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Isn’t it too soon?

Thinking about the euthanasia
of the animal that has already
been in its
“Last Chapter of Life”
for awhile now.

by Hugo van Duijn

Isn’t it too soon?

The text of this thin booklet and the hand-drawn picture of Clinto, a “real Frisian Stabijhoun” have been created by veterinarian Hugo van Duijn.

Prologue

This booklet was written shortly after the time we said goodbye to our dog, Clinto. As a veterinarian, I have been giving animal owners advice for over 20 years on the most optimal moment of euthanasia for their usually old, slowly declining pets, who have started on the Last Chapter of their life. For 15.5 years I too was the owner of Clinto or - as I always called him, lovingly of course - our “ugly crossbreed”.

And then the time came: Clinto was declining significantly and the questions I had always had answers for, now also arose in me. In order to get answers I ultimately consulted myself. I gave myself the answers I had already given others for over 20 years.

As these types of questions will arise many more times, I have put these thoughts on paper in the hope that they not only will help pet owners, but also the animals. I hope that, on the one hand, this booklet will help let the animals live on for a while, possibly with help from veterinary support. On the other hand, I hope that this booklet makes a contribution, so those unnecessarily long, miserable situations won’t have to continue.

Hugo van Duijn

The quality of life in the “Last Chapter”

More and more often pet owners come to me solely to consult about the very best and optimal time to say goodbye to their declining pets. They can’t make up their minds. On the one hand they feel the time is drawing near, but on the other hand they can’t accept the idea that the time may have come. In other words, the intention is to find out how you really think about the condition of your loyal four-legged friend. This, without thoughts of how much you will miss him when he is gone, or the 100 other reasons for not wanting to loose him.

On the next few pages I will try to give some tips and suggestions surrounding this subject. It could very well be that the decision can also be that there are still options! However, this does not mean that it isn’t good to logically list all the points one by one on how your animal is faring.

What is “The Last Chapter”?

This booklet is about those animals of which we know that they have started on their “Last Chapter” awhile back, but of which we are not sure that the chapter should be closed. That it concerns the “Last Chapter” could simply be due to age. Or better yet: with the infirmities that come with old age. After all, age in itself is not a disease. A Yorkshire terrier of 8 years old is young, but may be sick. A German Bullmastiff also 8 years of age is quite old, but may be very healthy.

Therefore the “Last Chapter” can also be determined by an insidious disease regardless of the age. Some diseases in themselves are not deadly, but do create an ever decreasing quality of life. For example, think of chronic joint disease, for which pain medication is no longer adequate and which makes walking nearly impossible. Also, there are chronic diseases of which can be predicted that they will cause very acute and fatal problems at some point. The problem is that you don’t know exactly when this will occur. A frequently occurring group of diseases in this category are the heart diseases. Sometimes we can control them with medication for a very long time, but ultimately and inevitably they lead to a very disturbing death. So disturbing that you should not want to do this to an animal and that you should feel that it is your duty to prevent such suffering as soon as the first signs present themselves.

Separate types of problems that could determine the “Last Chapter” are the behavioural problems. Sometimes they have been there for a very long time, or they are getting so bad that slowly but surely an impossible situation arises – despite attempts to change this behaviour. Naturally this depends for a large part on how much the pet’s owner can tolerate. Everyone has a line that should not be crossed, the goal is not to let it get that far. The most vivid example is tolerating aggressive behaviour until a serious biting incident occurs.

The criteria for quality of life

The quality of life determines whether it is worthwhile to continue living in the “Last Chapter”, or not. The term “Quality of Life” is actually just as vague as ‘not suffering’. What are the minimum quality of life requirements? How do you measure quality of life? A lot of thought has gone into finding a method to measure this quality of life one way or another.

The Committee Brambell (1965) formulated five liberties for the animal. Being an animal must be being free from:

1. hunger, thirst and incorrect food;
2. physical and physiological discomfort;
3. pain, injury and disease;
4. anxiety and chronic stress;
5. this in order to show their natural (own kind) behaviour.

