Lessons from the Dog
We chose hospice/palliative care for Aspen when her liver started to fail because we thought she was still enjoying some quality of life receiving love (lots of attention, pets, hugs) from our family, and lying on the deck and in the back yard. Aspen was our first family member to die, so it was uncharted territory for our children, Riley and Ryan.
One of the biggest benefits of palliative care for the children, and for all of us, was that it gave us a little more time together. Aspen had been part of our family life from the beginning and none of us could imagine life without her. While [it was] difficult to see Aspen not able to do the things she used to be able to do as a younger and healthier dog, the time together was precious and I think valuable for us all.
One thing we knew for sure was that when Aspen died, we had done everything we could to help her get better, and then to simply make her as comfortable as possible. Because we were implementing measures to ensure Aspen’s comfort the best we could, we didn’t think she was in pain or suffering. Riley and Ryan spent more time with her those last few months and had the opportunity to help take care of her.
The conversation I found most helpful for the children, and for all of us, was to consider, “What brings Aspen joy?” because that question made us focus on Aspen and her quality of life over our own feelings/wants/desires for her to not leave us.
We included the kids in those discussions and listened to their thoughts and feelings, which I think was valuable for all of us. They felt heard. If I had one takeaway message to share with others, it would be to sit down as a family and have that conversation together and/or with the family veterinarian.
The children saw their beloved Aspen become an elderly dog, and they were very fortunate to have the opportunity to help care for her until the very end. It was an act of love, and one that seemed fitting for a girl who had given us so much of the same throughout her nearly 13 years.
Although issues related to quality of life are important across the lifespan, there is much to be learned from the end-of-life experience of a dog in the context of family. For many adults, the death of a pet is the first recalled death experience (Knight et al. 2000). Because loss and grief are universal and occur throughout life, thoughtful consideration about how to shape those early experiences is critical.
Operationalizing positive regard for a dog is an object lesson for a child but it also benefits the dog. This parallel process—the socialization and education of children about relationship, and the welfare of a dog—cannot be separated. Regardless of the options available to a family, children can learn from developmentally-appropriate
involvement in end of life care provided to their family dog.
Palliative care and hospice are emerging options in veterinary medicine, but availability and out-of-pocket costs remain barriers to widespread adoption in companion animals (American Animal Hospital Association 2016). In both animal and human hospice care, the emphasis is on management of symptoms, broadly defined, but animal hospice includes an ethical requirement that veterinarians advocate for euthanasia if an animal’s suffering cannot be alleviated (American Animal Hospital Association 2016). Indeed, euthanasia remains a typical end-of-life care option offerd to companion dogs. In an international study of nearly 4000 dog deaths, approximately three-quarters of the dogs were euthanized
(Sontag Bowman 2017). In another study of nearly 5000 dogs in England, 86% of them were euthanized (O’Neill et al. 2013).
Conversations about euthanasia and the family dog need to be thoughtfully
considered within the context of developmental realities. For example, the typical reason for euthanizing a dog is pain/suffering. Children will not, unfortunately, always enjoy an optimal and pain-free life. There will be times when they are distressed, when they cannot engage in activities they love, and there will likely be periods of suffering; these things reflect the human condition. Further, children will interact with others whose quality of life might seem impaired through physical or mental disability. These realities provide context for conversations about euthanasia. Do we really want our children to think life has to be perfect to be worth living? That suffering is a reason to end life?
Conversations with children about euthanasia and dogs need to move beyond, “the dog was suffering.” While the explanation may well be true, the adult has the capacity to understand the nuances involved; a child may not. The broad application of death to suffering is probably not the message we want to convey to children, who will soon be adolescents and may well experience what seems to them to be true suffering. If not for the dog’s sake but for the children, euthanasia of the family dog should be done with a great deal of care and thought. If possible, adults may want to model exploration of alternatives to euthanasia (i.e., hospice and palliative care), and/or be clear and direct with children about the reasons a dog’s physical
suffering that cannot be relieved is very different from a human’s emotional, social, and/or physical suffering.
Quality of life is both subjective and contextual. Further, the universal existence of hardships and suffering makes decisions about what constitutes acceptable quality of life difficult. These challenges offer opportunity for adults to model compassionate care and decision-making skills when a family is confronting end-of-life choices for a well-loved dog. Leaving children out of the conversation about end-of-life choices for a beloved dog is a missed opportunity to model and practice decision-making skills, coping with challenging circumstances, and providing humane care to a well-loved dog. However, the extent to which a child is involved in end-of-life conversations and decision-making on behalf of the family dog needs to reflect developmental realities.
