End of life, dying, and death are often difficult subjects for most family members. The subject of end of life is no easier when it comes to our pets because they are often the best of friends and integral members of any family, no matter what that family looks like. Hospice care focuses on the care, comfort, and quality of life of a beloved living person or animal, who has been diagnosed with a serious or life-limiting illness and is likely approaching the end of life. Conversations about a person’s end-of-life desires and the legacy they want to leave behind can be so difficult for some individuals, as well as their family and friends, that discussing the eventual end of a pet’s life is not really easier, because it brings about triggering feelings regarding past loss, anticipated grief, guilt and a sense of responsibility as the animal’s advocate and best friend.
When a beloved pet or person is diagnosed with a life-limiting condition or illness, understanding how much time a patient has left and deciding how they will choose to spend it can be difficult to navigate. Often pet families particularly are frustrated by the lack of ability to anticipate their pet’s needs. For friends and family members — especially for young people who may have never experienced a death in their family — understanding what happens when anyone they care for is approaching the end of life, can be especially confusing and challenging.
Why is this? Well, when we broach the topic of death, we’re forced to confront our own mortality and come to terms with what will happen to our bodies when we die. But when we face the death of a loved one, we’re confronted with a different set of challenges. Sometimes knowing that “we are doing the right thing” and “standing strong” for a pet is important to a pet caregiver. Sometimes the presence of a pet is associated with a beloved person who has already passed away—and the pet’s mortality is another reminder that they aren’t here. Sometimes death is long expected, and a pet’s family must work through a complicated process of anticipatory grief. The family member(s) or primary caregiver has to evaluate their own quality of life if managing a pet’s illness in the home. Sometimes death is swift and certainly no less traumatic.
Fear of death is the second most common fear in the United States. Second only to public speaking. Often people don’t realize that the fear they may have of death is more a fear of suffering and pain.
No matter how someone dies, we each find different ways to grieve the loss of a loved one. Sometimes, we have to handle all the logistics around a pet’s complicated illness—at other times the family must all agree on how to honor their pet’s memory during death’s aftercare process. There is often an understandable challenge of dealing with the trauma when there is a hole left in the pet patient's family because of their loss.
While end-of-life, complex illness, and the dying process can sometimes be a complicated experience, having help along the way to manage a pet’s illness so that they are experiencing the highest quality of their day during the end-of-life process, and utilizing your veterinary hospice care team to hold space for you during your grief and to help you understand what’s happening can make the act of dying more manageable. That’s where having a palliative care plan, a veterinary hospice care team, and even an end-of-life doula can help.
Palliative care is specialized medical care for pets living with serious illnesses. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve the quality of life for both the pet patient and the family. Palliative care is provided by a specially trained team of DVMs, veterinary nurses, and other specialists who work together to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage of a serious illness, and it can be provided along with any curative treatment.
Palliative care teams focus on quality of life. They treat animals suffering from the symptoms and stress of serious illnesses such as cancer, congestive heart failure (CHF), kidney disease, cognitive dysfunction syndrome, liver disease, serious infectious diseases, degenerative joint or spinal diseases, and many more. The goal of palliative care is to relieve suffering and provide the best possible quality of each day for pets and their families. Tight symptom management may include medical or physical therapies to manage or alleviate pain, depression, fatigue, GI complications, nausea, loss of appetite, difficulty sleeping, and mild anxiety. Because animals cannot have their symptoms explained to them, we strive to balance this care with humane treatment options that cannot always include every treatment option that is offered in human palliative care. End of Life care is considered the humane course of action when a pet patient cannot breathe, experiences extreme anxiety, when a pet patient cannot receive adequate in-home care for their illness, or when a human being’s mental health and physical well-being is compromised by caring for their beloved pet.
Recent studies, including one published in the New England Journal of Medicine, have shown that human patients with a serious illness who received palliative care lived longer better lives than those who did not receive this care.
The palliative care team should spend the time it takes to help you match your pet’s treatment choices to your goals. This gives you more control over your pet’s care and will improve the family’s quality of life as they prepare for the end-of-life journey.
If your pet is facing a serious illness, they may benefit from palliative care. You can have palliative care at any point in your pet’s illness.