Because these liberties are also applicable to farm animals and their housing, it seems rather difficult to apply them to companion animals. With the five liberties in the back of my mind, I summarised the minimal requirements set for the quality of life of a companion animal, as follows:

“food, drink,
be happy and
be suitable
as a pet”

The first requirement: FOOD
Eating or not eating is simple to observe and body weight is easy to measure. It simply means that an animal has to have an appetite big enough so it does not loose weight and becomes emaciated. I am just assuming that good food is available. When an animal does not want to eat at all, you can postpone it somewhat by offering tasty snacks, but in all honesty this is not a good sign. Still it amazes me regularly how far some pet owners will go and have their declining pets loose weight, before they admit to themselves that their pet is not really eating properly any more. By focussing on that one small bite that is eaten in a week they say to themselves, he is eating SOMETHING, right? Often eating less is explained away with age, but strictly spoken age is not a disease. It’s the infirmities that come with age that trouble the animal. When an animal does not eat, something is wrong, and if the reason is that it feels too sick to eat, something has to be done.

The second requirement: DRINK
In all actuality also a simple requirement. Assuming there is always drink (clean water) available, it is logical that also enough should be drunk. Also in this case I am more than amazed of the blinders pet owners have on when the animal is too sick to drink. Sure, putting water in his mouth is well-intentioned, but that cuts no ice. A 20 kg dog needs one litre of water per day. This means 500 syringes of 2 ml (every 3 minutes 1 per 24 hours) and without spilling any!

Add to that the fact that sick animals often vomit or have diarrhoea, resulting in large amounts of that water coming out again. So in all reality more than that one litre is needed. Of course the difference with food is that this type of condition never takes long, because dehydration occurs very quickly. So here too: When an animal does not drink something is wrong and something has to be done.

The third requirement: BE HAPPY
This is by far the most difficult one. Here it is all about the ABSENCE of all sorts of problems, which cannot be measured very easily, contrary to not eating or drinking. This is also the reason I put all of these together. If I had listed them separately as reasons, the list would have been far too long. The problem mentioned most often is pain of course. An animal should not have pain, or certainly not too much pain. But what is too much? And how can a pet owner observe the pain of his pet? Research has shown that both pet owners and veterinarians cannot always tell very well. This is especially true with chronic pain, such as with arthrosis, and not so much with the pain of a broken leg. Nagging pain can be present for a long time and when it gets worse, it is also often called ‘old age’. The animal does not get used to pain that has been present for a while. In addition this pain makes the animal more sensitive to pain stimuli. A good way to ‘ask’ the animal if he has pain, is by giving him a good painkiller for a while and see if things get better.

Even the effect of a painkiller will not be enough at some point and, for example, if the (old) dog with arthrosis really cannot walk anymore, maybe it is time to say goodbye (or a joint prosthesis could be considered). Except for pain, which is often mentioned as the only one from a list of problems, there are many more things that should not be. Shortness of breath occurs frequently. Repeatedly I have seen (heart) patients who were very short of breath and did not have any more treatment options. And still, often something like: "But he does not have any pain...." was said. When in that case I explain that you really cannot literally suffocate the dog with love, sadly the penny drops: there is more than just “not having pain”.

With a bit of thought you could actually draw up the list of problems yourself and probably make it a long one. How would you like it if you had to vomit many times a day and nothing could be done about it? Would you like having two epileptic seizures a week despite taking the maximum medication? And if that is still acceptable, where do you draw the line? So actually you can determine very well whether you think your animal is still ‘happy’. However, towards the end of his life you often really don’t want to know. Occasionally the thought will come up, but you rather push it back quickly.