A five-year-old, for example, should have different input than a fifteen-year-old but no child or adolescent should make the final decision on behalf of a dog; that must be an adult responsibility because of the potential for guilt and second-guessing (American Animal Hospital Association 2016; Packman et al. 2014; Sharkin et al. 2003). Adults need to be clear with children that while they are invited to share input, final decisions are made by the adult(s) in consultation with the dog’s veterinarian.
This structure models appropriate boundaries, reduces the potential burden on children, and demonstrates important collaborative skills. One way families can involve children in end-of-life care of a dog and model thoughtful decision-making is through the use of an Individualized Quality of Life Scale. Children are invited to identify 3-4 things that the family dog loves to do, and these things then become scaling items to assess quality of life. For example, most dogs love to eat and so “Eating” might be an item on the scale.
Children can then generate response categories using words or pictures that allow them to identify where the dog is on the Eating Scale on any given day. Using a personalized scale provides an age-appropriate way for a child to have ongoing input into end-of-life decisions, reflects respect for the unique relationship between a child and the dog, and it provides a tangible avenue for adults to discuss what can be difficult topics, including euthanasia (Fig. 1).
Culture, religious and/or spiritual practices, and other individual variables will always guide conversations about euthanasia, and this is appropriate. Therefore, it is impossible to offer a one-size fits-all approach to discussing euthanasia with children. However, there are some common guidelines that can be implemented or adapted to help with the conversation about euthanizing a beloved dog.
First, it is important to convey to children that the decision to euthanize the dog is because there is no other way to make the dog better. Children need adults to reflect the importance of the dog in the life of the child, and not be cavalier about ending the relationship. Second, it is appropriate and important to let children see that the decision to elect euthanasia is a sad one.
Children should not be protected from the reality that ending life is not an easy choice, and done only because the other choices are worse. Third, children deserve age-appropriate answers to their questions. School-age children are especially curious about what adults might consider disturbing details; that curiosity is normal, and satisfying it is appropriate. Finally, it is important to consider word choice when discussing euthanasia with children.
Telling a five-year-old, for example, that the dog is being “put to sleep” could result in some significant (and understandable) fears about falling asleep. Word choice matters with children, and when we speak in euphemisms we risk planting some disturbing images in young minds.
Death is a common theme in video games, movies, cartoons, and other forms of childhood entertainment, and yet adults too often avoid discussing death with children (Lee et al. 2009; Miller et al. 2014).
Although this may appear to be a way to protect children from harsh realities, it may also reflect adults’ general discomfort with the topic of death. Therefore, it is not surprising that adults may wonder if children should be present at the euthanasia of a dog. This is an individual decision but veterinarians report that children do well when present during euthanasia. One veterinarian shared this experience as typical of the resilience of children during the euthanasia of their family dog:
Nona, age eight, draw me a picture of Budd. Nona met me at the car, took my hand and guided me into the house and directly to Budd, who had the drawing tucked under his head. She kissed him good-bye, hugged me, and went next door to visit her aunt. Five-year-old Henry, on the other hand, wanted to know when we’d be baking cookies.
Although veterinarians have the professional expertise to euthanize the family dog, parents or adult caregivers can and should engage, when feasible, in dialogue with the veterinary team before euthanasia takes place. The purpose of this conversation is to ensure accurate understanding so that information can be conveyed to children about what to expect during the procedure. In addition, the adult should
ensure that the veterinarian intends to follow the American Veterinary Medical Association’s recommendations for client-present euthanasia, including placement of a catheter and pre-euthanasia sedation (American Veterinary Medical Association 2013, p. 47).
Euthanasia does not always represent a “good death.” Dogs are euthanized for a variety of reasons, and not just because there are no reasonable end-of-life-care options. For example, dogs are euthanized at shelters due to lack of available homes, shelter overcrowding, and/or specific traits that make a dog a poor candidate for adoption. A stray family dog can be euthanized at a crowded shelter before a family can retrieve him; a family might be on vacation, not know where to look, and/or may assume the dog will return, for example. Dogs are removed and euthanized for a bite history.
Although American Humane (2016) and the American Society to Prevent Cruelty to Animals (n.d.) identify injection as the only acceptable choice for euthanasia dogs, gas chambers are still utilized in some shelters.
