Question:

I have a dog diagnosed with so much fluid around her lungs that she can barely breathe. The veterinarians feel certain a cancer is causing this but decided that the dog is so frail she would likely not survive a chest tap to draw off fluid. The dog still gets around, still wags, still seems happy and pain free although, of course, chronically out of breath. For the last three days she has refused all food in all forms. We’ve tried everything from dog kibble to rare steak, to baby food mixed with water to form a drinkable “soup”. Nothing even tempts her and she tries to hide when she sees us coming to offer food. She drinks water without problems, doesn’t vomit, has no bowel issues. I could use a syringe to force feed her but I am not sure if that is wise. Is it better to force food into a terminally ill dog or is it better to accept her decision to stop eating? She does not seem to be in any pain but she is weakening every day.

ANSWER:

You have touched on a subject that I am very passionate about and although I have not mentioned it in this column, it is obviously time.

Having worked in the veterinary field for many years, I have seen everything from owners that euthanize their pet at the first sign of a terminal illness as well as those that do everything for their pet to the point of where they verge on cruelty.

Which is ethical and which is fair to the pet?

The first scenario shows an indifference to the pet to the point of treating it like an object versus a living breathing member of the family. The second one makes me ask whom are they serving by keeping the pet alive while it is suffering? Technically, in most areas of the country, animals are objects and a vet cannot tell an owner that they should euthanize their pet without breaking some misguided law. They are restricted to making comments like ‘the animal is suffering’ or ‘if she were my dog…’ which are open to interpretation and owners can take the comments however they want.

What most owners fail to do is listen to their dog and dogs are actually pretty smart when it comes to their own death – they seem to know when its time. I have seen dogs fight back from the brink of death and lived a long, healthy life from that point on. I have also seen a look that is unmistakable in its meaning and they know it is time to say goodbye. I have seen both in my own dogs and I have learned some important lessons from them about death and euthanasia.

‘Just because we can doesn’t mean we should’ is one of those lessons. In human medicine, we fight until there is nothing left to fight and then we fight some more unless the ill person says ‘no more’. They can rationalize and understand what is happening to them, contributing significantly to their own treatment. A dog does not understand all the things that are going on with their illness so is it fair to subject them to treatment that causes them stress or discomfort. It is a fine moral line we walk and if there is a known or foreseeable positive end where the animal survives to live a long, healthy life, the end justifies the means. However, if the end is not a positive one, is it fair to the pet?

How I measure the ‘fairness’ is by the pain or discomfort levels the dog is already in mixed with how much more stress would the treatment cause.

In the case of your dog, the wagging tail and happy attitude tells me that letting nature take its course is the right thing to do and there is no need to end the suffering as the suffering is limited. However, force-feeding is stressful and the need to restrain her will further restrict her ability to breath. As she is working to get enough oxygen in her lungs and probably gasping, the chance of her inhaling some of that liquid food is high. Inhaling food or liquid is called aspirated pneumonia and it would only further reduce her ability to breath.

There will come a point where she is in too much discomfort and the inability to breath is causing her undo stress. This is where I feel that as a society, we treat our pets better then we treat each other. Euthanasia is a humane solution and in many ways, I think it is the greatest gift we can give our animals when there is nothing more we can do for them. It does not mean it is an easy decision and I usually recommend to owners facing this eventuality is to make a pact with their pet that when a certain point in their decline is reached, that is the time.

In the case of a young dog I lost to auto-immune hemolytic anemia, after her first bout that she should not have survived and only did because we used her as a guinea pig for a new type of treatment but not without some unfair consequences, I promised her I would never put her through it again. When it came back as we all knew it would, my decision was made and although it nearly killed me, I stuck by that promise with the agreement of my many vet friends – she had suffered enough and it was time to let her go.

With your girl, I would say something like when she can no longer walk up the stairs on her own or when she cannot make it outside. And the biggest indicators of all, when that tail stops wagging or when the happiness leaves her eyes. Unfortunately, it is only a matter of time and having yourself prepared for the inevitable is an important part of the process.

It may sound hokey but I do think a dog will let their owners know when it is time as well. All my dogs have given me the same look – a look of resignation, exhaustion and sadness - when it was their time to go as I have seen many animals give the same look to their owners as they are carried into the vet hospital for the last time.

Watch your girl and enjoy the days you have left with her. Keep her happy, content and pain-free. Talk to your vet about euthanasia and know ahead of time what to expect. Pre-planning final arrangements can make it easier as no difficult decisions need to be made while under duress. I keep my dogs close – their ashes are made into stepping stones for my garden with their images inlayed with stained glass. Granted, the artisan who makes them for me definitely looked a little disturbed when I handed him the urn of ashes but he got over it. He now offers the same service to many pet owners and they now represent a good portion of his income – strange how things come about some times.

My heart goes out to you and I wish you and your girl all the best.