On Monday, our dog Casi, aged 16 years and 9 months (almost 109 in human years!) was euthanized. Her weight had dropped from 53 lbs to less than 40, she was hardly eating anything (not even freshly cooked meat) and her mobility was increasingly limited. A week and a half prior, it took an hour and fifteen minutes to walk a mile and a half, and her enjoyment of water had been reduced to just standing in puddles and streams. But she still had spark in her eye and whenever we went out she was still eagerly following the First Rule of Dogdom - never let them leave you behind.
She had gradually declined over 2-3 years. Being a lab-mix, she loved water activities. Canoeing, kayaking, paddle boarding, hiking in the forest and cooling off in puddles and streams. From a kayak or paddle board she would just jump in the water. In a canoe, she would endlessly go back and forth, looking out on the left, then looking on the right, over and over. But the sport she loved the most was cross country skiing, because in the winter it’s cool enough that a dog can run and not get hot, and cross country skis match the speed of a dog’s trot.
Casi was by far the most wag-tail dog I ever met. If she was awake, her tail was incessantly wagging and it even thumped a bit when she was asleep.
In the last months of her life, every day we took her someplace special so she could stand or meander a little and just watch the world go by. She reminded me of my father. On his last day of life he wanted to go look out on the countryside, so we loaded him into the car and went out to a promontory over Heidelberg (he was living in Germany). We just sat and watched time pass. I think he willed himself to die later that night.
We were worried that Casi would have some kind of fall or not be able to stand up, leading to a crisis. Casi’s regular vet had suggested, a few weeks prior, that there’s merit to “leaving on a sunny day”. As things looked increasingly bleak, we picked a day in order to avoid a crisis, a date now forever in my calendar as Casi’s Day.
The hardest part about the whole process, for me, was that in the weeks leading up to her last day she seemed to know where things were headed. Happy when we took her to places she liked, but subdued as if lamenting that she no longer had the energy to explore or track down all the interesting smells. And have you ever wondered how much more interesting it might be to walk a dog if we humans could smell all the things that dogs can smell? Well,...maybe those smells wouldn't be interesting!
A few years earlier, Casi witnessed the euthanasia of Simon, a cat, who was already in his teens when Casi came along. So I think Casi knew why the euthanasia vet was at our house. Casi investigated the vet’s things, which surely smelled of the last day for other dogs and cats. As we hugged Casi for the last time, I noticed that she had tears in her eyes, which was most unusual because she never had much mattering around her tear ducts. I think she knew it was our last goodbye, that she would be carried out to never return. Her heart was breaking, just like ours. The vet said that some dogs really do seem to know.
Euthanasia for humans is highly controversial in the United States and around the world. Two months ago, the New York State legislature passed the Medical Aid in Dying bill, which has not been signed by Governor Hochul as of this writing. The delegates of the Medical Society of the State of New York were closely mixed on supporting this bill (they did), I was among the dissenters.
I really have no issues with persons having the autonomous authority to choose to die. We must accept that forcing a patient to stay alive can do more harm than allowing them to choose the place and time of their death.
My problem with euthanasia laws is that I think euthanasia should be constrained to specialists (who, in my mind need not and maybe should not be physicians). Moreover, physicians who practice the healing arts should be prohibited from performing euthanasia. That’s because, when someone is gravely ill, the single most important thing in a doctor’s “little black bag” is the patient’s Belief that the doctor will save their life. When patients give up, death is imminent. Maybe it happens, but I never saw medicines save the life of a patient who had given up. The will to survive is somehow very potent.
To keep patients from prematurely giving up, patients who are critically ill need to know that their doctor isn’t going to give up on the patient and that the doctor is not allowed to perform euthanasia. Euthanasia policy cannot compromise the will to survive. This is why euthanasia services should be provided through a limited specialty service. I care less about policy on how one gets "approved" for euthanasia, as that is just procedure.
Many physicians get upset with the word euthanasia, but I personally find “medical aid in dying” to be a semantic attempt to wash one’s hands of responsibility. “Medical” is an adjective denoting a relationship to the science of medicine or the treatment of illness or injury, and thus is incongruent with “aid in dying”. Termination of life is euthanasia, not a medical treatment.
Lastly, I see no reason why a euthanist need be a doctor. Not to start the IV, nor to push the drugs, and there is no pharmacologic exactitude that would require a physician’s training in dosing drugs – these are massive overdoses intended to terminate cardiorespiratory functions. Yes, euthanists should be well-trained, so that the procedure is humane, without suffering and completely effective without fail. It would be a very bad day if someone ended up not fully unconscious and in respiratory distress, or still alive after having experienced severe cerebral anoxia. Having a physician’s license won't confer perfection on the process.
Animal euthanasia is done with assiduous care. There is little reason to think it can’t be done just as well for us humans, with our loved ones gathered together to say goodbye. But euthanasia policy must not compromise the patient-physician (or patient-nurse) relationship as an unintended consequence.
In Part II, I’ll address the issue of diminishing physical functioning and quality-of-life, which played a major role in Casi’s decline and our decision to have her leave us on a sunny day.
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