top of page

Key concepts in (animal) palliative and hospice care

  • Sieske Valk
  • Nov 10, 2025
  • 6 min read

Updated: Jan 3

Black and white photo of a white cat sleeping in front of a radiator
Keeping my boy comfortable next to the radiator for as long as possible

In sensitive life-and-death conversations, language is everything

Having been a member of the International Association of Animal Hospice and Palliative Care for years, I always had a clear understanding of the two concepts when speaking to fellow members. But as I went into the real world, talking about the importance of the two, I encountered a misunderstanding about what they actually meant. Everything that I spoke about and did was brushed onto that big pile of end-of-life. Perhaps more poignant, I found that human physicians use ‘palliative’ and ‘hospice’ interchangeably, often speaking of terminal patients in the last few days of their lives, as being in palliative care. If medically trained people, human and veterinary, are associating the two terms with the end of the patient’s life, how can we have an informed conversation with the latter or their caregiver about the impact of palliative care on longevity, when all they hear is: “You have come to the end of your life”?


Below are a few key concepts I want to go into deeper, which help you in understanding my choice of language, before I delve into the matter deeper in the following weeks.


Palliative care

Having myself tried to omit the term ‘palliative’ for a bit to not scare caregivers off, I have slowly seen people speak out more and try to educate others. One of such is Shea Cox (one of the OG Hospice Vets), who did a great job in this Death Vet Diaries newsletter. Shea also gives great guidance to veterinary practitioners when it comes to communication around diagnoses, prognoses and possible therapies. I highly recommend reading this newsletter’s edition and listening to this Mostly Death Stuff podcast episode with Shea. 

I also love Palliative care physician BJ Miller’s description, as “The interdisciplinary pursuit of quality of life”. 

So, whether you’re terminal or suffering from a temporary or chronic condition, palliative care is accessible to you. It’s the care and symptom management that comes alongside the active treatment of a condition.


Hospice care

Hospice care organically follows palliative care when treatment is considered futile. The aim of hospice care is to keep the terminal patient physically and emotionally comfortable and spiritually supported. Additionally, caregivers are supported during this phase, too, with hospice carers being able to offer respite care when a caregiver needs a break. Hospice care can happen in a physical space such as a hospice centre, but often, it happens in the comfort of a patient’s home. 

In short, palliative care ≠ end-of-life care. Hospice care = end-of-life care.

Interdisciplinary care

I would like to stress the interdisciplinary part in BJ Miller’s quote. Just like in hospice care, medical treatment and comfort care are only parts of the package. They also include (but are not limited to):


  • Emotional support, such as from a bereavement supporter, or a friend who is a great listener (but isn't trying to solve your "problem"!) or a Death Doula

  • Psychological support, such as a psychotherapist/counsellor who can put your emotional reactions to loss in perspective with other events in your life, give you tools, and guide you through your emotions

  • Non-allopathic (non-Western) pain relief and therapies, such as herbal medicine, Traditional Chinese Medicine and Ayurveda, acupuncture, and massage

  • Manual therapies, such as physiotherapy and massage 

  • Practical support such as legacy planning, cooking or cleaning

  • Occupational Therapy, supporting you or your pet to be more comfortable in the home and routine (n.b. OT is a protected term and currently not a recognised profession in vet med)

  • Spiritual guidance, such as from a priest, pandit, imam, Buddhist philosopher or humanist guide


All these practices and modes of support are equally important to the quality of life of the patient and their caregiver(s). This support can come from professionals or the community. As Meier writes in Awake at the Bedside: 

Palliative care should be provided by a team. [...] Palliative care should be structured to provide an extra layer of support. [...] Everybody understands that you need an added layer of support in this broken healthcare system. Palliative care shouldn’t take anything away, and it shouldn’t ask people to give anything up.” (Meier, 2016)