The American Veterinary Medical Association (AVMA) recognizes that clients facing terminal illness in companion animals may desire veterinary end-of-life care for their animals. As offered within the context of veterinary practice, and as consistent with veterinary practice acts, veterinary end-of-life care gives clients time to make decisions regarding a companion animal with a terminal illness or condition and to prepare for the pending death of the animal. The AVMA views veterinary end-of-life care as care that will allow a terminally ill animal to live comfortably at home or in an appropriate facility. The animal's comfort and quality of life must always be considered when veterinary end-of-life care is provided. The American Veterinary Medical Association (AVMA) recognizes that clients facing terminal illness in companion animals may desire veterinary end-of-life care for their animals. As offered within the context of veterinary practice, and as consistent with veterinary practice acts, veterinary end-of-life care gives clients time to make decisions regarding a companion animal with a terminal illness or condition and to prepare for the pending death of the animal. The AVMA views veterinary end-of-life care as care that will allow a terminally ill animal to live comfortably at home or in an appropriate facility, and that includes the option of medical euthanasia. The animal's comfort and quality of life must always be considered when veterinary end-of-life care is provided.
As is the case in human hospice programs, hospice is considered when an animal patient has a terminal illness with a life expectancy of months to days. The veterinary end-of-life care team must include a veterinarian and trained staff who provide expertise in palliative care and pain control for such terminally ill animals. It is desirable to include other counseling and care professionals, however, advice regarding veterinary care should only be provided by veterinary professionals. The AVMA and Highland Veterinary Clinic endorse the use of the 2016 American Animal Hospital Association/International Association for Animal Hospice and Palliative Care End-of-Life Care Guidelines.
Maximizing the benefits of veterinary end-of-life care requires that any family/household members attached to the animal participate in the care of the patient. Family-centered death care is the paradigm for people and animals alike.
End-of-life care staff should understand that when using the term end-of-life care, what is generally implied is the provision of palliative care (including medications) for the remainder of a pet's life followed by humane euthanasia if an acceptable quality of life can no longer be maintained. Often families and team members consider the questions and fine points provided by The Ohio State Guideline “How Do I know its Time?” the Dr. Villalobos Quality of Life Scale written by Alice Villalobos, DVM, DPNAP and renowned veterinary Oncologist, when considering whether humane euthanasia is to be pursued. This differs from the human hospice approach where euthanasia is not looked upon as an endpoint.
The respectful closure of each unique human-animal bond through end-of-life services can be time-consuming for some veterinarians with regard to the medical needs of the patient and the emotional needs of the client, and it is our job to also respect the choices and needs that families express when pet palliative care and hospice is needed. Referring a client for end-of-life care does not imply that excellent care is not being delivered by a referring veterinarian, but provides an option for those clients specifically desiring more comprehensive end-of-life care.
Birth doulas and death doulas function like two sides of the same coin. A birth doula is a trained professional who assists someone before, during, and after childbirth. They work alongside your healthcare team to provide emotional and physical support, education, and guidance to make sure you have a positive birthing experience.
Similarly, a death doula — also known as an end-of-life doula, end-of-life coach, death midwife, or death coach — assists a dying person and their loved ones before, during, and after death. An end-of-life doula provides emotional and physical support, education about the dying process, preparation for what’s to come, and guidance while you’re grieving. A death doula for pets holds space for an animal’s caregiver and family as their pet faces a challenging medical condition or where the end of life is imminent.
A death doula wants to do as much as they possibly can to help facilitate what the animal and their family need. Death doulas who work with pet families, make sure the threads are connected between the dying pet, their family, and their veterinary team
End-of-life doulas aren’t licensed to provide any medical assistance, but they may advocate for the dying person’s wishes--or in the case of animals, the family’s wishes—and the pet’s needs while working together with healthcare providers.
In recent years, as a result of the COVID-19 pandemic and the surge of related deaths worldwide, there’s been an increased interest in hiring end-of-life doulas to help those who were dying and those who were grieving. There’s also been an increased interest in people wanting to become licensed as end-of-life doulas.
