Natural Death and Euthanasia: Finding the Middle Ground

Over the past decade, hospice care for companion animals has become increasingly available. I cannot say enough good things about animal hospice. It offers a tremendous benefit for our animals as they grow old or very ill, because it enables us to see that a terminal diagnosis or the disabilities of advanced age are no reason to throw in the towel on our animal, and that care extends far beyond simply trying to cure. Hospice places before us an array of treatment possibilities other than euthanasia. As animal hospice becomes more prominently recognized, it is worth giving some thought to the notion of "natural death" because hospice is often embraced by those who desire a natural death for their animal.

My sociologist friend Leslie Irvine called me recently because her 20 year old cat, Ms Kitten, was dying, and she wondered if I would like to visit with Ms Kitten before she passed. Unfortunately, Ms Kitten died before I got there, but Leslie talked with me about Ms Kitten's death and shared an account of Ms Kitten's last few days:

"When she began to show signs of declining, Marc and I agreed that we would not euthanize her unless she was suffering. We wanted her to exit life naturally. We did not need her to hurry. We were not afraid of seeing her die. We talked about how we might know the point of suffering; cats can be very stoic. We watched her closely for signs of pain. We also watched to see if she wanted to withdraw. To the end, she seemed comfortable being near us. She never flinched or had trouble breathing. I wonder now if the way she wandered around on Thursday was a form of 'terminal restlessness.' But it did not seem like distress or struggle. It was more like what she had always done, only more slowly and with pauses here and there."

Leslie wanted Ms Kitten "to exit life naturally." When I asked her why, she said that she believes we should let an animal live out its full span of life. And I find something dignified and right about Ms Kitten's death. She died as close to a "good death" as I can imagine: she did not seem to be in pain, she was surrounded by loving companions, and she just stopped breathing. For Leslie and her husband, a natural death was preferable to euthanasia, though they were willing and ready to take that route had she been clearly suffering.

Dying can be a time of opportunity. And for some people, the value of natural death is explicitly one of spiritual opportunity, as a time of transition from one kind of being to another. Although we cannot know what goes on inside the minds and hearts of our animals, perhaps we should be open to the possibility that they, too, might experience something profound as they die.

But I also think "natural death" can be taken too far, if we use "natural death" to denote some particular kind of death, as opposed to "unnatural death" (or some such). All death is natural, whether it takes place in the wild under the stars, on a cold metal table, or on the family couch. Death by euthanasia is every bit as natural as death by starvation, dehydration, or multiple organ failure. And we have, from the moment they enter under our care, such utter control over every aspect of our animals' lives and deaths that I'm not sure we can ever really, truly "let nature takes its course."

We can certainly simplify the moral terrain by placing natural death and euthanasia in opposition. If we commit to natural death in this sense, then our responsibilities are limited to standing by our animal and offering comfort as they die. But moral simplification is not what we want when it comes to end of life care for our pets.

Veterinarian and palliative care specialist Robin Downing told me during an interview that she has sensed, within the animal hospice world, an undercurrent which espouses translating and applying the exact same principles of human hospice to our animals, including an absolute prohibition against euthanasia. "Unconscionable!" she said to me. "Euthanasia is available and we have the liberty of applying it with animals. And we must. It is the ethical thing to do." In her view, the pendulum has swung from "let's euthanize today" to "natural death." And she doesn't like it. We need to move back toward the middle, toward a more balanced place. I asked her how many animals she has had die natural deaths. In 25 years of practice, she said, "not many." It just doesn't happen very often that natural death is in the interests of the animal.

If, as death unfolds, an animal is suffering considerably, then euthanasia is perhaps the humane path. How we define and judge "considerable suffering" is, of course, the nub of an irritating problem, and some people may be better at reading signs of animal suffering than others, or some animals better at signaling pain. Our own subjective values as pet companions will undoubtedly color our vision; if we are strongly committed to natural passing, perhaps we will "read" signs of suffering differently-as "signs of a transitioning soul" rather than "signs of an animal in torment."