Do we really treat the dying humanely?
It sure doesn't seem like it.
One day, almost two years ago, my wife Jeannie noticed that the stomach of our 11 year old dog Trixie appeared a bit distended. We had been thinking about switching to a vet closer to our house so we decided that this was a good excuse to do so. Dr. Winston felt Trixie’s abdomen then said, “There’s something there. Let’s do an X-ray.” A few minutes later he returned to inform us that Trixie had a grapefruit-sized tumor inside her. Fortunately an ultrasound technician would be at his office the following Monday so he could determine if it was operable or not. The next few days were tense to be sure.
Finally he called on Monday afternoon. The tumor was tangled up in her liver and thus inoperable. It was robbing her of blood faster than her body could produce it. He told us that it was only a matter of a few weeks before it would kill her. He said, “She will suddenly have trouble breathing and will panic. You don’t want to see that nor put her through that.” We agreed. Away at college, we called our kids to tell them the bad news about a member of our family they had grown up with and deeply loved. They both came home immediately to say their goodbyes. We had made an appointment with Dr. Winston for the following Friday to peacefully end Trixie’s life before the Hemangiosarcoma did. Golden Retrievers apparently are prone to this particular type of cancer. Mia arrived home on Wednesday. Sam arrived late in the afternoon on Thursday. Just an hour later it became clear that Trixie might not make it to the next morning. With Dr. Winston’s office already closed for the day, we had to call a local 24 hour vet. We took Trixie for her last car ride. Surprisingly she still found the strength to sit up so that she could put her nose out the window and enjoy the wind.
When we arrived at the vet’s office, she jumped out of the car and walked next to me to the front door as if nothing was wrong. We spent an hour with her before we were ready for the vet. She came in and gave Trixie a shot that made her fall asleep. She then asked us if we were ready for the final shot. Inside I was shouting out, “No! Let her just wake up!” but I knew this wasn’t what was best for her. We all nodded and the shot was given. Jeannie, with her hand on Trixie’s chest, felt her heart stop. We spent another hour in that room with her before we were ready to leave. It was one of the most difficult things our kids had been through but it’s also a part of life and we felt it was an important thing for them to experience. I know they wanted to see Trixie one last time as well.
Saving Trixie’s life was not possible. We could have waited a day, a few days, a week, for her to die on her own but that would have been terrible for her and for us. Ending her life that day was the humane thing to do. Humane sounds like it means treating someone as human. It actually means to be compassionate.
In late November 2023 my mom fell at the place where she and my dad live. Paramedics were called but Mom wasn’t complaining of pain nor had she hit her head when she fell (either of which would have resulted in a mandatory trip to the emergency room) so the paramedics felt she was OK. She had fallen so many times before that doctors were starting to wonder if her bones were made of titanium. They weren’t.
A few days later, walking around as if nothing was wrong, the unnoticed hairline fracture in her right femur, became a complete break. The two pieces of bone were separated from each other completely. I met with her doctor, nurse practitioner and her hospice nurse to discuss options. Mom was on hospice at the time not because she was dying but because it allowed a nurse to come see her regularly rather than her making trips to the hospital. The doctor was able to order it via a convenient loophole. The doctor said that surgery of this kind at her age had a 40% mortality rate. Mom had respiratory issues which would probably have increased that number. She would also have to be able to participate in physical therapy afterwards. If she didn’t have dementia, I think that might have been possible. Given her feisty personality and that she would not remember why she was having to go through painful physical therapy each time she had it, I did not believe she could do it. Surgery was a guarantee of suffering with little chance of recovery. The other option was to give her pain medication to keep her comfortable. This would mean that she would be bedridden. It would also mean she would be conscious less often which would result in her eating and drinking less. Over time, her body would simply not have what it needs and would begin to shut down. This is a very, very common way the elderly die.
We flew out to California immediately to see her. That first day the caregivers needed to move her. When they did, I heard her scream in a way I had never heard before and hope to never hear again from the mouth of anyone. The medication wasn’t enough so it was strengthened resulting in her almost never being awake. At one point she asked me why this was happening to her. I explained that she had broken her leg and was on heavy pain medication. Over the next few days she ate and drank less and less. A week later Mom died.
When it became clear that Trixie could not be saved and that keeping her alive would only result in more suffering for her, we did the humane thing. When we were told that my mother would not recover, she too was given medication but then was left to die on her own. That did not seem humane to me at all. How is it that we treat our pets more humanely than we do our family members? I know that doctors take an oath to do no harm. However, when someone can’t recover, when they are suffering and their death is imminent, ending their life is not doing them harm. Obviously if the individual is mentally well, they could be asked if they wished to consent to this. Thinking back now as I write this, we could have asked Mom what she wanted to do. That would have been the hardest conversation we would have ever had to have with her, but we could have done it. It just didn’t occur to me at the time. You might be thinking that given her dementia, she couldn’t consent. Doctors disagree. Our personal autonomy is our most cherished possession. The consensus is that if a patient with dementia is asked to make a choice and can provide a rational basis for that choice, they should be allowed to make it. We could have asked Mom. She spent her career as a medical social worker. She knew all about hospice. She likely could have made this decision for herself.
Regardless though, I doubt Mom would have chosen a week or more of unconsciousness that would end in her death over something quicker. I have also just discovered that California is one of the states that permits assisted suicide. Having said that, I’ll bet it takes time to jump through the legal hoops which means it likely would not have been a solution for her.
We really need to have a rational conversation about situations like this. I say rational because it’s a deeply emotional decision but we need to set those emotions aside so that we can focus on what is best for terminally ill member of our family. Doctors wish to do no harm but leaving a terminally ill patient to slowly die is doing them harm and that’s something that needs to change.
Surely we can find a way to treat our loved ones as well as we treat our pets.