The word hospice comes from the Latin words hospes meaning ‘host’ and hospitum meaning ‘hospitality.’ In the fourth century ad, Fabiola opened his home in Rome, providing respite for sick, weak and destitute pilgrims. This was continued through the Middle Ages for travellers who were ill and either had no family or couldn’t afford care. They died at ‘hospices’ run by religious foundations.

The first modern hospice as we know it was built in London and based on the philosophy of providing relief for all physical, psychological, social and spiritual pain. The first Canadian hospice was created in 1974, but it adopted the term ‘palliative care.’

Modern hospice care has morphed into a coordinated program utilizing professionals and volunteers for improving the quality of a patient’s last days. The primary goal is adequate pain control, but it also provides support to both the patient and the family.

Once hospice became established, it was inevitable that a corresponding interest in pet hospice would develop. Some hospitals wanted to offer hospice alongside traditional (immediate) euthanasia. For this reason, the First International Symposium on Veterinary Hospice Care occurred in March 2008 in California. The speakers talked about the advent of hospice and its incorporation into the veterinary world.

Like its human counterpart, veterinary hospice exists to manage rather than cure a patient’s terminal illness. At the same time, it prepares the caregivers for the end of the patient’s life. Unfortunately, virtually no books or publications have been written to train veterinarians in hospice care. However, much has been learned from experiences in human hospice and it begins with an understanding of the dying process. Without this background, we are bound to miss what qualifies for a peaceful passing (see sidebar opposite).

Many factors affect the decision to choose hospice rather than euthanasia. One of these is the owner’s personal fear of dying and the assumption that dying means suffering. Some people also look at dying as the culmination of an incurable disease rather then a natural endpoint to life.

There are financial and time considerations, as well as the caregivers╒ physical or emotional inability to care for a pet’s needs. There are also recommendations from people who do not have the same bond with the dog. They may voice their views as, “Don’t you think it’s time?” not understanding what the owner knows about their four-legged companion.

In some cases, the dog might have a physical disability that he accepts, yet to the owner, it is horrible. In these cases, it’s important to recognize the options. For example, consider a dog with hind-leg weakness. One of the speakers at the symposium suggested that this type of incapacity can be addressed by conventional techniques and providing firm, non-slippery floor surfaces to help weak muscles. When they fail, acupuncture can be considered. As well, some owners of paralyzed dogs consider customized carts and slings.

Another common issue in caring for dogs at life’s end can be fecal and/or urinary incontinence. This can sometimes be treated or managed with incontinence pads.
The decision to manage a dog with special needs depends on the caregiver. In contrast to human hospices where care is offered by the family, there are few owners who commit long-term to the needs of these dogs.

However, the overriding concern of most dog owners, and what often leads to euthanasia, is whether their animal is suffering. But, defining ‘suffering’ is difficult. It is also highly individual. Dogs may have a certain level of pain yet not want to die. Some tolerate it differently than others, which is also what we see in people.

The thing to remember is that dying by itself is not a painful process and many diseases do not generate pain. However, some do and it must be recognized and controlled.
Many medications are available to ameliorate pain, ranging from tablets (non-steroidal analgesics) to pain patches and injections. Pain management can sometimes be enhanced through holistic modalities. All these treatments aim to increase the dog’s comfort level.

A commonly asked question by people with dogs in their final days is, “How much longer does my friend have to live?” Just like human hospice, a valid prediction is rarely possible until very close to death. To many unfamiliar with the process, it takes a long time, but this is partially due to what we see on television. It takes time for a body to shut down completely.

If you have a dying friend, spend the little time you have left in a calm and quiet environment. Dogs in this stage of life can be startled by sounds and are sensitive to bright light. Remove food, as the smell can be nauseating. Touch, although desired by the caregiver, may not provide comfort to a dying dog in the last minutes or hours of life.