Research has revealed that cat caregivers emphasize the need for empathy when it comes to their pets more so than caregivers of dogs. This is so much the case that those with cats tend to use the pronoun “we” when talking to the veterinarian about their pet’s health. Those who have dogs, on the other hand, use the pronoun “I.”
It shouldn’t be surprising, then, that the new “Feline Hospice and Palliative Care Guidelines” put the spotlight on giving cats as much agency as possible in deciding how their final days, weeks, or months will go. “Cats can and do express preferences that can help to guide end-of-life caregiving decisions,” say the guidelines, released jointly by the American Association of Feline Practitioners and the International Association for Animal Hospice and Palliative Care. And it is a moral imperative to respect them and afford your cat as much autonomy as possible when she transitions from having an illness that can be cured to one in which the aim is simply to keep her as comfortable as possible until she takes her last breath.
For instance, you may want to help your cat live longer, but your pet may not have the will. You should not “impose” care in the form of medicine and other treatments, the guidelines say. You have to assess her willingness to participate in her own care.
This is more than a touchy-feely platitude. The guidelines state emphatically that your cat’s emotional health is as important as her physical health and even impacts her physical health. A cat made afraid or anxious will literally feel more pain, and that pain in turn will reinforce her fear and anxiety. It’s a vicious cycle that will only serve to make her discomfort spiral. Minimizing what the cat perceives as a threat or assault, by contrast, helps control pain.
Another way of putting it: If forcing medications or painful wound care on a cat makes her feel distressed to the point that she may “exhibit protective behaviors” such as trying to get away or trying to keep you away, you will have only made things worse by violating her autonomy. You either have to find a more acceptable way of administering care or let it go. “On balance,” the guidelines say, “the benefits of proceeding must clearly outweigh any potential harms or burdens to the cat.”
Beyond medical treatment
As you continually reassess your cat’s will to live and work to optimize her quality of life as she goes along, it’s important to make her environment as conducive as possible to her condition and situation. There’s no downside to this part of hospice care, as you can tend to it without stressing her or filling her with dread. Yes, such changes have to be decided on against the backdrop of considerations about your financial resources, your time, and your emotional reserve. But beyond that, it is simply a matter of adjusting your pet’s environment to increase her comfort and feeling of safety. To that end:
- Keep resources for resting, sleeping, eating, scratching, and toiling within easy reach. A cat’s environment may shrink as she loses the ability to get around, and that means you may have to move things in your home, perhaps from the second floor to the first. A lot of times, a sick cat will want her resources (other than her litter box—there should be one on each floor of the house) right where you spend the most time. Perhaps that’s the living room or family room. Think of that room as you would a room with a hospital bed for a person who can no longer take care of themselves. Everything they need is right there.
- Keep in mind that options for hiding increase a cat’s coping ability. Since your cat may no longer be able to run to her usual hiding spots, have some right where she spends most of her time in the form of an igloo bed, a high-sided box, or a carrier decked out with a cozy blanket and soft toys. Two or more hiding spots are better than one.
- Consider getting your cat a heated bed. Cats like the ambient temperature higher than we do even when they’re not sick (86 to 100 degrees, which is why you’ll often see a cat stretched out in sunlight). A higher temperature becomes more important for a cat who has become less active and more frail.
- Think about what you can purchase to make your cat’s life easier: perhaps a horizontal scratching post to replace the vertical one that she can no longer use because she can’t stand on her hind legs, or sturdy pet steps or a ramp to help her reach elevated areas. Access to high-up places is so important to a cat’s emotional comfort.
- Scoop out the litter box more often (they don’t appreciate going in when there are solids there), and also clean the litter box and put in fresh litter more frequently. Sick cats may urinate more often and void larger amounts of urine. Of course, you may also need a litter box with a lower “lip” so your cat can enter and exit more easily.
- Consider switching to multiple small daily meals rather than two larger ones. Stomach capacity is often reduced in a sick cat. Additionally, never force feed, even if you are worried about your pet’s calorie intake. Not only will that increase your cat’s distress, it will backfire by creating food aversions, making a tenuous eating situation worse.
- Do not introduce new scents into your home. A cat’s olfactory system is connected to her brain’s limbic region, which is associated with emotional processes. New odors can prove stressful and discomforting at a time that she needs things to be predictable.
Taking these steps will ease your cat’s end-of-life journey and respect the strong bond you have built with her over the years. To see the guidelines in full (with pictures of cats before and after they received the end-of-life care they needed and tips for how to make administering medication more acceptable to your pet), head to the website of the American Association of Feline Practitioners (catvets.com), click on the “Practice Guidelines” tab, and then on “2023 AAFP/IAAHPC Feline Hospice & Palliative Care Guidelines.”
Note: The new guidelines on feline hospice and palliative care make several references to people’s spiritual needs while their cat is dying and refer to the “disenfranchised grief” many feel once their cat passes—a term for those who do not get the necessary support from people in their circle because the grief they experience is not deemed legitimate. Next month we will address that grief and the ways in which veterinary chaplains are helping to bring bereavement over a pet’s death out of
the shadows.
