Today I have to face something I truly dread: deciding whether to continue medical treatment for my 10 1/2-year-old dog, who is not actively dying of a serious disease. My feelings are so complicated, and I’m not totally sure why.

For nearly 20 years, I’ve worked with the OHSU Center for Ethics in Healthcare on end-of-life issues. I’ve produced at least a dozen videos for professional and public education on Oregon’s POLST program, which stands for Physician Orders for Life-Sustaining Treatment. I feel strongly that people have the right to determine how they want to spend their final years on this planet, and this program makes that possible. A physician signs a medical order for a patient or their legal representative, and that order outlines what the patient does and does not want at the end of life. It deals with things like CPR, feeding tubes, a person’s desire to die at home. The POLST program began here in Oregon and is now being used and/or developed in a couple of dozen states. It works, and I’m proud to have helped get the word out.

When my mother died eight years ago, she had a POLST form, which told us that she wished to be allowed to die naturally if it should come to that. She did not want heroic measures taken if her quality of life would be seriously compromised. She was head injured, and even though we knew what her wishes were, it was still hard to decline treatment and allow her to die. But we did what she told us she wanted. It took her a week in hospice to pass away.

So today I am so conflicted. Bertie the Cairn terrier is nearly 11 years old. He suffers from severe allergies, so he’s had a lot of medical care over the years, naturopathic and specialty care. He’s cost thousands of dollars, has to have weekly shots, and has become increasing cantankerous in his dotage. But he’s a strong little sucker, and he just keeps plugging along. Just last year, we had to shell out $1000 to remove ten of his teeth. And it didn’t help his horrendous breath one bit.

Now Bertie is suffering from persistent diarrhea. He’s lost a couple of pounds — and he’s a small dog — and the vet isn’t sure what’s going on with him. Now they want to do a series of tests, ultrasounds and lab work, that sort of thing. Hundreds of dollars, for certain. Today I told the vet that I did not feel we could sink a bunch more money into treatment for Bertie. I have done my utmost for 10 years to take good care of this little dog. I loved him like crazy when he was a pup, and I’ve tried to overlook his faults. He is independent — not affectionate — barks like a fiend, gets in fights with other dogs, is ravenously hungry all the time (he will grab a sandwich out of your hand if you’re not careful, I swear) and is just generally a difficult dog. I’ve long said Bert is a problem I just can’t solve. I can’t give him away; nobody wants a testy little terrier with serious allergies. When he was diagnosed, he was only three — just too young to put down. I couldn’t do it, period.

And now I find this so painful. I imagine people think it should be easy, right? Just put him down. Take him to a shelter. Refuse treatment, and let him waste away. When I tell the vet I don’t want to spend more money on this dog, I start to cry, every time. I’m supposed to be quite practical about these things. I know that at end of life, it’s a time to be grateful for the time you’ve had and understand that quality of life it just so much more important than length of life. But I feel so bad that I can’t fight for Bertie like I fought for my last dog, who had cancer at six years old. I feel so guilty that I don’t love him enough to continue to do everything possible to keep him going. I know I should be practical here, but I just didn’t think it would be so sad.

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2 thoughts on “

  1. lisagroening says:

    I am sorry you have to go through this. Our little rescue Shih Tzu was put down last spring when it was clear she was not going to be able to breathe better and she couldn’t eat or drink water. In that case I was so glad and relieved for her to be free of her suffering. She, too, was not the world’s greatest dog. She peed everywhere and was indifferent to other family members. She couldn’t figure out how to go out the doggy door. She needed regular beauty appointments and lost many of her teeth, too. Still, it was sad. I miss her little Ewok face peeking out from behind the bathroom door whenever I would go.

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  2. Ken Keiter (@kenkeiter) says:

    Bertie’s a really difficult case and, as often as I’ve flippantly answered “we should put him down,” I don’t envy the fact that this decision ultimately comes down to you. Jane and I were remarking on the paradox that someone who makes these arguments about human beings is seen as cruel and cold. Bertie has gotten a lot of love, and aside from his ailments (most likely stemming from his pure-[in]bred genetics), has lived a great life with people that have cared deeply for him, despite the fact that he’s not of particularly enjoyable character much of the time.

    You and Jim have gone to bat for him over and over, but his body is starting to give out. This hard decision is no longer about something as simple as life or death, but has become, instead, about quality of life. Quality of death. As I grow older, the notion becomes clearer to me that the reason that human beings are so sensitive to these arguments is because death and life are not as black and white to us as perhaps they are to mother nature; we color them with every shade of gray, between.

    I’m surprised to say that, as I write this, my eyes are welling up with tears, but: the choice you have at hand is whether to let him suffer. You can put him through tests. You can put him on meds that affect his mood, make him sick, and lethargic. You can feed him special food that he may not like. You can wash him often to make sure he doesn’t smell. You can shield him from other dogs that he doesn’t get along with. But in doing so, what is taken from him?

    When I question what a Quality life is defined as for a dog, I can’t help but recognize that it is _not_ the same as it is for you and me. For a human, it is the connections you make with those around you. Love, and varying shades of it, are the brush that gives our human existence color. Jane suggests that love is a balm for human pain; that we can withstand great amounts of pain for love. But perhaps this is not so, for a dog. This is not to say that love doesn’t greatly impact a dog’s life but, instead, to suggest that they are not as capable of condensing fact from that vapor of nuance. Perhaps love, to them, is comfort. It is food. It is warmth. It is not defined, necessarily, as love, but as a lack of pain. I think that we stopped being capable of giving that to Bertie a long time ago.

    I don’t know whether you’ve already made this decision, but I am certain that no matter which choice you make, you should rest soundly knowing that you have done everything you can. Enabling him to _survive_ is not the same as enabling him to _live_.

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