Euthanasia

When people hear I’m a veterinarian, they usually say, “Oh, I love animals. I would love to do that. But I could never put them to sleep.” In truth, I never had any real trouble performing euthanasia during my first years as a vet. It was always sad, but so often necessary and generally so peaceful. I cried sometimes, and took some home with me briefly at night, but from the beginning I was able to disconnect enough from the task that thoughts rarely lingered.

One night a few years ago, I dreamed I was being euthanized.

It was the most terrifying experience I’ve ever had in a dream. It was vividly real. I remember calmly watching as a butterfly catheter delivered me to blackness. There was no noise. I knew a moment of panic and suffocation. Then I woke.

Since then I’ve felt the keen edge of our awesome responsibility – to usher a life out of existence, to extinguish a light that was burning, no matter how faintly, of its own volition. I feel immense gratitude that as far as I can tell, my patients don’t see it coming, and don’t know to fight it.

Some euthanasia is black and white: suffering must be eliminated, illness is incurable, quality of life is below any reasonable standard. Others are gray. No obvious suffering, but professed inconvenience; family does not comply with care instructions; or there hovers the ever-present servant of death: lack of funds. Both the black and the gray are more difficult for me now, and I bear the weight of them at night and in the automatic way I draw up sedation, the conversations I have with owners before and after, the dwindling volume of pink solution in each bottle, and the sad bundle I can’t bear to see linger on a treatment table waiting for its paw print.

I often assume all vets are like me – always acutely aware of the immense power we carry in being able to stop a heart. Then I remember that I personally spent very little time with this idea during the first years after graduation. I was far more concerned with how to keep animals alive than with how to let them go, and all they carried with them when they went.

Of course, nurturing life and maintaining health is a much larger part of what I do every day. But I believe I underestimated, with baby vet naïveté, how much the lives we end can, and should, affect how we practice and how we feel at work. I will always view euthanasia as a gift we can give.

It’s never been a responsibility I did not want. The difference is that now, with names stacking up in a drug log, the perspective that can only come with experience, and the memory of how helplessly I waited for oblivion in my own unsettling dream, when the time comes I am always breathless, never nonchalant.  When we walk down the hall, syringes in hand, papers signed, a pale horse walks with us, and demands respect.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

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About the Author

Dr. Katie Berlin is a small animal general practitioner in Mechanicsburg, PA. She is also a reader, a rider, a runner, a lifter, a teacher, and an art lover. She graduated from Williams College in 2000 with a degree in Art History and worked in art museums before going back to school and earning her DVM from Cornell in 2009. She is an avid supporter of Fear Free practice and the battle against compassion fatigue in the veterinary profession.

Euthanasia. The word itself makes all our stomachs drop. It is a gift to pets and a curse to owners – having the power to decide is something we are not comfortable with. However, when going through the euthanasia process with your own pets, you are in a position to make numerous decisions that can change the course of the overall process.

As a Registered Veterinary Technician, I witness euthanasias on a daily basis. Let me share from personal experience the 5 things I wish every pet owner knew.

1. It’s ok to cry.

People apologize to me all the time for crying over their pets. Whether it’s time to say goodbye, or you are simply having a hard time watching us draw blood on your dog, I wish you knew that I GET IT. Many of us who work in animal medicine (myself very much included) are totally neurotic, hypersensitive, and obsessive when it comes to our own pets.

I may seem calm and collected while working with your cat, but that’s because it’s my job and I can’t afford to be any other way if I’m going to be good at it. You best believe that the second my dog so much as sneezes, I go into a total state of panic, lose all common sense, and forget everything I learned in tech school.

So, when you are crying over the pet that you have loved for years, I assure you, I have nothing but respect for you. I respect how much you care. I respect your ability to make such difficult decisions. I respect your bravery. And please know that no matter how demonstrative you may be with your emotions, you are still keeping it together more than I would be in your shoes.

2. Be there, if you can.

I am lucky to work in a hospital where the vast majority of pet owners stay with their pets for the euthanasia process. However, this is not always the case. I urge you to stay with your pets, if you can, for multiple reasons. First, for my sake. One of the absolute most difficult things I do as a Veterinary Technician is take on the role of comforting and loving a pet as they pass on when their human is not there to do so.

It is an incredible weight to try to act on your behalf, and it is emotionally exhausting in a way that I cannot even begin to describe. When you stay with your fur baby, I can focus on my own job, instead of doing both of ours.