The fourth requirement: BE SUITABLE AS A PET
This business-like sounding requirement primarily concerns behaviour. The most frequent problems are aggression and being house-broken: “biting and shitting”. Not just the behaviour of the animal plays a role here, also the interpretation of the concept “suitable”. What is suitable for one individual may be unacceptable for someone else. For example, the first serious bite incident may already be unacceptable, especially when the victim is a child. Also not being house-broken is tolerated in various ways. The greatest problem with behaviour is that many pet owners feel very guilty just considering having the animal euthanized because of its behaviour – often the word ‘murderer’ is mentioned. However, I am convinced you should not efface yourself. The example of the seriously bitten child is the clearest. You should not want this to happen again. One solution could be to find the dog another home, but who is to say that another child will not be bitten there. And if this should happen: do you want this on your conscience? Belonging to the group of dogs this booklet is about, is also the biting aging dog, who, for example, starts to bite out of insecurity because he cannot hear or see everything very well any longer. You certainly cannot place such an old dog anywhere else. The old dog, which is no longer house-broken with its overly tired owner, is a more difficult case. But there are limits.

That limit is difficult to set, but if members of the family start functioning less well and everyone secretly hopes that the animal will pass away, you should ask yourself if you should wait for that to happen. The third category of behaviour is dementia. The demented animal can either be mentally absent or just very confused. For example, old dogs may stare at the wall all day long or audibly walk through the room all night and keep everyone awake. Old cats may meow extremely much without an evident physical cause. Is it desirable that nobody can sleep a wink? In addition: is an animal like that still happy? In such situations you should ask yourself if you want this to continue for the animal or for the owners. You don’t have to efface yourself with arguments such as: I cannot just put an animal that has been loyal all his life to sleep now, can I? If you make that difficult decision, it is never ‘just’, but because you see that it is the right decision for the right reasons. Only don’t confuse a rightful decision with a joyful decision!

The ‘right’ time

Except for people who are dead-set against euthanasia, almost everybody has the insight that there may come a time when it is best to euthanize a declining animal. However, determining the right time is very difficult. Pet owners will have to determine for themselves when this time has come, one way or another. The most they can do is ask someone else for advice. In order to stand behind your decision it is recommended to make that decision yourself and not, as happens so very often, leave the decision to someone else. As a veterinarian I really do not mind being asked the frequently asked question of what I would do if it were my dog, but I do tell the pet owner that my decision is not necessarily the same as someone else’s. The pet owner should not get the idea later that I said he ‘had to’. Of course this does not mean that I sometimes don’t find it necessary to steer towards a certain decision. For all that, this may also be steering towards the decision not to euthanize. As the right time cannot be calculated or made out, it will have to be a decision of the heart. Just because it is such a sensitive issue, this is very difficult. You have to try to determine how you feel about it, without being led by the thought that you really do not want to miss your animal. After all, this is one of the thoughts that don’t contribute to determining the right time. You see, the day that you can miss him will never come and if you wait for that day, there will never be a reason to stop your beloved pet’s suffering. Perhaps for that reason it is good to know that the optimal, best, right or only time does not exist. On the next page I will discuss a few considerations which nevertheless may help to determine the right time.

“Not too late!” instead of “Not too soon?”

You will never know if it is a good time. What you can find out (only afterwards) is when it was too late. So you should strive to be: not too late! This seems somewhat illogical, because if you don’t know the optimal time, wouldn’t you also not know when it was too late? That is entirely true, but there is a way to find out. Imagine what it would be like if your animal were to live another month just like the past month. It is essential that you think of everything, not just the things that went well. Be honest with yourself and also think of the things that left a lot to be desired. Of course this does not mean that an animal can’t be old. Bad vision, being hard of hearing and not being able to jump the fence are in itself no reason to end a life. When an old dog still functions well with medication or occasionally some other medical assistance, nothing’s the matter. However, if there are matters that go rather poorly, then don't walk away. Also list how bad things are going when it happens. In your reflections also involve how often something occurs and how long it lasts. Is it daily, once a month or somewhere in between? Does it last a minute or perhaps a few days? If you have really taken the time to review this month, then imagine that your pet died after a month of exactly that. At that time would you say: “He still has had a good time this month” or would you say: “That last month was actually suffering”. With the first answer it is good that you put things in perspective and you just start on your next month. With the last answer you should seriously ask yourself if you should start on that next month. Also consider: Better a week too soon than an hour too late!

