End of life
What can I expect?

Cancer patients whose disease cannot be cured usually do well for a while, but once their condition starts to decline, this happens relatively fast (meaning a maximum of a few months). This means that the greatest care is necessary towards the end of life. Because the declines can progress relatively fast, it is useful to prepare yourself for this. This happens preferably in collaboration with your veterinarian.

For comparison: in case of a sudden death, as in an accident, one can suddenly stop functioning. This is contrary to organ failure (e.g. chronic kidney failure) where after a bad period a revival can occur, which is again followed by a worse period during which the patient slowly but surely becomes less functional and deteriorates. For cancer patients a high quality of life is maintained quite long (weeks, months, to possibly years), but once the patient deteriorates, this generally progresses fast.

Depending on the tumor type, the disease can have a slow or fast course. More information can be found in the section tumor types (under the title prognosis).

Euthanasia

In case euthanasia should be necessary, this section provides more information to help you prepare for what a euthanasia entails.

Euthanasia finds its origin in the Greek words 'eu' (good) and 'thanatos' (death). A good death … it isn’t an easy subject. It is of course one of the hardest decisions to take, because when has it been enough? In one’s own thoughts it’s tempting to downplay: 'he still wags his tail when he sees me', 'she still eats', 'he may no longer want to walk, but seems to still enjoy the garden'.

To objectively estimate the quality of life of your own pet is a very difficult task. Being able to 'choose' when saying farewell can feel as wrong or overwhelming. As a general rule it is better to opt for euthanasia sooner than later, as waiting too long also means unnecessary suffering. Deciding when the time is ripe, is a very personal decision that only you and your environment can make. However, it is also important to take into account what your dog tells you via his/her appearance and behavior and what your veterinarian and friends advise.

Choosing euthanasia for your dog does not have to mean you’re “giving up”, but on the contrary that you choose to give your dog a last treatment. A treatment ending his suffering and allows him a dignified and peaceful end.

This is why it’s important to discuss this in time with your veterinarian, family and/or friends.

When?

Your veterinarian can advise you on which symptoms are to be expected in case your dog is losing the fight against cancer. You of course know your dog best as well as the signs typical for your dog indicating he’s not feeling well.

It can potentially help you to discuss in advance with your veterinarian where the threshold may lie for your dog’s quality of life. Afterwards you can regularly (e.g. every 2 weeks) check whether this threshold has been reached by evaluating different features of your dog.

This of course obliges nothing, but for many owners it can be easier to make a decision when the dog’s evolution has been mapped instead of having to rely on a slowly changing condition.

Eventually, the decision to move forward with the euthanasia for your pet will depend on what’s best for him/her, based on realistic expectations concerning the prognosis, what can be achieved medically and financially.

Where and course?

If the moment has come that your dog’s quality of life is no longer acceptable and you have decided to proceed with euthanasia, you can –together with your veterinarian- discuss the next practical steps.

Euthanasia can take place at the veterinarian’s practice, but if you prefer this to happen in a familiar surroundings, a house call can usually be made for this reason. If you have other pets, this gives them the opportunity to say goodbye, to understand what happened and start their own grieving process.

Maybe you’ll want to have an answer to the following questions:

  • How will the euthanasia proceed? Will this happen in a separate room and will it be possible to stay with my dog afterwards and say goodbye?
  • Can I bring others and if so, how many?
  • How many personnel will be present?
  • Can I pay in advance instead of afterwards?
  • Is there another exit than through the waiting area?
  • Which are the options after passing away (local pet cemeteries/crematoria)?
How?

If you dog allows this, a catheter will be inserted in a vein after which your dog will be sedated. This can take away potential pain and muscle tension. After this, an overdose of sleep medication is administered. Its goal is to cause a very deep sleep, from which the dog cannot wake up and therefore softly slips away. After all, the central nervous system is influenced by this high dose of somnifacients and informs the body to no longer give signal to breath or make the heart pump.

What can I expect?

The administration of a sedative can cause a slight nausea in some dogs. This is why it’s advised to stop feeding the dog 4 hours before the euthanasia. By doing so, vomiting during the sedation phase prior to the euthanasia can mostly be avoided.

During the euthanasia, it is possible that the dog breathes in deeply a couple of times before stopping to breathe altogether. This is a consequence of the effect of the given high dose of somnifcacients and varies from dog to dog.

After the dog passed away, it is normal that the body uses the remaining energy. It does so by contracting several muscles until no energy is left. This manifests itself by shivers over the abdomen (muscles of the flanks and belly that contract), shivering ears (contrasting ear muscles), urinate (contracting bladder wall muscles) and/or defecate (contracting muscles of the intestines). Usually, the eyes remain open.

What afterwards?

One can choose to leave the remains at the veterinarian. The latter contacts a service that comes pick up the dog to be cremated together with other animals. Usually, the euthanized animal remains cooled until then.

Another option is to have the remains be picked up by a crematorium that cremates the dog separately, after which the ashes are collected in an urn. These ashes can be dispersed or given to the owner. Pet cemeteries also exist.

Depending on your municipality, it is allowed to bury your dog in your own garden. If allowed by the municipality, the following conditions must be met:

  • The animal may not have died from a contagious disease
  • The animal’s weight cannot exceed 10 kg
  • The soil may not contain much loam or clay
  • The pit should be at least half a meter deep
  • You cannot bury the animal in a plastic or other poorly degradable bag
  • You cannot bury the animal on public terrain.
How can one help a grieving pet?

The demise of a pet can definitely influence your other pets. This can manifest itself via changes in sleeping patterns (sleeping more than usual or interrupted sleep), changes in eating habits (typically eating less), changes in self-maintenance, being less interested in normal activities, not liking being alone, starting to bark or moan for unclear reasons, changes in behavior or temperament, looking throughout the house for the deceased pet.

You can do the following:

  • Maintaining the usual routine: doing the same walks, even in case of a decreased appetite offering meals at the usual times. Should your pet after a few days still refuse to eat, it is advised to seek council from your veterinarian.
  • Ignore undesirable behavior: although it can be touching that your dog cries looking for his deceased buddy and you want to comfort him, this isn’t always indicated because this can unintentionally reinforce the grieving behavior. It is advised to comfort your dog when he is quiet, lies down or comes to you for cuddles.
  • Positive activities: walking, playing games and puzzles, giving attention and interacting may somewhat compensate the lost interaction with the deceased pet.
  • If multiple pets are present, it is possible that the passing away of a pet can cause a disturbance of the social structure. It is possible that several conflicts initially take place when everyone redefines his/her place in the group. Unless there’s a risk for injuries, it is generally advised to stay out of this and let them solve this among them.
  • Not distance yourself from other pets: sometimes pet owners can retreat themselves out of fear they will experience a similar loss with the remaining pets. However, pets can sense this behavioral change and behave even more affectionately or badly as an expression of their fear and double loss (their friend and their owner).
How to explain children what is happening?
Grief groups
References
  • https://www.veterinaryteambrief.com/article/time-say-goodbye-know-how-provide-peaceful-death?utm_source=Social&utm_medium=VTB&utm_campaign=Facebook.
  • https://www.vlaanderen.be/nl/natuur-en-milieu/dieren/gestorven-huisdier.
  • ​Lunney JR et al 2003. Patterns of functional decline at the end of life. Journal of American Medical Association 14;289(18):2387-92.