus Institute at
were first places of refuge for travelers, often those on a the Colorado State University College of Veterinary
religious pilgrimage. In the 11th century, the focus Medicine and Biomedical Sciences.
shifted to care of the incurably ill who either had no fam- During the ensuing years, a clear focus on quality of
ily or could not afford other care. Hospice providers were life during the end of life of companion animals has
typically members of various religious orders. In the 19th emerged, leading to the establishment of the International
century, the formal concept of caring for the dying Association for Animal Hospice and Palliative Care
emerged, first in France in 1842. In the late 1800s and (www.iaahpc.org) as well as the provision of postgradu-
early 1900s, several facilities that are still in existence ate continuing education on the subject for both veteri-
opened in England and Australia to attend to the dying. narians and veterinary technicians/nurses. Clearly, there
Religious orders continued to provide care, as this is a need for the veterinary profession to understand its
preceded the phenomenon of “medicalizing” the dying critical role in a pet’s end of life care. There truly is a
process. Hospice in the US began in earnest in the 19th “space” between ceasing to pursue a cure and the time
century, mirroring activities in the US and Australia. A when humane euthanasia is in the best interest of the
leap forward in the development of palliative care and patient. It is also worth noting that while only recently
hospice occurred following the 1969 publication of Dr has the term “palliative care” entered the mainstream
Elisabeth Kübler‐Ross’ seminal work, On Death and veterinary vocabulary, veterinarians routinely provide
Dying. She and others created awareness about the lack what qualifies as palliative care. Palliative medicine is
of adequate care for the dying, and sharpened the focus care that is not focused on a cure but rather on improv-
on the important role palliative care and hospice can fill. ing and maintaining good quality of life. Pets with many