Second, for your pet’s sake. The vet can be a very scary place for animals – they don’t understand what all these noises and smells are, or why these strangers are poking and prodding them. Do you want them to experience that fear alone? And have it be their very last memory? Your pet doesn’t know what we are doing or why – they only know that you are there, that you said it’s ok, that you love them.

I remember being a child, and how scary going to the doctor was, but how much more confident I felt with my mom there reassuring me. I imagine that is exactly how pets feel. If you can find the strength to be there, please do so. Please let your love, your touch, your presence be the last thing your pet experiences.

3. Keep the collar on.

One of the saddest things I witness during the euthanasia process is when humans take their pet’s collar off when they are still very much awake. To many pets, taking their collar off can have negative associations. For example, I know my own dog panics when I remove her collar as she knows it’s bath time! I want your pet to be as comfortable as possible, and that means not making any major changes immediately prior to euthanizing.

Pets are much smarter than we give them credit for, and they pick up on the smallest of cues. The unknown is scary to your pet, so even if they don’t know what the cues mean, the idea that something is new and strange and out of the ordinary is enough to cause them some sense of anxiety. So, keep the collar on until your pet has passed. Let them go in the state that they always were.

4. Make it a celebration.

Bring treats. Tell stories. Laugh and cry at the same time. Surround yourselves with all his/her favorite toys and beds and blankets. It’s ok to cry, and it’s also ok to celebrate! I love when people tell me they took their dog to the beach or napped in the sun with their cat right before coming in to the hospital. This is going to be one of the hardest days of your life, but it doesn’t have to be for your pet. I promise that the more you celebrate your pet’s life, no matter how long or short, the easier it will be to continue to live your own once this is all said and done.

It is ok to cry in front of your pet, to tell them how much you will miss them, to let them see you be absolutely beside yourself. I’m sure your pet has seen you at your worst before – I know mine has. But remember to celebrate, no matter how miserable you are. I promise it will make it easier for both you and your pet. What’s more, It will allow you to reflect on the euthanasia experience with positivity – you will remember that you celebrated and you will feel good about having done so.

5. Prepare.

I want this moment to be entirely about you and your pet. In order for that to be the case, several things must happen. First, you must understand the euthanasia process. If possible, talk to your vet or tech prior to coming into the hospital, or prior to starting the process – ask them to walk you through the steps of euthanasia so that you know exactly what to expect. Ask as many questions as you need to in order to feel comfortable with the process (or at least, as comfortable as you can be). Know what you’re walking into, so that your focus can be entirely on your pet.

Second, take care of business ahead of time when possible. Sign any required paperwork. Pay the bill. Decide on aftercare. Even go so far as to prepare your next meal ahead of time, arrange a ride, rent a movie, invite friends over – whatever you think might help you cope when you return home from the hospital without your pet. The less you have to deal with during and after euthanasia, the better. I want you to be able to focus entirely on your pet during the euthanasia and then entirely on yourself afterward. Let’s do whatever we can to make that possible.

Every euthanasia is different. Some are planned, some are sudden. Some may happen in your home, some in the hospital. Regardless, they are always difficult – to prepare for, to cope with, to experience. I hope these five things will help you to plan ahead and to make the process as beautiful as it can be for both you and your pet.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Ali was a beautiful golden retriever with a large liver mass in her abdomen. She had seen both her regular veterinarian and the local specialists prior to my visit with her. Her owner wanted her to be comfortable, and was open to euthanasia if he could not make her comfortable. She was already on some pain medication but she was not eating or moving much so he called me, a hospice veterinarian, as a last resort.

 

 

Initially, we changed Ali’s medications, added new ones and made a specific plan for her. The owner called me a few days later to thank me — she had jumped up on the bed that morning, which she hadn’t done in months. She spent the next few months enjoying life, hiking with her owner, traveling short distances and playing.

A few months later I was called out again – Ali had reached the active phase of dying. She was breathing harder, her abdomen had swollen with fluid, and she had stopped eating. But she was otherwise comfortable, so instead of euthanizing her that morning, we decided to give her one more adventure. Ali and her owner went out to a field and sat in the sunshine, where she died in his arms. It was a beautiful death for them both.

