THE END OF LIFE DECISION
A couple weeks past I was riding my scooter, on my way to an appointment. A man seeing me, waved me down. He introduced himself and said, I hear you work with dogs. I explained to him that I am a Behavioral Consultant and yes, I work with animals. Mr. Cunningham explained that he had a Wirehair Terrier, Murphy, who is very ill. He asked if I would come and take a look at him. I, very clearly, let Mr. Cunningham know that I work with the behavior of dogs, not the health of the dog. I am not a veterinarian and I do not do the work of a vet. Understanding that, Mr. Cunningham again asked if I would come and meet Murphy.
Murphy is a beautiful brown with a large amount of grey throughout his coat. He is 16 years old. His flanks are concaved, his ribs are showing, there is virtually no meat on his pelvis, and his back legs are very unsteady. Three years past he was diagnosed with kidney failure and was placed on a protein free diet. It was hoped Murphy could live another year or two. He has now lived three years longer than his prognosis, but after his blood exam in December, he was given three to six months. He is hard of hearing and his sight is not the best. He is also diagnosed with dementia. He will not lie down to rest until he is worn out and his legs cannot hold him up. He paces hour after hour. The problem is that his brain no longer tells him to lie down. He has lost that function of the brain. In spite of his health Murphy seemed to have more good days than bad, until this last week.
When I entered the house Murphy came right to me. I don’t know how aware he is but he seemed to relax as I petted him. He stood for a few seconds then walked away and continued his pacing. With tears in his eyes, Mr. Cunningham talked about Murphy’s history. Murphy was gotten from ARF as a puppy, and has been loved all these 16 years. Murphy has been a faithful, loving, affectionate companion. “He has been the perfect family pet.” I offered no evaluation and felt my place was to let Mr. Cunningham talk about his one-in-a-million, four legged, family member. I knew Murphy was living his last days. I gave my card to Mr. Cunningham and told him to call me any time if he needed to talk or if Murphy took a turn for the worse. I then left with a very heavy heart.
Mr. Cunningham lived just three blocks from me. As I rode past his house I would stop just to see how Murphy is doing. He remained pretty much the same, no better and no worse. This last Monday morning, early, my phone rang. It was Mr. Cunningham. I could tell immediately he was crying. “What’s wrong with Murphy?” I asked. He proceeded to talk about Murphy deteriorating in health. I told him I would be up in just a little while. Again, my heart was heavy.
I began my day and went to Mr. Cunningham’s home about an hour later. Both Mr. and Mrs. Cunningham were in the back yard with Murphy. Murphy, sensing I was there, came to me. As I scratched his chest he stood there, but it was obvious he was looking at me but not seeing me. I sat in silence for a few minutes, and then the silence was broken. “I don’t know what to do, Jim. When I think I should call the vet and put Murphy to sleep, then he’ll do something normal and I don’t think he is as bad as I thought. How do you know when to he needs to be put to sleep? I need someone to tell me what to do.”
“Mr. Cunningham, I can’t tell you what to do, neither can your vet. I do believe you will know. Murphy is sick. He is not going to improve, but you and Roberta need to make that decision together.” Mrs. Cunningham said she felt it was time, but Bob just can’t let go. I raised the question of quality of life. They talked about Murphy’s quality of life not having much quality and, “We know that is hard on Murphy.” Then I said, “I am not talking just about Murphy’s quality of life, but your quality of life.” I talked about the amount of guilt in these end-of-life decisions. We discussed how dogs completely depend on us to resolve their issues, take care of their health, their shelter, food, all of their needs. Now, at the end of life the dog depends on us to read the signs and make the right decisions. We often shrink from that responsibility because it is so painful. I said, “At this moment it is not about you making the decision, I think is about you giving yourself the permission to make the decision.” Mr. Cunningham said “I give Murphy permission to give up often. “Murphy doesn’t believe you,” I said. “I believe our dogs often do not give up the fight because he is still doing his job of caring for the owner.” This often happens with humans in the end-of-life days. Another question I felt Mr. Cunningham had to answer was if he was hanging on to Murphy for Murphy or himself. Mr. Cunningham said, “He will often come to me and just stand there looking at me and I wonder, “Is he trying to tell me something? Maybe he is telling me he wants to quit the fight and I’m not listening.”