In many ways, the core function of an end-of-life doula is to be present and listen to the needs of the person who’s dying, or the pet patient’s family, and the needs of those around them who are grieving.
The services offered by an end-of-life doula who works with animals could include a mix of the following:
Providing the opportunity to talk openly and honestly about the dying process.
Alleviating the anxiety, guilt, and shame often associated with death and dying, or caregiving of a pet patient.
Developing a plan for how the animal’s environment functions, looks, feels, sounds, and smells as they approach the end of life.
Coordinating with family and friends to evaluate visitation and participation by family members in the case of large families.
Overseeing 24/7 care alongside healthcare providers like hospice and palliative care vets.
Providing education and guidance related to the disease process as explained by the veterinary healthcare team.
Creating guided meditations and rituals specific to a grieving person’s religious faith or spirituality.
Sitting vigil with a person as a pet’s final moments approach or during euthanasia services.
Assisting with planning for aftercare services (cremation, burial, etc) or creative memorialization.
Provides follow-up companionship or refers to qualified mental health professionals or support groups for people who need/desire supplemental grief counseling after a pet has died.
There are a variety of accreditations available to those interested in becoming an end-of-life doula. Although there aren’t universally recognized requirements for becoming an end-of-life doula yet, organizations like the International End-Of-Life Doula Association and the National End-Of-Life Doula Alliance offer training and certification requirements that include:
Reading required materials.
Completing a work-study or class.
Participating in a multi-day training program or workshop.
Obtaining recommendations from healthcare providers and people they’ve assisted.
During her 20+ year career as a companion animal caregiver, veterinary business manager, and environmental advocate, Molly Welch learned that love and light comes in many many forms. In her personal life, Molly Welch (and her late husband Kim Welch), worked together to advocate, empower, and guide several friends and family members as they transitioned through death, and their loved ones during their grief journey and through death care. Molly and Kim enjoyed 16 years of marriage before Kim’s sudden, unexpected death in 2020. Molly shared many experiences working parallel to and within various medical and nursing care environments with Kim, and continues a tradition of great mutual respect for medical professionals. Hospice workers, volunteers, and palliative medical professionals dedicate their lives to performing excellent hands on care for patients and families. However, like birth itself, Molly Welch and her philosophy at Twilight Doula Services does not view death as a strictly medical event. The whole person, or animal, in the great transition from life, to end-of-life, to death from this world, deserves holistic and full care–mental/emotional wellness, spiritual care, and physical comfort. Families and clients with life limiting conditions often need more help navigating point of death care through doula services. A doula is a trained companion who is not a healthcare professional and who supports another individual through a significant health-related experience, such as birth, or non-reproductive experiences such as dying. In the Spring of 2020, Molly Welch completed the International Doulagivers Institute and the Doulagivers EOLD Certification program. A Doulagivers End-of-Life Doula is a non-medical professional that is trained to provide holistic care (physically, emotionally, and spiritually) to an individual and their family throughout the various end of life stages. She achieved certification as a Doulagiver, and passed the National End of Life Doula Alliance’s proficiency exam.
Molly continued to follow her own educational plan to offer a wide swath of end-of-life guidance in our area. Molly voluntarily joined “The Order of the Good Death” in November 2020. She was awarded the Green Funeral Service Proficiency Badge, and earned the NHFA (National Home Funeral Alliance) Proficiency badge for Home Funeral Guides in December 2020 and February 2021, respectively. It is her goal to advocate on behalf of a diverse group people in her community and to empower them (should they wish to be) to be involved in care for their own dead. Molly believes that the laws and norms that govern death, dying and end-of-life care should ensure that a person’s wishes are honored, regardless of age, sexual, gender, racial or religious identity. She also believes that her own death should be handled in a way that does not do great harm to the environment, and hopes to help those clients who seek the same after care.
Molly started Twilight Doula Services, LLC in Southwestern Indiana in August 2020 and envisions reaching clients and families through many doula packages that will meet their personal needs/wishes and it is her hope to train other local doulas to expand that reach in the next few years. Check out her services pages for more information, or call or contact us (812.484.8342), Molly is an associated paraprofessional member of the International Association for Animal Hospice and Palliative Care