 

Euthanasia isn’t an easy decision for pet owners to make, even for animals with terminal illness. Deciding when, where, and how only adds to the emotional aspect of that choice, and it’s during those discussions that they often ask veterinarians why euthanasia is recommended over taking the animal home to die a “natural” death.

 

Natural death, when supported by hospice, can be a graceful death, but there are a few myths that must first be dispelled:

 

5 Myths About Natural Death

 

1 – All natural death is bad.

 

A “natural death” in nature can be difficult, sometimes violent (think: predator, car accident, shot by gun or arrow).   But, in some cases, a natural death can be simple (like a heart attack). Then again, a natural death from something like cancer, which is a slower, more progressive disease, requires pain medications to manage pain, anti-nausea medications, sometimes chemotherapy, and radiation for palliation.

 

As a hospice veterinarian, I deal with the dying process from the palliative perspective, making an animal comfortable and managing clinical signs, sometimes up until their natural death. Hospice supported natural death can be as gentle a passing as euthanasia for some diseases, but family members must be aware of what will be involved. There can be significant nursing care toward the end, just like in human hospice, and there must be a veterinarian involved. A veterinary nurse, counselor or other mental health professional, respite care professional, groomers, and even pet sitters all can help provide a good quality of life as the animal progresses through their disease.

 

2 – Suffering always occurs during a natural death.

 

Life is suffering according to Buddha. However, the definition of suffering varies from person to person, so it’s not very helpful when dealing with end of life patients. If I remove “suffering” from the lexicon and, instead, define in terms of distress, I can better help my patient and their caretakers know what to watch for as the animal is going through the dying process. I can define distress by organ system and also include terms of emotional distress, giving caretakers more tools for evaluating their beloved pet so they know when to call their hospice veterinarian.

 

3 – If natural death occurs, I won’t have to make a decision for euthanasia.

 

This is technically a true statement. We all die. A natural death will eventually occur given the correct set of circumstances and disease processes, but it might not be a quick process and you shouldn’t kid yourself – there is pain involved.

 

But we can provide a quality dying process with animal hospice, and a quality natural death at home following a terminal diagnosis needs support from an animal hospice veterinarian and team. In animal hospice, patients are monitored as they go through the dying process so that medications can be adjusted or added as needed, and clinical signs are defined so that everyone can assess where the animal is at any time. This team helps care for the animal, supports the family, and can also help make a decision for euthanasia if needed.

 

4 – Euthanasia is the only way to help an animal die.

 

Euthanasia is one way that we can help our beloved pets transition out of the world, and it’s a gift to be able to do it. However, we do have new options that were not available even five years ago.

 

Animal hospice is another way to give an animal a quality dying process. We help the animal to have a good quality of life, and sometimes, we support them all the way to a natural death. An animal hospice veterinarian has additional training in advanced end of life care, either through a human hospice-run program or through the IAAHPC conferences that have been given over the past five years, and we expect an additional certification process to come soon. A hospice veterinarian should be supportive of the patient and the family, helping them know what to expect during the end of life process.

 

5 – Quality of life is the most important aspect for end of life care.

 

While quality of life is important, so is will to live and the quality of the dying process. Owners need to know that the quality of life discussion doesn’t mean they list the five most important things in their animal’s life, then choose euthanasia once three of those things go away. Remember, these are not generally puppies or kittens; these are often elderly patients who are approaching the end of life, so just as 80 year-old humans are not the same as 20 year-old humans, they can still have a vibrant life even though they are not doing the things they used to do. If an 80 year-old human can be supported through walkers and medications, so too, can our end of life animal patients.

 

 

Animal hospice with a hospice veterinarian who has further training in end of life care can provide enormous support and comfort for the end of life patient and help owners make the right end of life decisions for their pet and their family. Euthanasia is one way to relieve suffering –there’s nothing wrong with making that choice, and it can give our patients a gentle death – but know that it’s not the only way to relieve suffering. If you do make a euthanasia decision, make it because it is the best option for everyone involved.

 

 

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Dr. Lynn Hendrix is a leader in the Animal Hospice field.  One of the authors of the IAAHPC guidelines for Animal Hospice and now a VIN contributor for Animal hospice, she also does public speaking on various hospice topics and has been a contributor to the IAAHPC conference for the past 4 years.  She owns Beloved Pet Mobile Vet based in Davis, CA focusing on Animal Hospice and End of Life Care.