While we talked Murphy’s back legs gave out a couple of times. We talked about how dogs will not show pain, that it is instinctual. I told them about my brother’s dog who was hit by a school bus. Buddy’s leg was severely damaged. He did not express pain, even after his leg was amputated. The last thing I felt needed to be said was, “The burden of guilt mainly comes because we think that we are doing something “to the dog” rather than “for the dog.” I think that thought gave Mr. Cunningham a new perspective of the situation. Mrs. Cunningham said, “This is the last dog we will have. I can’t do this again.” I didn’t reply as I understand that feeling. That feeling may change later and it would be inappropriate, foolish, and unfeeling to challenge that expression in a time like this.
“I would like the vet to come here to put him to sleep,” said Bob. I affirmed that and if his vet couldn’t or wouldn’t do so I know a vet who will. He called his vet and left the area to talk to her. I don’t know what that conversation was, but he was on the phone for about ten minutes. Mr. Cunningham returned to ask his wife if Thursday afternoon, 5:30 would be alright. Now each of us had tears in our eyes. They agreed that the time would work. It was a solemn moment. I reminded them that God cares deeply about their pain and weeps with them in this heart crushing time. To try to lift the moment I said, “You know, God was asked, one time, why he created the dog. God said, ‘I didn’t. I already had one.’” I told them that it is in keeping with my theology that dogs will be in heaven, and someone asked Billy Graham that question. Billy Graham said, “God knows what will make me happy in heaven and if that includes my dog, my dog will be in heaven.” I believe that, and I comforted my daughter when, as a child, our family dog died. I told Mr. and Mrs. Cunningham I would plan to be there with them Thursday. I then, with my hands on Murphy, said a prayer. With a heavy heart I excused myself.
That afternoon I called Mr. Cunningham and asked if I could run up for just a minute. I have CDs of music from Through a Dog’s Ear. There is one titled, “Calm for Elderly Dogs.” I explained how to use the music over the next couple of days. I also suggested that 15 minutes before the vet’s arrival that Murphy can be made comfortable and play the music which will insure he is relaxed and leave this world with an environment of love, calm, comfort, and dignity. With that, and the assurance that I will be there with them Thursday, I left.
Today, Mr. Cunningham called and asked me not to come to be with them this afternoon. He said his children called and wanted to be there and he asked them not to. He and Roberta wanted this to be a private time. In asking the children not to be there he felt he should call me and make the same request. I assured him that he did not need to explain, I understand completely. He thanked me for the use of the player and the CD, “Calm for Elderly Dogs.” He later told me the night before they put Murphy to sleep, they played the music, and it was the only night, for weeks, that he slept all night. They began playing the CD 20 minutes before the vet arrived. The music did what it was produced for, and relaxed Murphy. Murphy, very calm and relaxed, passed very peacefully.
This is one of hundreds of stories involving the end of life of a families pet, be it a dog, a cat, or a horse. For most of us our pet is a family member. We say they are like one of our children, and the fact that dogs retain their neotney, we are not far off. People often compare the death of a pet with the death of a child. I can’t fully explain the connection humans have with their dogs, but the bind is both relational and spiritual. We develop oneness with our one-in-a-million dog. The means by which our beloved pet is taken will vary, but that bond is strong. The story about Murphy is about our adored pet becoming terminal and having a lingering illness. As time goes on it is understood that the prognosis is dismal and the illness will most likely take our beloved’s life. Murphy developed multiple maladies, any one of which was terminal, but together left him with no hope and very little time.
Now, my friends were faced with an excruciating decision. It is a heart wrenching process. We wrestle with our emotions. Is it time? How do I know? Just when we make the decision he does something a normal dog would do. We question our self. Maybe he is not as bad as I thought. Maybe I am rushing things. He is not showing pain. We go on and on rationalizing, explaining away, hanging onto hope, not wanting to let go because of a mixture of love and guilt. We vacillate between denial and acceptance. We ask, “How do we reconcile the end-of-life decision with a loving, caring act?”
