Introduction
One enduring question in palliative and supportive care is who remains present to offer comfort and companionship amid loneliness, suffering, and grief. Clinical assessment appropriately considers symptoms, prognosis, treatment preferences, advance directives, and available caregivers. These assessments may not fully capture the relationships that sustain a person in everyday life. This is particularly important when serious illness progresses, and conventional assumptions about family, marriage, and caregiving no longer adequately describe a patient’s circumstances (Zheng and Ni Reference Zheng and Ni2025).
Living alone does not necessarily equate to experiencing loneliness, although depression remains prevalent among older adults who live alone (Zheng and Ni Reference Zheng and Ni2025). People may live alone because of widowhood, separation, migration, personal choice, or lifelong singleness. Some have never had a boyfriend, girlfriend, spouse, or long-term romantic partner. Conversely, living with other people does not necessarily mean experiencing meaningful companionship. The clinically relevant question is therefore not simply whether a patient lives alone, but who belongs to the patient’s community of accompaniment.
Companion animals encompass domesticated or captive-bred animals kept within a community to provide companionship, enjoyment, practical assistance, or psychological support (McGhee et al. Reference McGhee, Dempster and Graham-Wisener2022). Companion animals are an important but often overlooked part of this relational landscape (MacDonald and Barrett Reference MacDonald and Barrett2016). Research in other healthcare settings has associated companion-animal relationships with coping with stressful life events, reduced loneliness and depressive symptoms, greater engagement in activities of daily living, and increased social interaction. Emerging research in later life has also examined associations between dog ownership, physical activity, mental health, and healthy brain aging (Adams et al. Reference Adams, Murray and Bauman2025; Potter et al. Reference Potter, Martini and Sands2026). Although these findings should not be interpreted causally or as evidence that pets replace human or professional care, they suggest that human–animal relationships deserve greater attention in palliative contexts (McGhee et al. Reference McGhee, Dempster and Graham-Wisener2022).
A recent study of 97 undergraduate students found that 62% believed pets behave unusually when their owners are approaching death (Claxton-Oldfield et al. Reference Claxton-Oldfield, Agnew and Allen-Tanner2025). This does not establish that animals can predict death. Rather, it illustrates the cultural and relational significance people attach to animals at the end of life. The more important palliative question is what these relationships reveal about presence, vulnerability, dependency, and accompaniment.
Companion animals within the patient’s relational world
Palliative care has progressively expanded from disease management toward multidimensional attention to physical, psychological, social, and spiritual suffering (MacDonald and Barrett Reference MacDonald and Barrett2016). Nevertheless, the patient’s social world is often documented primarily through human relationships. Companion animals may therefore remain clinically invisible even when they occupy a central place in the patient’s daily life. Kabel et al. (Reference Kabel, Khosla and Teti2015) identified three key themes in the human–animal bond: pets as spiritual companions, sources of unconditional support, and providers of purpose and meaning in life.
For some patients, an animal provides routine, physical contact, emotional security, and a continuing sense of responsibility. Feeding, walking, grooming, or simply sharing domestic space can structure a day increasingly disrupted by illness. For a person living alone, the animal may be one of the most consistent forms of companionship available (Kabel et al. Reference Kabel, Khosla and Teti2015).
This relationship should not be reduced to the language of therapy. A companion animal is not necessarily valuable because it produces a measurable clinical outcome. Rather, the relationship may matter because it is part of the patient’s ordinary life. An intervention is something performed for a patient; a relationship is something lived with another. Asking about a pet may consequently provide insight into home life, attachment, identity, routine, responsibility, and sources of meaning.
The relational significance of companion animals can also extend into bereavement. Plys et al. (Reference Plys, Smith and Portz2022) observed that the effects of bereavement following a resident’s death extended to family members, friends, and pets who had shared a meaningful relationship with the deceased. Such observations challenge an exclusively human-centered understanding of the patient’s relational network.
Caring for the patient includes caring about the animal
The presence of a companion animal becomes particularly significant when advancing illness threatens the patient’s ability to provide care. An anticipated question such as, “Who will take care of my dog?” may appear secondary to pain management, prognosis, or treatment decisions. For some patients, concern about the animal’s future is inseparable from their own end-of-life experience (McGhee et al. Reference McGhee, Dempster and Graham-Wisener2022).
Cooney et al. (Reference Cooney, Kogan and Brooks2021) examined pet owners’ expectations regarding end-of-life support and after-death care for their animals. Their findings highlight the practical and emotional importance of planning for what will happen to a companion animal. For patients living alone, this concern may be especially acute: the patient may be the animal’s sole caregiver, while the animal may be the patient’s most constant companion.
