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Published in: Medicine, Health Care and Philosophy 1/2022

Open Access 01-03-2022 | Care | Scientific Contribution

Dying like a dog: the convergence of concepts of a good death in human and veterinary medicine

Authors: Felicitas Selter, Kirsten Persson, Johanna Risse, Peter Kunzmann, Gerald Neitzke

Published in: Medicine, Health Care and Philosophy | Issue 1/2022

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Abstract

Standard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be ‘put to sleep’, while veterinarians have begun to integrate principles and practices from hospice care. We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the (dis)analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the (animal and human) patients’ wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care.
Footnotes
1
The terms pet, companion animal and animal will be used interchangeably throughout this article, unless explicitly indicated otherwise. Animals in the focus of our interest will be those sharing a close emotional relationship with their owners, therefore, such as dogs and cats.
 
2
It may be argued that species membership constitutes a morally relevant difference, making efforts to compare the good death ideals of human with veterinary medicine obsolete or at least uninteresting due to the lack of practical implications. We do not take this to be true for at least two reasons. For one thing, this issue remains one of the most heatedly debated in philosophy. The possibility that some human and animal end-of-life situations may in fact have equal ethical implications due to their morally relevant similarities should not be dismissed lightly, therefore. Furthermore, even if someone is personally convinced that there are morally relevant dissimilarities between all animals and all human beings, a descriptive analysis of how corresponding good death ideals or end-of-life situations change and influence one another, is important in its own. Modern palliative medicine acknowledges a patient’s right of self-determination as well as individual values and worldviews. It should be prepared to being frequently confronted with quite different views on these matters, therefore. We will get into more detail on two aspects where species membership could and has been argued to (not) constitute a morally relevant difference below.
 
3
When referring to dying or the dying process, we will typically have in mind the last days or hours in the life of an individual, unless indicated differently. Our focus in this paper is not so much dying as a preparedness to one’s death or the acceptance of one’s mortality—even though these points will be mentioned and discussed throughout the paper—but dying understood as the very last phase of life. Death will be understood in a comprehensive way. A good death encompasses many more aspects in our understanding, thus; including, but not limited to, the very last moments in an individual’s life.
 
4
In fact, Radbruch et al. acknowledge that due to incompatible normative frameworks among European palliative care providers, full consensus on these matters will be unachievable. For instance, there is considerable dissent among the members of the EAPC on whether the provision of euthanasia and physician-assisted suicide should be integrated into the practice of palliative care, or whether they constitute opposites (see Radbruch et al. 2016, supplemental material, Table 1). For this reason, the palliative good death ideal that is being described here and hereafter should not be mistaken as a consensual position among European palliative care providers, but as one (albeit prominent) position.
 
5
This paper is concerned with euthanasia, but most deliberations also apply to physician assisted suicide (PAS). As our focus here lies on the comparison to veterinary medicine, we will not go into detail of morally relevant similarities and dissimilarities between euthanasia and PAS.
 
6
Radbruch et al. (2016) emphasize that wishes to die should not be taken at face value as they are complex, often ambivalent and require a careful and sensitive communication with the patient. This issue is of high ethical and practical relevance, but what we are interested in here is what this passage tells us with regard to more general views on the patient’s quality of life within the palliative good death ideal.
 
7
Whenever we will speak of a ‘natural’ death hereafter, we will refer to this understanding. ‘Natural’ death thus will be used as a shorthand for a non-hastened, non-prolonged and non-induced dying process. It does not refer to the withholding of pharmaceuticals, symptom management, medical technology or the like.
 
8
The article is no longer included in more recent editions.
 
9
The terms pet owner, caregiver and client will be used interchangeably, as they typically refer to one and the same person.
 
10
Untreated dogs have an average survival time of about one month, whereas chemotherapy leads to a life prolongation ranging from 2 to 24 months (Stephens 2019, p. 2).
 
11
It is interesting to note that these statements also reveal an uncertainty about whether both situations can and should be regarded as analogous or not.
 
12
The view of the moral irrelevance of species membership does not necessarily lead to a pro-euthanasia attitude. Jessica Pierce takes an assimilationist position on the matter, challenging not only our reluctance in euthanizing humans but also our lack thereof when it comes to killing animals. According to her, we should probably be more open to euthanasia in case of humans and more reluctant in case of animals.
 
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Metadata
Title
Dying like a dog: the convergence of concepts of a good death in human and veterinary medicine
Authors
Felicitas Selter
Kirsten Persson
Johanna Risse
Peter Kunzmann
Gerald Neitzke
Publication date
01-03-2022
Publisher
Springer Netherlands
Keyword
Care
Published in
Medicine, Health Care and Philosophy / Issue 1/2022
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-021-10050-3

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