Pet hospice is increasingly an option for people wanting a dignified death for a terminally ill companion animal. Like its counterpart in human medicine, pet hospice, also known as veterinary or animal hospice, resonates with pet owners who see their companions as important members of the household and deserving of a peaceful end. Yet as pet hospice becomes more commonplace, there's a greater likelihood for abuse by hoarders and well-meaning individuals lacking the skills and resources to provide adequate end-of-life care.
Pet hospice has been around for at least two decades. It is modeled after human hospice with its emphasis on managing a patient's terminal illnesses while preparing the family for the end. Today, a growing number of veterinarians and nonveterinarians alike offer owners the option of hospice as an alternative to immediate euthanasia (see JAVMA, Aug. 15, 2006, page 484). Seeing that pet hospice was becoming more and more popular, the AVMA in 2001 issued its Guidelines for Veterinary Hospice Care, which were reaffirmed earlier in 2007.
The AVMA guidelines are a valuable resource, according to Dr. Gary J. Patronek, but the assumption is veterinarians and veterinary technicians are part of hospice when that isn't necessarily the case. "Those guidelines, while helpful for veterinarians who choose to participate in hospice, don't completely address the larger issue of who can do hospice," said Dr. Patronek, director of animal welfare and protection at the Animal Rescue League in Boston.
The AVMA's hospice guidelines were written with the pet owner providing palliative care at home in mind, explained Dr. Gail Golab, director of the AVMA Animal Welfare Division. Still, Dr. Golab thinks the guidelines can be used to provide guidance for privately owned hospice facilities. Regardless of the setting, veterinary participation is a must for any legitimate hospice, she explained.
"Hospice goes beyond providing a mechanism to administer fluids on a regular basis to the animal that has kidney failure. It's not just about prolonging an animal's life—it's about making sure that animal's quality of life is good. That means there's a professional checking on the animal on a regular basis, and if there's pain control or other intervention that's needed, they'll do what they can to be sure it's provided," Dr. Golab said.
Concern over the potential to corrupt the pet hospice concept pertains to a lack of regulation. Pet hospices, unlike human hospices, don't need a license to operate. Moreover, no state veterinary practice act specifically places hospice within the purview of veterinary medicine. So, anyone can offer pet hospice. It's not the veterinarians who worry Dr. Patronek; but rather, it's the individuals who could use hospice as a guise to hoard animals and those unable or unwilling to give terminally ill pets palliative care. "Done right, hospice is a noble effort. But done not so right, it's torture," he said.
Evidence of abusers of the pet hospice concept is hard to come by, but that doesn't mean abuse can't or doesn't happen. Kim Intino, director of animal sheltering issues for the Humane Society of the United States, isn't aware of any cases specifically relating to "hospice hoarders" but wouldn't be surprised if they're out there. Identifying any kind of hoarder can be difficult to do since, on the surface, so many of them lead normal lives. Also, they tend to be especially adept at garnering sympathy for themselves because of their work, making their hording operation that much harder to expose. "A lot of our information on hoarding is anecdotal; it's based on experience and there's not a lot of hard research," Intino explained.
In 2006, a man operating a home-based hospice in New York for sick and geriatric animals had his 85 cats and dogs seized amid allegations the animals lived in inhumane conditions. Ultimately, the man, who said he did not believe in euthanasia, was not charged and the animals were returned. In addition, Dr. Patronek recalled an encounter with a hospice provider whose idea of a good death was letting the ill animal die on the bed between her and her husband.
"Hospice isn't the place for someone who just wants to hug dying animals," Dr. Patronek said. Terminally ill animals require almost constant attention, and hospice provision requires ongoing assessment of an animal's condition, pain control, and, if necessary, euthanasia. "You may know a dog's dying of bone cancer, but there's still a lot of diagnosing and treating that needs to be done in the context of appropriately managing a patient at the end of its life that I don't know how you could do as a layperson," he said.
At Angel's Gate, a nonprofit pet hospice with two locations in New York, founder Susan Marino understands the demands of caring for dying animals. "It's not a job where you close the doors at 5 o'clock, and you go home and have a nice dinner and enjoy your family. It's a 24/7 commitment and not something people should take lightly," said Marino, who started the hospice some 15 years ago.
Even though she was a pediatric intensive care nurse, Marino got her veterinary technician license so she could better help the animals in her care. Marino works with area veterinarians, and the staff at Angel's Gate includes another full-time veterinary technician, a groomer, a person who provides enrichment for birds, and a bevy of volunteers. She believes hospice providers should be trained and supports the licensing of hospice facilities. "I would encourage it. I hope, eventually, it happens," she said.
Kathryn D. Marocchino, PhD, president and founder of the Nikki Hospice Foundation for Pets, a nonprofit organization that promotes pet hospice, says Angel's Gate is a perfect example of how a pet hospice should work. Conversely, Dr. Marocchino acknowledges that certain individuals drawn to offer pet hospice may mean well, but they can end up harming the animals they want to help.
"I'm sure there might be some misguided people out there who might say, 'I'd like to start a hospice for pets,' and they're doing it without veterinary participation, which is frightening. This is something that's going to have to be regulated in the future, otherwise, you're going to have a problem," Dr. Marocchino said.
Whether states will require pet hospices to be licensed remains to be seen. There is certainly a desire for greater leadership in a largely undefined area with the potential for animal abuse. Dr. Marocchino would like to see the AVMA or an organization dedicated to veterinary hospice lead the way. As for Dr. Patronek, he thinks the AVMA should identify those components of hospice that only veterinarians can provide so state veterinary boards can look at the issue for themselves.
"We're upset about nonveterinarians doing teeth floating, dentistry, chiropractic, and any number of other things that probably don't involve the level of comprehensive care that hospice does," Dr. Patronek said. "On pet hospice, I think we're asleep at the wheel."