Veterinary hospice provides a useful relational parallel. Bishop et al. (Reference Bishop, Long and Carlsten2008), describing the Colorado State University Pet Hospice program, demonstrated an approach to end-of-life care that attends not only to the animal but also to the people emotionally and practically connected to it. The model recognizes the dying process of an animal as a relational experience. Human palliative care can draw an analogous lesson: if veterinary hospice considers the human relationships surrounding a dying animal, human hospice should also recognize the animals that may surround a dying person.
This recognition does not mean assigning animals the same clinical status as patients or expecting palliative professionals to provide veterinary services. It means acknowledging the animal when it materially affects the patient’s wellbeing and care planning. Relevant questions include: Who will care for the animal during hospitalization? Who can assume responsibility if the patient becomes unable to do so? What arrangements are needed if hospice care begins? What will happen to the animal after the patient’s death? These questions are not peripheral to end-of-life care. For some patients, they are part of end-of-life care.
Animal-assisted interventions should likewise be interpreted cautiously. Scagnetto et al. (Reference Scagnetto, Poles and Guadagno2020) examined anxiety and depression in end-of-life care and found that responses to animal-assisted intervention may vary according to individual characteristics, including gender and pet ownership. The significance of companion animals therefore cannot be reduced to a uniform therapeutic effect. Their contribution may be psychological, relational, existential, practical, or some combination of these.
Companion animals and the meaning of accompaniment
Companion animals also invite palliative care to reconsider the relationship between autonomy and dependence (McGhee et al. Reference McGhee, Dempster and Graham-Wisener2022). Autonomy does not require independence. A person’s ability to make meaningful decisions is different from the ability to live without assistance. Human life is characterized by dependence from its beginning and often increasingly so near its end. Yet healthcare systems can unintentionally frame dependency primarily as a deficit.
Human–animal relationships make another possibility visible. A person’s diminished mobility does not necessarily diminish the animal’s attachment (Cooney et al. Reference Cooney, Kogan and Brooks2021). Physical weakness does not make the person less worthy of relationship. The reciprocal character of the relationship is not symmetrical – the human provides food, shelter, protection, and care, while the animal may provide companionship, routine, affection, and presence – but this asymmetry does not make the relationship insignificant. Instead, it demonstrates that dependency can coexist with dignity and vulnerability with relational worth (MacDonald and Barrett Reference MacDonald and Barrett2016).
This insight is especially important for people without conventional caregivers. A lifelong single person may have no spouse or partner and may have only distant relatives or a limited social network. A person living alone may nevertheless have rich relationships and meaningful social connections. Conversely, someone surrounded by others may experience profound isolation. A companion animal may provide genuine companionship, but it cannot substitute for professional or community support (Kabel et al. Reference Kabel, Khosla and Teti2015).
Rather, the animal should prompt further questions: Who will support this person as illness progresses? Who will care for the animal? Who will notice deterioration? Who will respond in a crisis? Who will remain present when the patient’s independence diminishes? These questions point toward a broader concept of a community of accompaniment. Such a community may include relatives, friends, neighbors, faith communities, healthcare professionals, volunteers, and companion animals. This framework avoids pathologizing lifelong singleness while also acknowledging that relational vulnerability can exist regardless of marital status.
Conclusion
Companion animals occupy a significant place in the lives of many people, yet their role remains insufficiently considered in palliative and supportive care. Evidence from other healthcare settings suggests potential associations with coping, loneliness, mood, daily functioning, physical activity, and social interaction, while emerging palliative literature highlights the emotional and practical importance of human–animal relationships. These findings warrant attention without overstating causality or positioning animals as substitutes for professional care.
The deeper contribution of companion animals may be conceptual rather than merely therapeutic. They remind palliative care that accompaniment is not confined to conventional family structures and that relationships of significance may extend beyond those documented in the medical record. Living alone is not necessarily loneliness, and lifelong singleness is not social deprivation. What matters is the network of relationships through which a person experiences belonging, responsibility, meaning, and presence.
Future studies in palliative assessment should therefore ask not only who is the next of kin, but also who is part of this person’s community of accompaniment. Where companion animals are integral to that community, their welfare and future care may appropriately form part of psychosocial assessment and advance care planning. Collaboration among hospice professionals, social workers, veterinary professionals, animal-welfare organizations, community volunteers, and faith communities may help address practical vulnerabilities that otherwise remain unseen.
At the limits of curative medicine, accompaniment becomes one of the most important forms of care. Companion animals cannot cure, replace professional support, or eliminate the vulnerabilities of dying (MacDonald and Barrett Reference MacDonald and Barrett2016). They can, however, provide continuity, routine, attachment, and presence. Ultimately, they remind us that care does not always require a solution. Sometimes, its most meaningful expression is simply to remain present and stay.
Acknowledgments
None.
Funding
This essay received no specific grant from any funding source.
Competing interests
None.
Open access
