23 Feb 2015
Susan Gregersen
Job Title
Indianapolis is the heartland of the United States and, with compassion at the forefront of the work done by the 140 veterinary professionals and support staff attending the fourth International Association of Animal Hospice and Palliative Care conference (IAAHPC), an apt destination.
Most delegates had travelled from around the US and Canada to meet leading practitioners and academics dedicated to offering specialised veterinary care to families facing the emotional end of a pet’s life. Maybe the choice of location was to blame for the UK representation – the British delegation consisted of two veterinary surgeons, including myself. But the 20 hours of travelling time was more than worth it to meet our pioneering North American colleagues for networking opportunities, lectures, round-table discussions, workshops and upwards of 26 hours of CPD in end of life care work. The conference was a well-rounded meeting of the some of the best minds in the field.
The IAAHPC’s mission is to promote hospice/palliative care for animal companions as an alternative to premature euthanasia and as an alternative to prolonged suffering, which can result either from isolating an animal in intensive care or from inadequately treating the animal at home. The emphasis is on the terminally ill animal’s quality of life and recognising hospice/palliative care gives family members precious quality time with the pet, and helps them cope with the approaching death of their beloved companion.
Tthe IAAHPC is dedicated to promoting knowledge of, and developing guidelines for, comfort-oriented care to companion animals as they approach the end of life. As in previous years, its annual conference gathered professionals who are involved in the growing industry of end of life animal care. It is overwhelmingly represented by vet colleagues operating mobile practices throughout the US and Canada (around 80 per cent of the attendees). The rest are support staff in either pet loss and bereavement, pet aftercare services or non-veterinary based hospice care.
The recent emergence of an online directory of veterinarians offering in-home pet euthanasia (with or without hospice care) in the US and Canada is a direct reflection of the growing demand for this type of specialised care. According to Kathy Cooney, directory manager, educational chairman, then vice-president and president-elect of the IAAHPC, more than 210 such services are listed in the directory, with more added each year.
After the IAAHPC conference in Denver last year, I was fortunate enough to spend a couple of days with Dr Cooney at her practice adjacent to the Rocky Mountains. She’s an innovator in this field and, in 2006, founded an instantly successful speciality vet practice in Colorado, solely offering in-home euthanasia. Mirroring recent human hospice advancements, her practice has added in-home animal hospice care, a fast-emerging field that reflects the changing demands of clients, plus a private practice-based eco-friendly pet crematorium. A visit to the manufacturer was included as a field trip at this year’s conference.
Dr Cooney repeated the success of last year’s euthanasia laboratory, teaching various techniques on cadavers brought in from the local ASPCA – an unusual scene in a four-star hotel, but one that recognised an important topic sparsely taught at university. Many road stories – good, bad and ugly – were shared by the attendees while they significantly improved their skills in this challenging procedure without the intimidation and worry of sad and emotional clients being present.
Hospice care originates from concerns about the poor quality of care for terminally ill and dying human patients during the mid-to-late 20th century. In many aspects, animal hospice care leans on substantial extrapolations from the human equivalent. But in one major area, of course, it’s completely different: as vets we are granted the special privilege of giving an animal a planned death through euthanasia, which is at our disposal when patient comfort is compromised and no longer possible.
When introducing this speciality of animal hospice to the UK, it must be stressed that, despite the direct links and similarities to human hospice philosophy, animal hospice is most often (but not always) carried out in the pet’s own home and, most importantly, with the end goal not necessarily being a hospice-assisted natural death, but, more often, an actively assisted peaceful death by means of euthanasia. These two final outcomes of hospice care (euthanasia versus natural death) are diametrically opposing positions. They represent a spectrum of views held by members of the association and the profession alike, and the inherent controversy inspired an ongoing and lively ethical debate, hopefully to be openly continued.
“Hospice care is about giving patients and caregivers control, dignity and comfort during the time they have remaining to live. Importantly, hospice care offers spiritual support to caregivers and accommodates their beliefs about death and about afterlife as much as possible”(adapted from the IAAHPC Guidelines 2013 – see www.iaahpc.org ).
Animal hospice and palliative care helps caregivers of ill or dying animals ease into an acceptance of death, provides time for them to adjust emotionally to the loss of their animal, and reduces the stresses arising from end of life decision-making and care.