The hardest step in this decision process is the step we have to take beyond the emotional self. It is natural to want to do everything to keep that life with us. This pet has been a part of our life, our family, for five, ten, eighteen years. He has been there when I leave and excited when I come home. This dog has comforted us in bad times, shared our joyous times, and aided our healing when we were sick. He goes to get my socks, picks up what I drop, and picks up and puts away his own toys. I can’t imagine a day without him. I just can’t let go. The very first question we have to ask and answer is, “Am I keeping him alive for ME or for HIM/HER?” There is a point at which our caring becomes selfishness rather than consideration for the suffering our beloved pet is experiencing. I don’t say this judgmentally, but understandably. However, it is our pet that is physically and emotionally suffering. How do we get beyond our self and our grief so we can make that final decision to end his/her suffering and life? After all, our dog has depended on us for everything, and is now depending on us, to do what it cannot, to make his/her end-of-life decision. None of us feel up to this, but we cannot delegate this to someone other.
As a behavioral consultant I am often asked to tell the owners what to do. I never take that responsibility upon myself. I always refer to the owner’s veterinarian. The vet will address the medical issues, but unless the animal is showing suffering or he/she is dying on the table, the vet will help the owner to be fully informed, but the final decision has to come from the owner. In the long run this is the way it should be. If I have to look back on the death of my beloved, one-in-a-million dog I don’t want to reflect on someone else making that decision. When I took her into my home and family, I accepted the full responsibility for her, including her end-of-life needs. She trusts me for everything, including this, and as excruciating as that will be, it is mine and my wife’s decision to make. There are helps and considerations that will help me know when it is time to say, “Goodbye.” Hopefully, this will help you.
As a former pastor and therapist, I have been involved with hundreds of end-of-life experiences. Often a parent, a child, or mate, lingered because the grieving of the family made it difficult for the dying person to take that last breath. Many times I have talked to the family that perhaps it would be helpful if they gave their loved one permission to give up the fight. Other times it was the ill person giving the family permission to let them go. I remember the child who told his parents it was okay to let him die because Jesus was standing near to take him to heaven. My personal rules were, 1) I would never intimate, suggest or direct a family to make the end-of-life decision. 2) It was my place to stand with, support and affirm those who needed to make that decision. 3) I would never intimate, suggest, or direct how or how long one should grieve loss. For me, I would never get between one’s doctor, the family, or the patient. I carry that protocol with me into my animal behavioral career. This is one reason one’s veterinary is a part of my team building. These emotions are very complex and deep, these times very difficult. But this time can be a blessed time as well. If you have never read, Merle’s Door, by Ted Kerasote, I highly recommend it to you.
When I have had an owner ask me how they will know when it is time, I often say, “He will let you know.” I believe, many times, this is true. In the story above, Murphy would come and just look into the eyes of his master. The old Murphy had already left. What was he trying to say? What was he asking? Many times Murphy would go to another room by himself. He would pace for hours, as if he had someplace to go, but couldn’t leave. An animal cannot understand what is happening to his body. How much money and emotion are you prepared to spend just to give him a few more months with you? Our Nekayah had a Mast Cell Tumor on her leg. We spent several hundreds of dollars to have it removed. Chemo was recommended as a precaution. When the process was explained to us we could not bring ourselves to put her through those months of suffering. We have now had three years more with her and, as far as I know, she is doing fine. Did I make the right decision? At the time I wasn’t sure, but I had to gather all the information and my decision had to be one informed. My head said, “Maybe.” My heart said, “No. Don’t do that to her.” I’m glad we made that decision. Medical procedures may extend a life, but to what kind of life?
There comes that time when we have to stop wrestling and vacillating with the inevitable decision and bring it to a conclusion. The essential question we have to ask and answer concerns one’s quality of life. Certainly the quality of life for our beloved pet, but also the quality of life of the owners. This is often forgotten. Consider these,
- The family has to take shifts, one stays home while the other leaves for needed errands.
- We takes shifts during the night.
- We are exhausted each day.
- We can’t eat, our hearts are so broken.
- Vacation is postponed or put off all together.
- It is hard to impossible to have friends over.
- What finances are involved (vet visits, medications, treatment)
- We can’t agree on what to do, it’s hurting our home atmosphere.