Sedation is one of the major controversies in end-of-life care medicine. I’m grateful that it isn’t as rare as it once was. When I talk to veterinarians about sedation, this is what I hear from those who don’t use sedation:

1. I don’t need sedation to hit a vein

2. Sedation takes too long

3. Sedation makes hitting the vein harder.

Can you spot the problem? Not one of these objections has anything to do with the owner or the pet! When it comes to euthanasia, it’s ALL about the owner and the pet.  Have you ever watched a client before and after sedation? The difference is incredible! The tension leaves their face and body. They are able to focus on saying goodbye rather than wincing and being upset when their pet objects to handling. Most importantly, they get to spend a few minutes with their pet and see that there is no pain or anxiety. They know in those few precious moments that their pet is still alive and is no longer suffering. Some will even laugh through their tears at the sound of their pet snoring peacefully.

Do you know what it looks like to a client when you perform standing euthanasia on their pet? I do, because so many of my clients have told me about their past experiences and demanded sedation for their next pet.

“He just dropped dead.”

“It happened so fast.”

“One minute she was standing up and the next she was dead.”

“She died before I could touch her or tell her goodbye.”

That’s what they tell me.

We think a smooth euthanasia looks like a smooth surgical induction, don’t we? Perfect and peaceful? Not to our clients! There’s a reason for the “kissing corner” in hospitals when they take your loved one away to surgery. No one should have to see someone they love go from conscious to unconscious that fast. It’s scary. Have you ever seen someone faint? Even if they were caught and gently lowered to the ground, would you say it was a pleasant experience? Now imagine that it wasn’t unconsciousness – imagine it was death.  How disturbing would that be?

Sedation is for both the pet and the owner.  Needles hurt. I dislike hearing a guarantee of “painless euthanasia”. If they can feel a needle, it’s uncomfortable. So why would we put ourselves, our clients or our patients through unnecessary discomfort?  If that isn’t enough to convince you, let me try this: not sedating will drive clients away from your practice. I know, because they call me for help after they have had “a bad experience”. They insist upon sedation. They won’t go back to their last veterinarian because it wasn’t used.

Sedation has the secondary effect of calming the owner. It’s a twofer! The pet is asleep and the owner has a little bit of their burden removed. Sedation also allows me to let an owner get close to their pet during the euthanasia process. That contact is so important! When an owner brings their pet in for euthanasia, I allow them to remain with their pet throughout their passing. Breaking that bond isn’t necessary.

I know it’s tempting to whisk their pet away to put in an IV catheter, but have faith in your vein-hitting ability. Every second the owner spends apart from their pet is a second of increased anxiety and guilt. If that pet cries out or comes back shaved and bruised from unsuccessful attempts at a catheter – it’s even worse. Sedation is the ultimate safety net. I often miss a vein on the first try. With sedation, it’s only a big deal if I make it a big deal.

If you do it right, sedation typically takes no more than 10 minutes (that’s if you give it subcutaneously like I do).  That gives you time to make a short phone call, answer an email or quickly scoot in to see a patient.  I give my feline patients drug cocktails with whopping doses of acepromazine. My canine patients get both acepromazine and xylazine.  I give myself two legs to get a vein for euthanasia. If I don’t, they get it IP or IC.

Yes, in front of the owner. For the record, I’ve only had to go IC twice.  I almost always get the vein (and I’m not a great phlebotomist by any stretch of the imagination). We have a tendency to psych ourselves out with superstition about veins. The truth is, most dying pets have lousy veins anyway. I would much rather poke a pet multiple times while they are sleeping and can’t feel it than to wrestle with them and poke them multiple times while awake and stressed. I make sure to tell the owner that part of the reason for sedation is so that they don’t feel any more needles even if I have trouble accessing a vein. I’ve never had an owner express anything but relief and gratitude at this statement.

Instead of worrying about how euthanasia can be easier on you, worry about how to make the worst day of pet ownership easier on your client and patient. Pre-euthanasia sedation is becoming the norm. Those of us who do in-home euthanasia see every day how grateful our pet parents are for that moment of peace, just watching their beloved pet breathe.

Euthanasia can be less stressful for everyone if we take the time to be mindful of what constitutes a peaceful passing. By using sedation before euthanasia and keeping that pet in the presence of their owner, you will preserve and honor the Bond that is the reason we do what we do.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.