Page 1622 - Clinical Small Animal Internal Medicine

1560 Section 14 Social and Ethical Issues in Veterinary Medicine

in these patients. Keep hair trimmed short around the
VetBooks.ir genitals and anus to facilitate cleaning. It may be worth
considering a whole‐body trim to make day‐to‐day
grooming easier for both the pet and pet owner.
Reusable/washable diapers as well as diapers with
replaceable absorbent pads are available for animals
whose incontinence is intermittent or unpredictable.
Waterproof bedding covers facilitate clean‐up. Cats may
need to have one side of their litter pan cut away to make
entry easy. If the pet has any areas of devitalized tissue
that secrete serum and form crusts (e.g., a tumor that
cannot be removed), lemon juice in a 1:1 dilution with
water can be used to cleanse the area, and absorbent fab-
rics like cotton T‐shirts may be used to help manage
exudates. Waterless shampoos also work well to keep
immobilized pets clean.
Figure 175.4 A cart can restore and maintain mobility. Source:
Courtesy of Robin Downing, DVM.
Happiness
Happiness may be the most subjective of the quality of Mobility
life parameters to be measured during the pet’s end of As the inevitable decline toward approaching death pro-
life time, but it is an important one. It is in this area in ceeds, animals may lose their ability to move indepen-
particular that the veterinarian must listen very carefully dently. How much of an impact this makes on the pet’s
to the client’s report of how the pet is doing overall. The quality of life and the family’s ability to continue end of
pet’s mental state and psychosocial well‐being are criti- life care may depend on the size/weight of the patient as
cal components of quality of life. Dogs and cats commu- well as the willingness of the pet to accept assistance.
nicate with their eyes, their facial expressions, and their There are many mobility assistance options available for
actions. These are social creatures, and their happiness pets of all sizes, and simple environmental modification
depends upon interaction with “their” humans. Animals may make a profound impact, allowing a pet to sustain
engage in many mutual care behaviors that can be mim- its own ability to get up and down and move around
icked by the human caregiver to contribute to happiness, (Figure 175.4). Providing nonskid floor surfaces, pre-
including stroking and sounds of contentment (e.g., venting unsupervised access to stairs, utilizing ramps for
purring while interacting with a cat patient). entry and exit from vehicles, as well as slings, supportive
Owners of animals receiving end of life care must be vests, and pet wheelchairs are all simple strategies for
instructed to think through the activities the pet has sustaining mobility. The owners of immobilized end of
enjoyed over its lifetime, and then to consider how those life pets must be instructed in the details of preventing
activities and interactions may be modified to provide decubital ulcers. The size of the immobilized pet relative
joy to the pet. For instance, the author worked with a toy to the size and strength of the pet owner must be consid-
poodle who had been felled by a stroke. She became par- ered when deciding whether to proceed with palliative
alyzed in the rear legs and profoundly paretic in the front and hospice care versus opting for humane euthanasia.
legs. Her greatest joy before her stroke was playing tug‐
of‐war with a cloth toy. She would bring the toy to one or More Good Days Than Bad
another family member and ask them to play. The family
simply modified this game by initiating play sessions A single “bad day” in the end of life time of a pet is some-
themselves. This dog obviously derived great joy from thing to be expected, but more than a few bad days in a
these play sessions. row suggests that quality of life may be too compromised
Many end of life pets will cheer up and greatly antici- to continue palliative and hospice care. If the pet is
pate their interactions with their human family mem- “turned off” to life, is no longer responding to activities
bers. Feeding, grooming, play, simple stroking, and in its immediate environment, or is withdrawing
strategic placement so that the pet may watch what the from interactions with family members, then quality
family is doing are all simple strategies for enhancing of life is compromised. The overarching goal in a pet’s
happiness. McMillan makes a strong case that animals end of life care is to maintain a healthy, two‐way, interac-
not only do experience happiness, but that their happi- tive human–animal bond (Figure 175.5). When the
ness contributes immeasurably to their quality of life. In HHHHHMM score drops below 35, it is likely that
general, we can equate happiness with the will to live. the end is near. It is the obligation of the veterinarian