“If only I found him dead in his doggie bed…”

Often I hear the owners of declining animals say: “If only I found him dead in his doggie bed” (or some variation thereof saying the same). It is good to think about what is actually said here and why. The expression that you wish that an animal one day lies dead in his bed can also be made at the earliest beginning of his life. What you mean then is: I hope that after a long and healthy life he will die in his sleep some day. In the case of a declining animal, however, that wish is no wish for the long-term. Imagine, you are still in bed early in the morning and you have not yet seen your pet that day. If you are thinking: “I wish he was dead in his bed right now” then something totally different is going on. This is actually a very direct wish. If you were to translate that wish literally, you get a much more confronting text: “I wish he was dead…”. So, on the one hand we are dealing with a pet owner who dearly loves his animal and does not want to miss him, but on the other hand wishes that this same animal was dead. This seems to really contradict itself, but I still hear people say this regularly. That they really do not entirely comprehend the meaning of their expression shows in the fact that they are rather startled when I explain what they just said. Then they will say: “Yes, ehhh, but we really don’t want to loose him!” This major contradiction can only mean one thing: the animal is doing so poorly that the owners (subconsciously) realise that it would be better if he died. They would be at peace with that, despite the sorrow. So then why be startled by my explanation?

They understand that it would be better, but don’t want to ‘cause’ it by making that awful appointment. They will feel ‘guilty’ about his death. Many pet owners even tell their pets they are sorry when I euthanize them. But acting timely is also part of being ‘a good pet owner’.

The greatest dilemma is therefore taking the initiative to putting your animal to sleep. It is so difficult that you start to hope for the easiest solution: that the animal dies in its sleep in his bed. I believe that pet owners should recognise these kinds of thoughts as a sign that it is possibly really time to say goodbye (very) soon! If you really love your pet a lot, but despite that still wish he would die, that literally should put you to thinking….

…. a backseat driver

Quite often people in your immediate surroundings give off signals that they think it is time your animal should be put to sleep. This frequently is quite aggravating to pet owners and leads to anger. They will think: “Who do they think they are? I will decide when!" This last is of course entirely true: You will decide when. Of course you can leave it at that and think … it’s easy being a backseat driver. However, do remember that usually there is something the matter, especially if you hear this more and more often. Surely not everyone is saying it to hurt your feelings. After all nobody thinks it is easy saying something like that to a pet owner and it might just be that others look at the animal’s quality of life a little different than the pet owner himself. Perhaps that is the time to be brave enough and wonder why the people in your immediate surroundings would say something like that. If you decide that things are still going pretty good, then there’s nothing wrong with that. It probably would be a good idea to reflect on what specific conditions are needed to come to the conclusion that it really can’t go on like this. The following chapter is about those specific considerations.

Not vague but specific! What do you or don’t you want?

When I see an animal of which I think that the quality of life should be considered, there is often not much needed to ‘spontaneously’ get into a conversation on that subject. Mostly I want to find out if the pet owner has thought about this before. A simple question like: “Is everything still going alright?” is generally enough. There are three possible answers. The first answer is a convincing “Absolutely, no problems!” and then a few details on what this entails. That sounds good so I leave it alone. I just confirm that old age is not a disease and hope I have contributed to the realisation that as pet owner you occasionally should ask yourself how things are going during the last chapter of your pet’s life. Not too often, just occasionally. The second answer is something to the effect of: “You can really notice he is getting very old.” Then I ask what you all can notice this on. Usually there is a list of old age discomforts and then I briefly discuss “food, drink, be happy and be suitable as a pet”. I also point out to the pet owner that the changes in the health of the animal do not necessarily have to be serious, but that it is wise to mention them anyway. After all, there are quite a few old age infirmities that can be managed well as long as you start doing so early enough. I mention this to prevent people from staying at home thinking nothing can be done anyway. Whether something is actually done is decided together of course. However, it would be a real shame if you would have wanted to do something but waited too long. Regretfully I have experienced this far too often.