Loving owners don’t want to be selfish and relegate their pet to a financial decision, but all of these factors have to be considered. It is never selfish to rationally ask the hard questions, and to honestly answer them. If you are not taking care of yourself physically and emotionally, you cannot care for your sick pet well. The quality of life for you, the owner, has to be considered. There are times when our grief is so expressive that it is hard for the pet to let go. His job, for all these years, has been to take care of you. We can add to our pet’s weakening condition by making his letting go more difficult. There are things we can do to help us comfort our self.
During this time of our beloved pet’s weakening, one thing that could help is to begin a pictorial album. Allow him/her to live again by arranging the album from puppyhood to his/her senior years. Caption all the photos and laugh and cry together. Write a daily journal of his/her daily progression. Note the things he/she was able to do, but how each day is taking its toll. Both of these activities will help you stay clear in the decisions you have to make. Bring in a “baby sitter” so you and your mate can go out together. You need to take time for yourselves and step out of the emotional environment in the home. It’s okay. Give yourself permission to step away for a few hours or a day.
Murphy loved car rides. No matter how sick he was, if he could go for a car ride, it made him feel good. Does he/she love ice cream? What about a cheese burger? Maybe a peanut butter pop cycle? Ice cubes? When you think you can’t do anything for him/her and you feel helpless, perhaps there is that one thing that will make you both feel good. Fix a place for him/her with those favorite, soft blankets, a soft bed, perhaps her bed. If she will be immobile for several days the softness will prevent soars. Place her water nearby. Place near him/her the favorite 2 or 3 toys, and a favorite chew. He may be too weak to interact with these, but he knows they are there.
You will want to check him/her often to see if she is becoming incontinent. He/she has not peed in the house for years. This can be very stressful. Have some diapers available, and reassure her it is okay. If he/she can still move around a bit, you can make a sling out of a towel and help him/her go outside.
Here are some factors you can consider in determining quality of life.
- Is “Marley” irritable, restless and/or confused?
- Perhaps “Marley’s” appetite has decreased or is lost. Is “Marley” drinking less water, or drinking water excessively?
- If there are other dogs in the home, are these attacking or picking on “Marley?” Very often this happens when one becomes the weakest in the home. It doesn’t mean the others are cruel. Do not punish, but mange. It is a natural behavior in the wild.
- Does he/she go off alone? Maybe removes himself and goes off to another room?
These are signs of a deteriorating life due to untreatable conditions or aging. These are ways in which the dog is “telling” its owners that its quality of life is vanishing.
What about pain? How can we tell if he/she is suffering pain? This is a little more difficult because animals hide their pain. In the wild an animal doesn’t show pain as that signals being a weak one in the pack.
- Has he/she begun to snap at you when you touch him/her in a certain area? This has never happened before. Well, he/she has not just become mean. This is information that there is pain in that area.
- Are certain activities avoided? Jumping up on the bed, catching a ball, or turning his/her head. These can be signs of pain. Maybe he/she won’t lift the paw and put it in your hand. Don’t make or coax these behaviors if he/she is avoiding them.
- Perhaps he/she has become reclusive. Often an animal will go off by itself to suffer or to die.
- He/she may not eat the same diet. Kibbles can be too hard to swallow. Softer food and less may be the new diet norm.
Every new sign of deterioration will be painful to watch. One thing that might help is, again, to journal what is happening. Write how this makes you feel. Do not hide or bury how you feel inside. To do so will not take your pain away, but if you pent-up all that grief inside it can cause you to become ill (or snappy). Watch your pet as irregular patterns of behavior are often the first signs of illness and pain. No one knows your pet better than you and these things are telling you something is not right. Make an appointment with your vet.
Grief is a very real emotion and a natural response to loss. I do want to mention, so you will be prepared, not everyone will join you in your grief. There are those who will say, “It was just an animal.” As insensitive and ignorant as these may be, I don’t believe they are trying to be cruel. They just have no understanding of how deep the human/animal bond is. They have missed out on this wonderful, joyous, experience of life. They will never understand and I will not waste my time or theirs trying to explain my grief. To do this will only result in one’s feeling worse.
