Hospice and Palliative Care for Cats

Dealing with a serious chronic disease or making end-of-life decisions can be difficult and traumatic for pet parents. While there is no easy way to approach these questions, in recent years, there has been a movement in the veterinarian industry to bring some of the benefits and philosophies of palliative and hospice care from human care into veterinarian medicine.

What Is Palliative Care for Cats?

Although they may seem similar, there are some crucial distinctions between palliative care and hospice care. Palliative care is any treatment that “supports or improves the quality of life for patients and caregivers by relieving suffering. This applies to treating curable or chronic conditions as well as end-of-life care,” according to the American Veterinary Medical Association (AVMA).

Palliative care can include a wide range of therapies such as acupuncture, laser therapy, therapeutic massage, supplementation, specific diets, pain management, and home modifications. Palliative care can be done in the home or a veterinary hospital. It is not a cure, but a means to make your cat comfortable as they experience different forms of illness.

What Is Hospice Care for Cats?

Veterinary hospice, on the other hand, is “a philosophy or program of care that addresses the physical, emotional, and social needs of animals in the advanced stages of a progressive, life-limiting illness or disability,” according to the AVMA. Hospice is typically reserved for pets that have a life expectancy of 6 months or less.

The goal of hospice is to relieve a pet’s suffering and improve their quality of life as they near the end. Typically, hospice takes a team of people, lots of planning, and constant revision of the plan. Care teams may include veterinary staff as well as the pet’s family and caregivers.

Does My Cat Need Hospice or Palliative Care?

Palliative care should be included in treatment for any condition that affects your cat’s quality of life, whether it’s acute, chronic, or end-of-life care. Hospice, on the other hand, is generally recommended for cats that have about 6 months or less to live.

One way to look at this is that a cat can be placed on palliative care to relieve suffering associated with a disease or condition, but not be admitted to hospice. However, palliative care—supportive measures to make the cat comfortable—is also a fundamental part of hospice and end-of-life care.

No matter what type of treatment is recommended, the foundational goal of veterinary medicine is to do no harm. When a veterinarian is designing a treatment plan involving palliative care, hospice care, or humane euthanasia, there are four bioethical considerations:

1. Respect for autonomy
2. Non-maleficence (do no harm)
3. Beneficence (intent to do good for the patient)
4. Justice

Pet Hospice or Euthanasia?

There are many factors that can affect the decision to pursue hospice or humane euthanasia. Either way, palliative care should always be provided.

When a pet receives a terminal diagnosis or you see that your cat is not responsive to therapy, it can be overwhelming. The veterinarian may say that your cat is in their last hours or days, and you need to have them euthanized as soon as possible to relieve their suffering. In this case, the decision will not be when, but where—with a veterinarian coming to your home or you taking your cat to a clinic.

If you have more than a few days to decide and it’s possible for your cat to be comfortable during this time, it can be helpful to sit down and determine your goals for your cat. Questions to consider include:

1. What would you like the outcome to be?
2. Would you like more answers about what is going on, such as a diagnosis, if one has not been found?
3. Would you like to just make your cat comfortable because the back and forth to the office and the extensive testing is stressful?
4. Are you interested in some combination of approaches?

Answering these questions and discussing your reasoning can be very helpful to your cat’s veterinary team when it comes to making informed decisions about what may be beneficial for you and your cat.

Once you’ve answered the larger questions, you and your veterinary team can make plans for either hospice care or euthanasia. The goal is to gain a better understanding of what you and your cat need, and for the veterinary team to do what they can to modify a treatment plan. They will consider your cat’s comfort, look at the realistic and possible outcomes, and weigh the benefit of new tests or therapies against the diagnosis.

It is important to remain receptive to your veterinary team’s suggestions. This is an emotionally charged time because, while your veterinary team is not judging you for the choice that you make either way, they also want to do what is best for your cat. In some cases, this may mean that a specific therapy or test is not possible without hurting your cat’s quality of life.

If you feel overwhelmed or the treatment plan isn’t working as expected, communicate that with your veterinary team.

Common Cat Illnesses That May Lead to Palliative or Hospice Care

It is difficult to separate diseases that may require only palliative care versus hospice or euthanasia.

In many cases, cats will live long lives with a chronic disease. In other cases, a disease can progress quickly and may soon require hospice care and/or euthanasia. Cats may also develop secondary health issues that may require hospice and/or euthanasia.

Common diseases that might result in palliative or hospice care include:

Degenerative joint disease—Joint diseases attack the connective tissue and structures of your cat’s joints, resulting in pain, decreased mobility, accidents, constipation, and muscle wasting.

Dental disease—Cats that do not respond well to treatment or can’t be treated may be reluctant to move around, which can severely decrease enjoyment in life. This can result in complications that cause malnutrition or dehydration, which can lead to more serious issues such as pancreatitis or fatty liver.

Neurologic disease (lumbosacral disease, disc disease, cervical pain)—Neurologic disease affects the nervous system, including the brain, nervous system, and spine.

Dermatologic disease (dermatitis, otitis, recalcitrant wounds)—While dermatologic lesions are rarely the primary cause of euthanasia, their secondary effects may cause infection or decreased quality of life.

Visceral disease (IBD, pancreatitis, megacolon, constipation, idiopathic cystitis)—Conditions that affect the internal organs can be tricky to manage. It is not uncommon for these diseases to initially require advanced treatment and for cats to be hospitalized to stabilize them.

Cancer (primary tumor or treatment-related, including radiation side effects)—When cancer is caught in early stages, treatment may be promising. However, when it’s caught in later stages or there has not been a good response to treatment, pet parents are left with the decision to euthanize or to support their cats through a hospice program.

Persistent postoperative pain (onychectomy, mastectomy, limb amputation)—Unfortunately, complications from surgery can result in phantom pains and other conditions. In these cases, the focus of care is to reduce pain and discomfort. If there is no response to pain management, there’s a severe decline in quality of life, and euthanasia may need to be considered.

What Types of Treatments Can You Expect for Cats in Palliative Care or Hospice?

Therapies for degenerative disease include hip replacements, pain medication, anti-inflammatories, hydrotherapy, weight loss, acupuncture, and massage. Home modifications may include ramps, modified litter boxes, and modified outside time and playtime.

In cases where cats have trouble pooping or peeing, the cat may need to eat a modified diet, have their bladder manually expressed, or have frequent enemas. Typically, if a cat has lost nerve sensation to a specific area of their body, they do not feel pain. In these situations, you may have to make home modifications and spend significant time to ensure that your cat has a good quality of life.

Some conditions require long-term management, which can be frustrating for both pet parents and the cat.

Featured Image: iStockPhoto.com/Liam Bell