It is important to remember that an animal is NEVER put to sleep BECAUSE the owner decided to visit the veterinarian. This connection does sadly enough exist in the pet owner’s mind. If there are any doubts it is always better to visit the veterinarian first. Too many animals have been put to sleep too soon because they were NOT taken to the veterinarian. The third possible answer can vary from: “We don’t think it will be too much longer” to tears. At that moment it is time to start asking more questions and possibly just make an appointment to review matters. During that conversation often vague concepts such as "I don't want him to suffer" and "as long as it stays within limits” or “he does not have to pass go” will surface. As mentioned before these types of well-intentioned criteria don’t work. They are too vague and therefore not very useable. They have to be changed into something more specific. Various examples can be given to make quality requirements more specific and you can get them started with: “I want (do not want) that” followed by something specific, something measurable. For some people this works better than the previously described “emotional methods”.

Once a pet owner told me that based on a conversation we had about her old dog with severe arthrosis, she had made up a plan. Once the day came that her dog, despite painkillers, injections, or whatever other measures, was no longer able to make it to the end of her short street walking on his own, she would put him to sleep. The thought behind this was: I do not want to wait too long and I do want to save him from unnecessary suffering. She kept her word. The owner of an 18-year old cat with a chronic kidney problem had created different criteria. The cat was quite alert, but continued to loose weight, drank a lot and changed her food intake often: one day she would not eat then she’d eat well for a week again. The owner did not feel right putting the cat to sleep after just one day of not eating. On the other hand he realized quite well that this was really the last chapter in the cat’s life and that he was obligated to take control. He decided that five days without eating a bite was the limit. If an animal due to a disease regularly has an epileptic seizure and the cause thereof is either unknown or incurable, you will have to take care of it with epilepsy medication. At an older age this medication only lasts a limited time. It will be good to think in advance about how many seizures are still acceptable to you and to have the animal put to sleep once that number is exceeded. So you determine in advance: I do not want him to suffer with more seizures than……

You can also do this when the animal cannot get up on its own anymore. Of course there is nothing wrong with helping occasionally, but how often is acceptable? Do you want to wait until you have to carry your 30-kilogram dog to the field three times per day so he can do his business? Is that 30 kilograms of importance or is it also no fun for a very small dog if it cannot walk on its own? When your cat is awfully nauseous and vomiting severely due to a kidney problem, how often do you still want to see this, or perhaps not at all anymore? It is desirable to think of something in advance, so the animal actually makes the decision. At the time the animal reaches the criteria you have set at a prior good time, you won’t be so overcome and you won’t keep making excuses to convince yourself that it is not that bad.

Which arguments count and which don’t?

To come straight to the point: there is only one argument that counts: the quality of life of the animal (in which unacceptable behaviour takes up a strange place). In addition there are many, many arguments that do not count in determining the right time. These can be arguments to have the animal put to sleep or just the opposite. In the end it comes down to the fact that you have an obligation to keep up a certain level of quality of life, but you are not required to go to great lengths – neither with apparently simple things. Where these limits lie and how far someone is willing to go with using therapies, knows huge differences (both in pet owners and in veterinarians).

The decisions should be well-considered decisions, preferably made in consultation with the veterinarian. However, the ultimate decision lies with the pet owner of course.

“He can still do so much”

There are the arguments to put a declining animal to sleep that really do not count, but which are always brought up. There are three groups: the arguments about all the things that are still going well with the animal, the arguments that have nothing to do with the quality of life and the arguments based on the comparison of animals and people. First the things that are still going well. NEVER has an animal died due to things that were still going well. Still, they are ALWAYS brought up in the consultation about euthanasia. By the way, I am also guilty of thinking this way, which you can read further down. I understand quite well that pet owners think: “He is still wagging his tail when he hears us”, “He is still eating so well”, “He does not have any pain” or: “She still plays with the other cat sometimes”. They may all be true, but they are never the reason not to put the animal to sleep. The reason to put an animal to sleep regretfully cannot be compensated with the things that are still going well. Look at it like the final examination of high school: some insufficient grades are not cancelled out simply because of other good grades. You did not flunk because you had an A in Math, but because of the F in English. So contrary to your feelings, you have to let yourself be guided by the things your animal cannot do any longer rather than by the things that are still going reasonably well or good.

