미국수의사 – 2016 AAHA/IAAHPC End-of-Life Care Guidelines

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End-of-life (EOL) care and decisionmaking embody the critical final stage in a pet’s life. Veterinarians should not allow an EOL patient to succumb to a natural death without considering the option of euthanasia and ensuring that other measures to alleviate discomfort and distress are in place. An EOL treatment plan should consist of client education; evaluating the caregiver’s need and goals for the pet; and a collaborative, personalized, written treatment plan involving the clinical staff and client.

Like human hospice, animal hospice focuses on palliation of a patient’s clinical signs while addressing the emotional, social, and spiritual needs of the caregiver.

Animal hospice does not accept a pet owner’s decision to allow a pet to die without euthanasia unless measures are in place to alleviate discomfort and distress.

Medical conditions appropriate for hospice or palliative care are: terminal diagnosis, chronic/progressive disease, progressive/undiagnosed disease, chronic disability, terminal geriatric status

It is important to advise clients about the expected disease trajectory. Ensure that there is a clear understanding of all diagnostic and treatment options available. Consider scheduling a dedicated EOL appointment 1 week after the need for hospice care has been identified.

Collaboratively with the caregiver, hospice options that are reasonable for both the caregiver and the patient need to be determined. It is important to provide a detailed EOL care plan using language that caregivers can understand.

Treatment options should be guided by the four principles of medical bioethics; 1)respect for autonomy 2)non-maleficence 3)beneficence and 4)justice. The veterinary team may need to adjust the treatment plan accordingly as an EOL case progresses. Treatment options and clinical interventions should always reflect the bioethical principle of “do no harm.”

Grief is a natural response to loss and it changes over time. Timely, empathetic, and non-judgemental communication is the hallmark of the effective client support. Bereaved caregivers may benefit from professional grief support counseling.

To minimize anxiety, the client should be informed of every step of the euthanasia procedure.

Never assure anything – it is important to adequately communicate to the client what to anticipate with the dying process as well as postmortem changes that may occur.

Never rush the process – clients want, and need, your undivided attention and you have and obligation to give it to them.

Consider the use of language and how subtle word differences can have an impact; instead of saying, “When you are ready,” say “When you are as ready as you can be.”

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