Plus-Hex CLINICAL
Introduction
End-of-life care( EoLC) and euthanasia are among the most emotive, complex and delicate issues veterinary staff will encounter, and the way in which they are handled by the practice team will greatly influence a client ' s opinion of a practice.
EoLC is often referred to as‘ palliative care’ in human medicine, where it is commonly associated with cancer treatment and a terminal prognosis [ 1 ]. Today, veterinary professionals are increasingly encountering terminal, chronic and acute diseases, such as organ failure, trauma and medical conditions where the patient ' s quality of life( QoL) is a key component in deciding when EoLC should commence [ 2 ].
EoLC is a major component of a veterinary nurse ' s( VN ' s) role within the veterinary practice, where the support and care of the owner, as well as the patient, is required. This aspect of veterinary nursing is undoubtedly challenging and emotional, with its unique complexities hard to fully understand until they have been experienced. Veterinary surgeons( VSs) are under increasing pressure in all aspects of practice and, often, despite their best intentions, they do not have sufficient time to fully support owners during consultations and an animal ' s EoLC [ 3 ].
With pets now living for up to twice as long as they did 40 years ago [ 4 ], the veterinary profession needs to better understand and respond to the care requirements of more senior patients. Pets quickly become much-loved and valued members of their family; often, this bond gets stronger over time and with the ageing of the pet. This can result in difficulties for owners when medical decision-making is required, especially when an animal is facing EoLC and potential euthanasia.
Background
I worked in the charity sector for several years, including at a large rescue centre, which provided me with significant experience in assisting with euthanasias and supporting owners through their animal ' s EoLC. This gave me a new perspective on veterinary nursing.
When I later relocated to a rural mixed practice, a comment made by one of my seniors resonated strongly with me:‘ It’ s better a day or two too early, than a day too late. Euthanasia is something that is so important to get right, not just from an animal welfare point of view but because it is the experience an owner will remember most about a practice.’ I recognised that EoLC was a triad of factors: the animal, the owner and the owner ' s relationship with the practice.
Around 9 years later, I felt I was competent in supporting owners through EoLC discussions and euthanasia, but my concept of QoL changed again when my own staffie-cross dog, Finna, faced a very sudden change in her condition, when her chronic kidney disease rapidly became end-stage renal failure.
Despite advising so many owners‘ You ' ll know when it ' s time‘, I found myself constantly questioning if it was yet time for my own dog. I was tormented by thoughts such as‘ What if I left her too long?‘,‘ What if I didn ' t detect her unhappiness?‘ or‘ What if I made the decision too soon?‘. I knew my time with my beloved sidekick of 10 years was ending, but I felt I owed her so much, and, as a veterinary professional, I also felt a sense of duty to her. I owed her dignity and time, yet I wanted as much time with her as possible.
A friend, who is also a VN, recommended I use a QoL assessment. I completed the assessment daily and it helped me view my dog subjectively, in the way I would view a client ' s pet. By using this resource, despite facing one of the hardest decisions I ' ve ever had to make, I have no doubt that the moment I said goodbye was the right time to do so.
This article discusses and evaluates the considerations and tools that were helpful when assessing my dog ' s QoL, supporting my dog ' s EoLC and when having to make decisions around euthanasia. I also discuss how the veterinary team, and specifically VNs, can better support clients when assessing their pet ' s QoL.
Learning outcomes
• Know how to use QoL scales to aid decision-making
• Evaluate different types of QoL assessment
• Know how to support an owner during a QoL assessment of their pet
End-of-life care in the veterinary profession
EoLC can be considered an alternative to immediate euthanasia when a terminal diagnosis is made. It consists of the provision of treatment and care that aims to alleviate pain and suffering. EoLC is often referred to as palliative care. According to NHS England [ 1 ], the World Health Organization defines palliative care as‘ an approach that improves the quality of life of patients... who are facing problems associated with life-limiting illness, usually progressive. It prevents and relieves suffering‘. When discussing end-of-life provisions, the focus is on alleviating symptoms through medical and nursing care, with the knowledge and understanding that this treatment will not cure the underlying medical condition. In human medicine, the term EoLC refers to the last year of life [ 1 ]. However, in the veterinary field this concept is often applied on a much shorter timescale and is commonly used in the context of a terminal diagnosis or imminent euthanasia.
Volume 40( 4) • August 2025
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