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One Health Week: Death as a One Health issue, could doctors learn from vets?

As part of the upcoming One Health Day, we will be publishing a series of blogs to celebrate One Health. Here, BVA Past President Robin Hargreaves talks about his approach to end of life discussions, and we should all talk about death more often and earlier than we do.

One Health blog 2018Last year I was approached by Rowenna Baldwin, a film student at the Northern Film School at Leeds Beckett University. Rowenna had developed a keen interest in end of life management in veterinary practice and the effects of pet loss on people because of her own experience losing a pet horse. During her research she had found out that I had written and spoken a number of times about my approach to this important and difficult part of veterinary general practice.

Ultimately Rowenna produced a powerful and moving 20-minute film Goodnight Friend that is currently doing the rounds of documentary festivals and competitions. The film featured volunteer clients from our practice who shared their experiences and discussed their loss with each other and me. There were also contributions from the Blue Cross Pet Bereavement Support Service.

We recently had our first public screening, and afterwards I spoke with the audience about my approach to end of life discussions and the tremendously difficult decision making around companion animal euthanasia.

Reflections

I was still reflecting on this when I noticed in my newsfeed an article about a report from the Royal College of Physicians: Doctors 'need to start early conversation with patients about dying'. The report called for physicians to be much more open with terminal patients and those who are very frail and at significant risk of dying within the next 12 months.

A strong theme of my discussions around veterinary euthanasia is that we must talk more and talk earlier about dying and try to help people get away from the entirely negative feelings around euthanasia. We must talk more openly about why we feel it is such an important provision, to be embraced as a gentle and peaceful way out of suffering and a seriously inadequate quality of life.

People often say to me: “I couldn’t do your job, putting all those animals to sleep.” In fact, the situation is quite the opposite. I couldn’t do my job if I wasn’t able, when facing insurmountable illness or injury, to help an animal gently to pass away.

Attitude to animals

Our attitude to animals is changing and more particularly our attitude to companion animals. As we come ever closer to considering pets as accepted members of the family then it becomes harder not to see the decisions around end of life in the same terms we might for a human family member.

Perhaps in the past cultural attitudes provided a distinction between the sanctity of human life and dominion over animals, and this allowed us to make decisions about their lives without taking into consideration their sentience – a concept that we now readily accept.

Pet loss

Whilst many owners wrestle with the responsibility of ending an animal’s life, it is also the case that many clients will make the comment after a peaceful euthanasia: “Oh, I hope someone will do that for me if I end up like that,” or, “I wish we could have done that for a loved one.”

I am concerned that people might find the comparison of pet loss and the loss of a loved one trivial, but hearing clients describe their feelings of guilt and desolation convinces me there are very valid parallels.

I have spent over 30 years gradually building an understanding of the management of end of life situations and I hope that I am now at least able to offer comfort and guidance to my clients and, through that, enable them to make decisions that they are reconciled with.

I get great satisfaction talking to younger colleagues about what I have learned and how that learning revealed itself in the infinitely varied situations we are presented with. I wonder if we might have something useful to share with our medical colleagues as they are encouraged to have similar frank but compassionate conversations with patients and relatives facing their final days.

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