Although this quote speaks of a broken North American human healthcare system, I would argue we could apply it to the veterinary sector as well. Veterinarians have been regarded as the gatekeepers of all knowledge and care when it comes to keeping companion animals comfortable when chronically ill or at the end of their lives. Yet, time and again, I hear about pets not being prescribed pain relief for age-related osteoarthritis or veterinarians telling willing caregivers that diet is the only therapy for an IRIS-2 diagnosis. Navigating and managing holistic palliative and hospice care is a skill, or rather a speciality, similar to in-home care. I would say we shouldn’t even expect all GP veterinarians to be able to be a coordinator, educator, facilitator, caregiver, emotional and spiritual guide. They are under enough stress as it is! It’s people like those behind Love, Baxter and Tanya’s Comprehensive Guide to Feline CKD who are questioning business-as-usual, and are providing evidence-based education to the caregiver directly and links to a network of professionals who can support a family. Being able to spar with several people, including the veterinarian, and receive guidance, as I have been receiving since Lewis’s CKD diagnosis, is so important for that feeling of control and the comfort of the patient concerned. In the end, this will help the caregiver feel like they have done everything in their power, and have a support system to keep them accountable when the time comes to euthanise.

A clump of trees at midnights under a starry sky
Our own little clump of trees on the farm during a clear sky night

End-of-life doula

You have probably heard of birth doulas before, and possibly about death doulas. But what are they? ‘Doula’ comes from the Modern Greek word doulē, meaning ‘female slave’ and was originally:

“a person, providing non-medical, emotional, and physical support to a woman and her family during pregnancy, birth and post-partum” (Oxford English Dictionary).

An end-of-life doula provides the same support, but on the other end of the spectrum of life: death. 


Death doulas can support a dying person in getting their affairs in order, giving non-medical support (e.g. massaging feet or combing hair), singing or setting up a rota for visits from friends and family, or just sitting with the person as they sleep or are dying. An end-of-life doula for companion animals can do the same, but in my experience, it’s generally the pet’s caregivers that death doulas support. However, I have been providing respite care to caregivers in the past, caring for a severely ill pet while the caregivers take a breather for a day.


Caregivers

I have always had an issue with the term ‘owners’ even though that is the legal term for companion animal caregivers. In Dutch, the word is ‘Baasje’ which literally translates into ‘Boss’ and gives off strong slavery vibes. ‘Pet parent’ is also something I am not accustomed to using. Not because I want to dismiss the strong bond between a companion animal and their human which can often feel like a child-parent relationship, but because of the danger of anthropomorphising the animal. 

I prefer to see an animal as its own person and species, with distinct needs that need to be considered, especially at the end of life or in illness. 

I have personally settled on the terms ‘caregiver’ and ‘guardian’, but wouldn’t pick a fight with someone if they choose to use something else. We are guardians or caregivers of the people we take care of, whether they have bare skin, fur, scales or feathers.


Pronouns

When describing an animal, just like with any human animal, I write about (s)he or they. This is because I see each animal as a person.


This view of the more-than-human world is inspired by Anthrozoology studies, which study the relationship between humans and non-human animals, and on the language used in Robin Wall Kimmerer’s book Braiding Sweetgrass in which she writes the following: 

“Indigenous ways of understanding, recognize the personhood of all beings as equally important, not in a hierarchy but a circle” (Wall Kimmerer, 2013). In that same line, I will refrain from calling an animal “it”. 

I prefer to use the pronouns she, he or they when I’m unsure about their sex.


These are just a few of the concepts that I believe are important to understand before I continue writing about palliative and hospice care. I know a lot could be said about euthanasia and natural death as well, but I’ll save that for another edition. Which concepts do you think are important to discuss, either with caregivers or peers? Let me know in the comments.


Sies.



About me

My name is Sieske Valk (pronounced as Sees-kuh Falk). I started my career as a veterinary nurse in the Netherlands. After a short stint working as a climate change researcher, I set up an animal care company in London, called Sies Petcare. This grew into Autumn Animals, the UK’s first holistic palliative and hospice care organisation. Trained as an end-of-life doula for companion animals, I supported numerous families through the autumn of their furry friend’s life, and after. I live with Lewis the cat (18) and husband Jamie, in beautiful Devon.


I currently offer research and consultancy services for veterinary businesses wanting to improve their palliative and hospice services and support their team through the challenging cases. If you’d like to have a chat about this, go to www.calendly.com/autumnanimals or autumnanimals.com.

Comments

bottom of page