Grief is the healing process that helps us accept and live in our new normal. In the Peanuts cartoon series, Charlie would often exclaim, “Good grief.” It doesn’t seem like it when we are going through it, but grief is good. It says a lot about you and it says a lot about your beloved pet. It speaks to your deep love, connection, and attachment to that which is lost. I will recount the grief process here.
These are the familiar five stages of grief identified by Elizabeth Kubler-Ross in her book, Death and Dying. Robert Kavanaugh, in his book, Facing Death, expanded these five stages to seven. I refer to these seven stages in my counseling because they allow for more inclusiveness to the process of adjusting to loss and transitioning to one’s new normal.
- Shock & Disbelief
- Acceptance & Hope
Regardless of the model, remember, these are not a fixed sequence. A person may shift up or down in these emotions. The important point to make is that there is no fixed way a person is to grieve. There is no fixed time for one to grieve. There is no fixed resolution or new normal for one’s grief. If you get “hung-up” in one of these stages then talk to someone. Here are some suggestions that can help us heal.
- You can have a memorial service for your pet. I am an Animal Chaplain. I have held a memorial service for horses and dogs while I was in Law Enforcement. Some people may think this is silly because “it’s just an animal.” So, don’t invite them. Invite those who love and understand you.
- Make a scrapbook to honor the life of your beloved pet.
- Write a poem or a letter, or a song for your pet.
- Volunteer your time at an animal shelter.
- Make a donation to ASPCA or local shelter in your pet’s name. Include his/her bio.
- Plant a tree in your pets name on your property.
- Make a collage of your pet’s name, collar, tags, toys, blanket, etc.
- Have a special memorial urn for your pet’s ashes.
- Locate and attend a Pet Loss Grief Group. In my area we have a group called, HEAL (Healing Every Animal Loss). Each of us that lead this group are professional therapists and we want a person to come and share their story, pictures, and the loss of their pet. Some people come who are preparing for the loss and others come who have already experienced their loss.
- If you do not have a grief group in your area begin talking to others who have a heart like yours and begin a Pet Loss Grief Group. Research, find and talk to others who have begun a group, gather information and form a group. You will honor your pet and you will touch the lives of others who are grieving.
Many times a person will say, “Never again. I will not have another pet.” I never answer this. They may or may not, but at that point this is a real feeling and there is no right or wrong. Once the person has worked through their grief this may change. My only counsel is not to think in terms of getting another dog just like “Marley.” Some people, in their grief, may run out and buy two or three dogs to fill that void inside. Because I did this one time, I do try to guide this if possible. However, the person needs to do what is right for them.
“How do I know when it is time?” I don’t know how to answer that, because your situation is unique. But if you have read this you will have more information to help you make an informed decision. Deciding what to do is agonizing. Actually deciding the how leaves you feeling guilty. You can’t explain your decision to “Marley,” so you feel like a murderer. And when it is “that time,” you hope “Marley,” or God, or yourself, will forgive you. Hopefully you will know it was for “Marley’s” best and that your decision, as painful as it was, it truly was for him/her.
It is normal for owners, in this situation, to feel they are doing something “TO” their beloved pet. If that thinking can be shifted to knowing you are doing something “FOR” your beloved pet the guilt will be minimized, leaving you to deal with the pain of your loss. Remember again, your pet has to trust you to make these decisions for him. You have to protect him from further sickness, further pain, and further suffering. When we took him/her into our home, our family, and our hearts, this was part of the unwritten contract. To make this end-of-life decision is not a nefarious act. As excruciating as this is for any of us, you are doing the most loving and unselfish thing you can do. Making this decision is to give the ultimate gift of love to end your beloved pet’s deterioration and suffering. As you have been faithful to each other for all these years, you are being faithful this one last time.
I would like to write about after the death of “Marley.” It would take another paper the length of this one. I will say this, I do not believe that love ends. I believe as Billy Graham said, “God will provide our every need in heaven. If God knows our “Marley” is needed for us to be complete in heaven, then “Marley” will be in heaven.” I believe this is included in that “hope,” which is the seventh stage in the grief process.
Someone asked God, “Why did you create the dog?” God said, “I didn’t. I already had one.”