Companion Animal Euthanasia: Help for the Client and Veterinary Team
Peter Foley,
MSc, DVM, DACVIM
Pet Loss and Grief
Dealing with pet death and their owners’ grief can be very stressful for the
veterinary team. Surprisingly, however, these can also be among the most fulfilling
moments in your career, if you are able to deal with them in a healthy way, because you
can be a real source of comfort and support to the client. Conversely, the stress generated
by these encounters drive many animal health professionals from clinical practice.
All clients experience grief when they are faced with a beloved pet’s death.
Normal grief is defined as a normal emotional response to an external, consciously
recognized loss. Grief is self-limited, and gradually subsides within a reasonable time.
Grief can be anticipatory when knowledge of the impending death is foreseen. For
example, the client begins grieving the moment a diagnosis of a fatal disease such as
cancer is made – it does not start with the pet’s death. Different people may manifest
grief differently, and their outward display of grief does not always reflect the depth of
feeling they have inside. Sometimes grief is complicated, when more than the animal’s
companionship is being lost. For example, the loss of a service dog can be particularly
upsetting because not only is an animal friend being lost, but also the freedom that that
partnership brought to the owner. Unresolved grief can be experienced when a current
grieving episode triggers memories and feelings of another loss experienced in the past
that was not fully dealt with. In rare instances, grief can be pathologic when the feelings
that are experienced are so overwhelming that the client is profoundly depressed, and
may even have suicidal or homicidal thoughts. While veterinary team members are not
trained to treat unresolved or pathologic grief in their clients, they should be aware that
these exist and should not hesitate to seek out help for the client from mental health
services.
Helping Clients Face the Decision to Euthanize
In North America, few animals die directly of natural causes. Euthanasia is
performed in the vast majority of cases to spare the animal the prolonged suffering and
debilitation of a “natural” death. In many cases, the client and the veterinary team agree
on when euthanasia is warranted. It can be very stressful if the client feels that
euthanasia is not warranted, and the veterinary team does. Likewise it can be very
stressful if the client wants to euthanize an animal that the veterinary team feels could be
cured or at least given a chance. In cases where the veterinary team feels euthanasia is
appropriate, but the client does not, one has to be very difficult that the client not be
pressured into making a decision for euthanasia. In these situations, the client is seeking
veterinary care in the hope that the animal can be cured. They have not understood or
accepted how grim the prognosis is and how much the animal is suffering. If they have
an optimistic outlook and they are confronted with a veterinarian who is pressuring them
to euthanize, they now have to protect their pet from the veterinarian who is trying to kill
it. This is obviously a dynamic the veterinary team wants avoid at all costs. If clients
allow themselves to be convinced to euthanize their pets when they have not fully
accepted that this is the best course of action, they will regret their decision, and for a
long time afterwards they may be angry with themselves and their veterinary team
because they “abandoned their pet in its hour of need.” The objective instead should be to
help the client understand the disease process the animal is experiencing. In particular
the client need to understand the animal’s comfort level (pain, respiratory distress,
nausea, etc), and the prognosis for relieving any distress. Once the client fully
understands the situation their pet is experiencing, the decision for euthanasia is usually
made quite quickly.
Sometimes the veterinarian and their staff may be tempted to judge the client for
their reluctance to euthanize the pet: “He’s keeping the dog alive for his sake, not for the
dog’s sake.” Be careful about judging clients in this situation. The very fact that the
owner has taken the time to seek veterinary care, and is spending hard earned money
proves that they are taking the situation very seriously. Be patient with clients as they
struggle to understand and accept bad news. Often the information needs to be explained
several times before the client can fully grasp the gravity of the animal’s situation.
Concentrate on explaining the disease in layman’s terms, with particular emphasis on the
animal’s comfort and prognosis. Avoid minimizing or “sugar-coating” the information.
You do not need to be insensitive, but if the animal is suffocating from its lungs being
full of fluid, then it is “in significant distress trying to breath” not “a little short of
breath.”
When Clients Want to Euthanize and the Veterinary Team Does Not
In situations where the client wants to euthanize a pet, and the veterinary team is
reluctant to do so, it is important to know what the policy of the clinic is. We need to
have a service in our society that is able to destroy unwanted animals, otherwise owners
will be obliged to abandon or attempt to destroy the animals on their own. In some
communities, it is an animal shelter or animal control authority that performs this
function. In others, it is the veterinary team. In other practices, the policy is to perform
euthanasia only on animals with significant disease. Some practices leave the decision up
to the veterinarian. Be careful not to pass judgment on owners who are presenting pets
for euthanasia for apparently minor reasons. On the outside, they may appear to be
nonchalant about it. Realize, however, that few people take such decisions lightly, and
that it probably took a lot of courage to bring the pet to the veterinary clinic and face
being judged by the most animal-loving people in the community. Realize as well that
people in this situation often see themselves as having few options to solve the problem.