Palliative care and hospice care are two separate concepts, although they are frequently confused and are used interchangeably because of their significant overlap. Palliation is defined as “relieving or soothing the symptoms of a disease or disorder at any stage of an illness”. Palliative care is of special significance in the context of terminal illness and end of life care. However, research has shown palliative care expedites recovery from illness, making it an important component during efforts to cure a patient’s illness.
Many of the vets who attended IAAHPC operate mostly mobile services, providing general, as well as at-home, palliative and end of life veterinary care for pets and their owners. It is our shared experience if we didn’t provide these services, owners might leave their pets unaided and under-medicated due to various practical or psychological obstacles at a highly emotional time where decision making and finding options can be a difficult and time-consuming exercise – in particular, within the constraints of normal vet practice.
With the support of colleagues through the IAAHPC, the upcoming proposed animal hospice certification programme and the publication of Animal Hospice Guidelines in 2013 (see www.iaahpc.org ), it is possible to streamline and grow more uniformly the services offered to clients at this seminal time of pet owner- ship, while knowing there is a general professional consensus as to the level and extent of supportive professional services being offered.
“The broad spectrum of knowledge we gained, as well as the opportunity to network with other end of life vets and pet care professionals doing exactly what we do, truly made the conference a huge success, especially coming from the UK where this field is largely overlooked at the moment,” said Caroline Ficker, The Home Visit Vet and only other UK representative at the conference.
I met Caroline at last year’s conference in Denver, Colorado. She is an Australian, ex-pat vet who has been treating pets at home in the London area for almost 10 years. We had very similar views and aspirations on moving this under-exposed area forward in the UK. It was obvious we, and a few other professionals in the UK, had been working in isolation to try to raise awareness. It is our hope to continue to bring the successes and experiences gained in the US to the UK and bridge the gap of expertise in this field.
It is obvious the US is leading the way in this field as more veterinary professionals are realising the vast gap in compassionate, but professional, services available to clients in the period from being given a terminal diagnosis or managing difficult old age to the time of being ready for euthanasia.
Affording this highly emotive time of an animal’s life far more attention is becoming not just good practice, but also very sound business, as is reflected by the recent explosion in the US in available vet services, franchises and nationwide services.
“I am thrilled to see the excitement and thirst for learning when it comes to this topic of animal hospice,” said Dr Cooney. “Each year, more veterinary professionals and other pet care associates are looking for exactly the information we are presenting at these conferences. These professionals are hearing the pet parents in their communities and are responding to their requests for services like animal hospice.”
Amir Shanan, founder of the IAAHPC, referred to its first conference four years ago and has seen significant attendee growth since then.
“It was an overwhelming success,” he said. “And here we are today, vastly increasing our attendance at these meetings every year. This is confirmation for us that palliative care and pet hospice business practices are seeing a tremendous growth in awareness and interest.”
At this year’s conference we were educated in various elements of animal hospice, including a full day of business-related topics for the budding animal hospice practice. Topics across the four days included:
There is no doubt this less technologically appealing, and – some would say – sub-academic field of animal hospice, has been less attractive than other more high profile aspects of veterinary medicine, leaving behind the compassionate and human-animal bond-based aspects of vet practice.
With large end of life practices or franchises such as Lap of Love, Pet Loss at Home (nationwide) and Home to Heaven (Dr Cooney’s multi-vet practice) leading the way in the US, these growing practices are paving the way to balance the technology focus of veterinary practice with this softer, but equally important side of veterinary care. It is worth noting this gentler approach is also leading to some very hard results, as the growing success and number of US-based end of life practices clearly demonstrate.
The IAAHPC has set its annual conference for October 2015 in San Diego and welcomes anyone interested in joining this small, but growing niche of end of life care. High on the agenda in 2015 is developing the knowledge base and having a hospice certification programme approved within the next couple of years.
The specifics of the conference will be available on the website at www.IAAHPC.org
For more information on animal hospice services in the UK, please contact IAAHPC president Dr Cooney, at [email protected] or Susan Gregersen at [email protected]
Euthanasia laboratory 2014 at the Hilton Indianapolis, with Kathy Cooney (second from left in photo on the right), then vice-president of IAAHPC.
The author says attendees significantly improved their skills without the intimidation and worry of sad and emotional clients being present
Top: Dinner at the bio-response eco-cremation manufacturer. Above: (from left) Kathy Cooney, Alice Villalobos, Amir Shanan and past-president Coleen Ellis.