“We aren’t ready yet”

Secondly there are the arguments that really have nothing to do with the quality of life of the animal. These too are nearly always brought up and they are quite understandable. They are expressions like: “We can’t miss him yet”, “We aren’t ready yet”, “I fully agree that the situation is untenable, but I have to get used to the idea”. These three examples are all about the pet owner and not about the animal. They often follow a statement that it really cannot go on and the realisation that it would be better to have the animal put to sleep. Of course as pet owner you do not want to loose your pet, but this should never be a consideration, no matter how true it is. It very much depends on the condition of the animal of how acceptable it is to still get used to the idea. Often I see that people (sometimes even repeatedly) cancel the awful appointment for euthanization, because the owner is not ready for it. Later, quite frequently in fact, follows the realisation that it has continued on too long. There are still more arguments that are separate from the animal, but which can be very emotional. Usually it concerns animals that have a higher ‘emotional value’ than the average pet. With the cat of a deceased partner, for example, the sorrow of the loss of the partner may surface again. Often there are animals that were or still are a great support to people with often major and severe problems. In addition there are people who do not necessarily experience much support from the animal, but who have so many other problems that ‘they just cannot handle’ the euthanasia of the animal as well. With all respect for the severity of the circumstances: these problems are separate from the quality of life of the animal and should never be a reason to prolong the suffering of the animal, no matter how difficult it may be.

There are also a few less severe reasons that are all about the pet owner. Often they want to wait with the euthanasia because one of the family members wants to be present. Whether this is a problem depends on the condition of the animal and how long it would take before that family member can be present. An arthrosis patient can easily wait until the daughter comes home from school. The short of breath heart patient literally does not have time to wait until the owner comes home from a business trip in three weeks. The principle of the matter is, however, that once it has been decided in good consultation that it really is not desirable to have the animal suffer, there really is not a single good reason to wait on putting the animal to sleep. What a long wait exactly entails, is somewhat flexible and occasionally adaptable to the circumstances, but no matter how long you decide to wait, also realise that you have just decided that this cannot go on any longer.

“Euthanasia is sad”

Yet another category of arguments is stemming from the comparison of people and animals. However, that comparison does not always fly. The condition of an animal paralysed from the neck down is nearly always seen as unacceptable, while this is quite different in people. Thoughts are also different on demented people versus demented animals. In elderly people there are plenty of therapeutic procedures taking place, while for animals it is often said that they are too old for extensive surgeries. You will often see people in wheelchairs, but about dogs, which are strapped to a pair of wheels due to their paralysed hind legs, people think quite differently.

On the other hand, people sometimes die in a way I would like to spare my dog. Therefore, it does not seem to be very valid to use arguments about what you would do if they were people. There is another argument that is often brought up: euthanasia is sad. I think this is mainly true for the pet owner due to his sorrow. Being put to sleep to the animal is no worse than getting a little anaesthesia injection or even an annual vaccination. If an animal gets upset because of the annual vaccination, then this can also happen with euthanasia, but not because the animal knows what the effects of the injection will be. Nothing indicates that the animal is aware of the difference between one injection or another. There are people who say that their animal knows what is about to happen. I just think that the animals are only feeling bad because they sense that the owner is upset. I also believe that animals do not realise that there will be another day tomorrow and stop to think that their life is at an end. Perhaps you can say it is sad when the animal gets nauseous as a result of the anaesthesia and that’s why I try to avoid that. Being put to sleep is certainly not as sad as continuing a situation with an unacceptable low quality of life.

Regrets

In connection with euthanasia I see two types of regret. First there are the people who afterwards regret the fact that the animal was put to sleep. Of course this is horrible, but I do think regret is often confused with sadness and sometimes anger, especially when it concerns a family member who was not sure yet and was ‘convinced’ by others. I know it is easy to say, but you should not have regrets, because you only cause more pain and sorrow than you already have.

