Never say die? Vet and palliative care doctor join forces to encourage talking about dying well  


Doctors and vets are starting to talk together more through the WHO’s One Health initiative. But how many are comparing professional notes about supporting patients and caregivers facing the end of life?

Dr Caroline Hewson and Prof Scott Murray.

Veterinary surgeon, Dr Caroline Hewson, and Professor Scott Murray, Co-chair of the European Association for Palliative Care Primary Care Reference Group, teamed up to present a show at the Edinburgh Festival Fringe.  

This unusual show came about at the Edinburgh Festival Fringe in August 2018 because Caroline had heard about the three typical trajectories of physical decline that are now often mentioned in palliative care for humans (Illness trajectories and palliative care | The BMJ). Some veterinarians in America are already talking about those patterns and Caroline too was struck by how family pets can show the same three patterns of decline as humans, ie acute, intermittent and gradual. She now refers to these to help vets and pet-owners that are deciding how best to manage life-limiting illnesses in pets ( So, Caroline and I decided to speak together at this public event, thinking that the general public might find talking about their pets living and dying well easier than talking about their own mortality. And so they did!

The first statistic highlighted humorously to the lively audience of pet-owners and others was the fact that humans and pets all have a 100 per cent mortality rate, despite great progress in medical and veterinary sciences. And this death rate was not likely to change!

Rescue cat, Lupin, with his owner.

The second fact we shared was that pets and humans die following similar patterns of decline. For example: larger-breed dogs are prone to osteosarcomas that rapidly progress, cats frequently get kidney failure, and many of our furry friends can become frail and get arthritis. Sudden deaths are uncommon now for everyone.

The audience then spoke out about what frightens them about their own or their pet’s demise. Pain, anxiety, relationships, facing death and honesty were all shouted out. One person said she cried when her dog died but could not when her mum died. We also heard that pets, like humans, can quite often receive futile overtreatment. After heart-felt discussions, it was also good to share the fact that palliative care can help deal with all these diverse issues if help is requested early on in the course of the illness.

Take-home message for attendees

It is good to talk about the final frontier, to boldly go and discuss it, and prepare for likely eventualities … and then get on with living a full life until then. Having considered our mortality, life may be more meaningful and richer than before! Considering the likely course of events for pets can also help them receive the most appropriate treatments for them, and not necessarily everything that could be done!

Links and resources

Acknowledgement: With grateful thanks to Bruce Mason for producing some of the images used in this post.

Next week on the EAPC blog, Noreen Holland introduces Rían: The therapy dog who’s a leading member of the team at Our Lady’s Hospice in Dublin, Ireland.


This entry was posted in Palliative Care & Animals and tagged , , . Bookmark the permalink.

5 Responses to Never say die? Vet and palliative care doctor join forces to encourage talking about dying well  

  1. Katrina McNamara says:

    Many thanks for your blog and bringing the similarities between adult and
    animal palliative care to the fore.

    I’m fortunate to have had a Vet who supported palliative care for one of my
    dogs who had a mitochondrial condition, giving me the confidence to cope
    with her deteriorating health. I also work in children’s palliative care and
    could see the similarities between the pathway followed in children and the
    potential with animals and the importance of good management as for many
    their pet’s experience will be the first experience of death and possibly
    palliative care, so definitely something which fitted with the work in
    humans on compassionate communities.

    Thank you for drawing out the similarities and bringing the world of human
    and animal medicine and care closer together.

    Katrina McNamara

    • pallcare says:

      Many thanks for commenting Katrina and we are delighted you enjoyed the post. Posts from the children’s palliative care community are warmly welcomed if ever you’d like to contribute. Kind regards from the EAPC social media team.

  2. Marilyn Kendall says:

    Very interesting post, and I do think this could be a way into discussing dying and death for some people. I have two horses and my vet’s website has a very good page on end of life care. The information is matter of fact about the practicalities, but also acknowledges the challenges in decision making, and provides reassurance that I won’t have to face this on my own. My GP practice website seems to have nothing on palliative or end of life care, and doesn’t list it as a service it offers. Food for thought there!

  3. smurra says:

    Many thanks for these interesting responses. Seems like as a GP I should try drafting something to be available on GP practice websites, signposted clearly “End of life” or “Dying well” with some information and advice about having as good a death as possible in due course. Might be key points from our “How to live and die well’ video mentioned above might be a start.
    Patients frequently order repeat prescriptions and seek advice for many things using their practice website, so something about this may be appreciated by some patients and carers.
    What do you think? Really grateful if anyone can point to some examples of this from throughout Europe. No point in reinventing the wheel !

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