Client-Present Euthanasia
Not so very long ago, it was considered very unusual for a client to be present at
the euthanasia of their pet. Now, the situation is reversed, and it rare for a client not to be
present. Having the client present for the euthanasia adds challenges, but often helps to
bring closure to owners struggling with the death of their pet. For many owners, it is
important to comfort the animal at the end, so it does not die anxiously in the presence of
strangers. When planning a client-present euthanasia, it is important to choose a time of
day when you are unlikely to be interrupted by other emergencies. For some practices
that is first thing in the morning; for others at the end of the day; and for still others a
euthanasia in the client’s home. When the client arrives at the clinic, they should be
taken to a private area so they do not need to wait in the waiting room with other clients.
The room where the euthanasia is to be performed should be large enough to be
comfortable for all the people present – usually a minimum of four people (the client and
friend, the veterinarian, and one staff member to assist). There should be enough chairs
for everyone to sit, and the floor or table should be made comfortable for the animal with
blankets or pillows.
Regardless of the time and setting, it is best to determine details of paperwork,
payment, and disposal of the body prior to the euthanasia procedure. A consent form
should be signed by the client indicating ownership, the identity of the animal, the request
that euthanasia be performed, and the plan for disposal of the body (owner leaving with
the body, clinic disposal, cremation, post-mortem examination, etc).
Even if the client has been present for the euthanasia of a pet in the past, they
should be prepared for what they will see. This should include an explanation of how the
drugs work, pointing out that it is an overdose of an anesthetic medication, that the drug
is painless, and that because it is an overdose, it not only anesthetizes the animal and
makes it fall asleep, it also anesthetizes the heart and lungs after the animal falls asleep.
The animal is not aware of its heart of lungs ceasing to function. There are some things
the client may witness that may be disturbing if they are not prepared for them. In
particular, the some animals may feel dizzy or disoriented as the anesthetic first takes
effect. This may cause them to bark or meow for a few seconds just before they fall
asleep. I explain that this is not a sign of pain, but rather of surprise, and is common in
all animals just as the anesthetics begin to take effect. I find this vocalization is more
common in healthier animals, and it seems to happen less commonly if rapid acting
anesthetic agents like thiopental, propofol, or alfaxalone are used before the pentobarbital
euthanasia solution. Owners should be cautioned that the eyes of dogs and cats tend to
remain open after death. They should also be aware that as the body relaxes, the animal
may urinate or defecate, so we put absorbent pads under the animal for this purpose. I
caution the owners that they may see some reflex muscle contractions after death. In
particular, I tell them that the muscle that controls breathing, the diaphragm, can contract
after death – sometimes, even minutes after the animal has stopped breathing. The
animal can sigh unexpectedly when this happens. If clients are not prepared for this, it
can be shocking, as they worry that the animal is somehow reviving itself.
Once I take the client to the room where the procedure will be performed, I ask
them if they are ready for me to take the pet around back to place an intravenous catheter.
Either the cephalic veins in the front legs or the saphenous veins in the hind legs can be
used. Frequently, I prefer the hind leg veins as they allow the owner to be closer to the
animal’s head as I am euthanizing the animal. Once the catheter has been placed, I bring
the animal back to the owner and again offer them time to spend alone with the pet.
When everyone is ready, I have my assistant gently hold the pet’s leg so the pet does not
withdraw it suddenly as I inject the euthanasia solution. Death happens within seconds. I
listen to the heart for any signs of life, and clearly let the owner know that the pet has
died (“He’s gone”, or “He is dead”). Clients are frequently surprised by how rapidly the
death occurs, so they need to be informed that it is over. Often clients want to talk about
their pet at that time, and I give them as much time as they need. I always offer them
time alone with the body if they want, and sometimes they take me up on that offer. If
you leave the client alone with the body, be sure to tell them when you will check back
with them (usually 10 minutes), so they can prepare and compose themselves before you
return.
When the time comes to escort the owner from the room, I leave the animal in the
care of my assistant, so that the last look that the client has of their pet is with someone
who is carefully tending to the body. It can be disturbing to the owner to have them see
the body left alone and unattended in the room as they leave. Likewise, do not place the
body in a plastic garbage bag in front of the owner, and always handle the body gently as
if the animal were still alive and just asleep. Seeing the body being jostled or improperly
supported can be distressing to the owner.
We routinely make paw prints in quick drying modeling clay that can be
purchased from most craft stores. Clients often appreciate keepsakes like paw prints,
locks of hair, collars, and leashes. We also routinely send condolence cards signed by
everyone who has cared for the animal. There are condolence cards that are specifically
designed for pet death, but my own personal preference is blank cards with nature scenes,
landscapes, or flowers, and I write the message myself inside. With clients who are
particularly isolated in the community, or who have had a particularly hard time with the
death of their pet, we usually give a follow-up call in the next day or two, sometimes
accompanied by flowers.
Some clients want to memorialize their pets in some way. Often that takes the
form of making a contribution to some fund to help other animals: a donation to the local
animal shelter, a donation to a research fund that investigates particular diseases in
animals, a fund that provides care to pets of clients with limited finances, etc.
Clients often sympathize with me, and say that euthanasia must be one of the
hardest things about my job. I agree that it is not easy, but at the same token I feel very
humbled and privileged to help people through this very difficult time. I am seeing
people at their most vulnerable, but also at their most courageous, noble, and loving.
That is a true honor to serve people at that time in their lives.