One adult shared “when I was a child my mom routinely took kittens and later, one of our dogs who had an unfortunate tendency to resource guard (including biting), to shelters. Although I was an adult when I realized what that meant, the reality that animals we loved died in collective terror with other animals in one of those gas chambers still haunts me.”
Euthanasia is not the only cause of death for dogs; some dogs die in accidents. Accidental deaths of dogs have particular implications for children. When asked about the loss of a dog in childhood in a university course on death and dying, a surprising number of students shared stories about lasting implications of accidental deaths of pets. One student shared that following the accidental death of her pet, “I cried myself to sleep that night. I questioned everything that I should have done or could have done. When I closed my eyes I would see his trusting big, brown eyes.”
Children have the capacity to feel lasting guilt and responsibility for the accidental death of a dog, even when they are not responsible. However, sometimes children are directly responsible for a dog’s loss or death. This scenario is typically the result of an adult failing to keep both the child and the dog safe. It is critical to a child’s short-and long-term well-being that she does not have dog care responsibilities beyond her abilities. Accidental losses and deaths can be the unfortunate consequences of expecting a child to perform dog care duties beyond her physical and cognitive capabilities, and with that comes a potential lifetime of undeserved guil In addition to imposing an unfair burden of guilt on a child, an accidental death or injury to a dog can be a traumatic experience for a child. With the increasing awareness of the impact of childhood trauma (Substance Abuse and Mental Health Services Administration 2014), professionals and other caring adults should be concerned about a child who has experienced or witnessed the accidental death of a dog. Again, the salient point is not that a dog died in a traumatic way but that a loved one died in a traumatic way; to many children (and adults), the distinction between a dog and a human is less important than the nature of the relationship. The loss of a valued relationship is a loss, regardless of whether the loved one had two legs or four; the impact of trauma needs to be considered when that loss is seen as preventable, unexpected, off-time, and/or disturbing to witness (Cohen and Mannarino 2011).
Prevention is the best course of action when considering accidental deaths of dogs and the impact on children. Many “accidental” deaths (and lost dog losses) are easily prevented. For example, a dog who is safely in a fenced yard or being walked on a leash is unlikely to be hit and killed by a car, or to simply disappear from a child’s life.
Carelessness with a beloved dog can interfere with relationships across a lifetime. One older adult shared that his puppy was being watched by grandparents and was accidentally killed after the garage door fell closed on it; his relationship with his grandparents never recovered. Adults may not appreciate the potential implications of an accidental death or loss of a dog on children.
However, adults who are made aware of the potential impact may be willing to manage the family dog(s) in different ways; although sometimes difficult, these types of conversations with adults are important to have for the sake of children—and the dogs.
Some dogs die unassisted deaths from natural causes. Although lacking the potential trauma associated with accidental deaths, and free from the sometimes troubling implications of euthanasia, unassisted deaths may not be uncomplicated deaths in the mind of a child. The death may be sudden and unexpected, for example, or involve blood or vomit. The dog may not have peacefully died in her sleep, and her positioning or environment may reflect suffering and/or struggle.
The dog may have died alone, invoking feelings of guilt. Cause of death may be unknown, inviting fertile imaginations to run wild with possibilities. Regardless of how it occurs, the death of a dog is considered a Stressful Life Event (SLE) for a child (Coker et al. 2011). As adults consider decisions about a family dog, it is important to remember that the six-year-old will continue to process events surrounding a loss for many years.
What doesn’t concern a younger child may haunt a teenager who has the cognitive abilities to understand past events in very different ways. For example, a small child may find comfort in thinking the beloved dog has been “sent to live on a farm” but the teenager and adult that small child becomes will not only realize the truth, but will also know trusted adults are not so trustworthy after all. Decisions for a well-loved dog don’t simply have to make sense to the young child but will also need to seem responsible and appropriate to the teenager and young adult that six-year-old will become in the future. Indeed, those memories may last a lifetime;
one nearly 80-year old shared his thoughts on the loss of a dog as a child:
When I was very young, maybe six, our parents surprised us with a dog. They had dropped us four kids off to get an ice cream near Shattuck and Rose. When they came to pick us up, there was a new stranger in the car, a toy collie. But when we moved when I was eight we had to leave that dog behind, the new residents of the home would take it. I don’t recall any
special goodbye, just like leaving old furniture, or the old car which we left for those people as well. I do recall not wanting to leave, hiding in my ‘fort’ while my parents frantically looked for me as they prepared to drive down to train station, perhaps I didn’t want to leave a friend.