The "Art" of Euthanasia
A few days ago, I read Jill Breitner’s post in a veterinary group about euthanasias that were stressful for both her and her pets. From the account, it would seem that the injection of the pre-sedative drug stung, causing a sudden panic reaction in the patient. While the procedures were uneventful after that point, the memory of the pets’ dramatic reactions haunted their guardian. (See "Pet Euthanasia Gone Wrong," August 2017).
In more than 30 years as a veterinarian, I have heard of a number of accounts similar to this. In my career, though, I have dedicated my practice to using only low-stress techniques, especially at the end of life. This is the art of euthanasia.
The veterinarian did warn Jill that the injection of sedative might sting her pets, but she was completely unprepared for the degree of her pets’ reactions, which seemed aberrant and needlessly painful. And unfortunately, the pets’ startling reactions are a major part of the last memories she has of her animal companions.
It is not just the last breath. As a young veterinarian, I would wonder why owners would cling to their elderly dogs, asking only for a nail trim and refusing an exam. I finally asked one owner if I could examine her dog so I could help her
keep her pet healthy. She responded, “Okay, but don’t tell me I have to put my dog down.” I sincerely reassured her that this was not my agenda, and was finally able to examine the dog. As I worked, she shared the story of her previous pet’s euthanasia, and her fears about facing that event with her present senior dog. The grief-filled memory from 15 years earlier was ever-present in her mind, especially with her current senior dog.
Veterinary Industry in Transition
I didn’t have any training in euthanasia as a veterinarian. That may seem hard to believe, given that veterinarians may perform that procedure daily. All of my training came from on-the-job experience. Today, many vets receive training about client grief, and yet still learn little about the actual euthanasia procedure. Training in how to provide a peaceful relief of suffering is not standard in the veterinary educational system.
Pre-euthanasia sedation cocktails were first introduced by anesthesiologists in the 1990s. I attended a presentation on the topic in 1997 and never did a euthanasia without pre-sedation again.
At the North American Veterinary Conference in 2012, Dr. Dani McVety, founder of Lap of Love, a network of veterinary hospice providers, shared her euthanasia protocol, stressing the importance of a pre-euthanasia experience with no pain, reliable sedation, achieved with only one injection. She clearly defined the art of euthanasia. I felt good that my staff and I were already providing that care and had embraced it through our commitment to Low Stress veterinary practice.
The Patient Experience is Paramount
Providing a pain-free, smooth transition from awake, to asleep, then no longer alive, is not easy. The veterinarian and staff must have a plan for minimizing the patient’s pain, stress, and anxiety – before the appointment if possible. All thought must go to using drug mixtures that will not add to the patient’s present pain or anxiety. Drug delivery needs to be non-stressful to allow the body to respond in gradual relaxation.
That said, it’s important to realize that there is no single protocol or drug that will deliver this experience for every patient, under every circumstance. And in some practices, veterinarians and staff are held to strict protocols. In other practices, there may be a lack of understanding the holistic nature of euthanasia. Some pain with injection cannot be eliminated, yet one can choose the best route of administration to minimize this. Low-stress options include diluting injectable drugs, using local anesthetic creams to reduce the pain of injection, and using a butterfly needle rather than a catheter.
The setting for euthanasia is also not always the most calm. Yet the focus must be on a smooth transition from life to death, no matter what setting, age, or status of the patient. The best patient experience is what provides the best client experience. The last memory is always the one freshest in our minds and what we carry with us.
While I cannot make all euthanasia experiences perfect, I can take many steps and custom-tailor the products I use to each individual patient, in order to provide something as close to perfect as possible. I hope that the low-stress veterinary-care movement gains ground, and that education in the art of euthanasia becomes standard. Our patients and the people who love them deserve this.
Dr. Sally J. Foote is owner and head veterinarian of Okaw Veterinary Clinic in Tuscola, Illinois. Dr. Foote’s certifications include Low Stress Handling Silver Certified, Fear Free Professional, and Animal Behavior Consultant by the International Association of Animal Behavior Consultants. Dr. Foote is also currently the President of the American Veterinary Society of Animal Behavior and the Executive Director of CattleDog Publishing, the legacy of Dr. Sophia Yin.