A second and much more frequently occurring regret is the regret of having let the situation with the animal, which was already untenable, continue on (much) too long. This regret rears its head once the animal was put to sleep (or spontaneously died). For the animal the second type of regret is far worse!

Finally: the story of Clinto

Actually a decision about Clinto was made twice. The first time was when he was almost 14 years old. Clinto had a tumour in his neck, which after tests appeared to be malignant. I removed the tumour, but regretfully it came back. Or better said: it had not been removed in its entirety. So the question arose: “Are we going to operate on this strong old boy again or are we going to wait until one way or another he isn’t doing well any more and then put him to sleep?” The last part can be defended very well, because nobody is obligated to operate on such an old animal. It does not make you a bad pet owner if you think that is going too far. Life expectancy is not that great anymore purely because of the age. One business owner once described it as follows: “It is actually an investment in nothing…” At home we decided to continue anyway. The thought behind it was: age is not a disease and he is still going strong otherwise. Blood tests also did not show anything bad. To continue in the same manner as the first time did not seem wise. Clinto had an MRI done to get an idea of how much the tumour had spread. This was disappointing in the sense that the outlines on the images of the MRI scan were poorly visible. However, here too is true: you decided something and that decision does not suddenly become a bad decision simply because the results are not what you expected.

Next Clinto was operated on by a colleague, who had specialised in cancer surgery. After the surgery Clinto slept in our bed for the first and the last time in his long life, just so we could keep an eye on him. With a lot of care and pain medication he pulled through and recovered well. On examination the entire tumour appeared to have been removed.

The second time a decision was made about him was at the age of 15.5 years old. Clinto had less and less control over his hind legs even though he knew how to ‘hide’ it quite well. One day I found him in some kind of split. While whining he tried to get back on his feet without success. Anabolic drugs and painkillers had a temporary effect, because after some time had passed, my wife found him helpless like that again. We could feel that the time of saying goodbye was drawing near, but when? We have three sons and decided to use the principle of “the most votes count”. It does sound a little weird now that I am writing this down, but if you consider that each of us loved him the same and would not just vote for euthanization, I thought that was a good idea. In any case it was specific and measurable. The first two votes were in fast: two sons thought this could not go on. I had all sorts of thoughts on what was still going well: he still ate well, he drank well, he would still win in a fight with the other, much younger dog (in order to be exhausted for a half hour afterwards of course, but still). And maybe the most important: once you helped him get back on his feet, he walked faster than I!

However, when soon after that I found him in his helpless condition again, and additionally this time in a significant amount of dried up faeces, the penny dropped. I did not want him to have to try and get up crying, perhaps for hours, again. All those things that he still could do suddenly did not count anymore. We would not put him to sleep because he still ate well, drank and fought, but we would put him to sleep because of his hind legs. Still doubt reared its head, but also, immediately, the question: “If this is not enough, then what? How often exactly (being specific) did I want to find him again in the dried faeces before deciding that it had been enough? Two times? Ten times?” The answer was ZERO times. With this I became the third vote and we decided to let Clinto go. The two remaining votes did not need much convincing. We put our ‘ugly crossbreed’ to sleep at our home. Did we regret it? No, he did not deserve to suffer like that any further. Did we grieve for him? Yes, a whole lot.

© 2012 Hugo van Duijn

Published by AST Farma B.V. www.astfarma.nl

ISBN 9789081884006

Translated by: Hendrika Bonner Bonner Translations LLC

Who is this booklet for?
With this booklet we have tried to put forth some thoughts and reflections on whether or not it is time to say goodbye to your pet. An aid in coming to a wise and responsible decision for both the animal and the pet owner.

About the author Hugo van Duijn studied veterinary medicine in Utrecht. He works as a veterinarian for companion animals in the Dierenartsengroep West-Brabant [Veterinarian group] in Etten-Leur.