End of life support starts from the moment the client calls the practice to the moment the patient’s brain and cardiac functions cease. The need for support does not stop when the patient is deceased.
Of course, loss is not always caused by euthanasia. It may be a patient that passed at home or due to an accident. The reason for the loss will impact the client and how they process their grief. It will also affect how we support the client.
We may almost have a script that we follow when performing a euthanasia, some soothing words and phrases that will show our sympathy and respect for the situation. Euthanasia means “gentle death”, the process in which the life of a companion animal or working animal is ended in a humane way.
It may be that the client is well aware of the process, how it happens, what to expect and what may unexpectedly happen. They may have been through this before. Each time they were supported and understood the process. But what about those who have never witnessed the euthanasia process? The methods vary but the intention is always the same: to provide as painless and dignified ending of a life as possible.
It is vital that we remember that what is our normal is abnormal for the client. They do not see loss on a regular basis like we do. Supporting the client is not just about the sympathy but the explanation of the process, letting the client know what may happen and what is to be expected from us.
A quality of life assessment appointment may be an option, a chance for the client to discuss with the vet their worries and concerns, and have the vet answer any queries. This appointment would also be useful for the client to realise they have done all they can and that euthanasia is the only option. This helps to alleviate the guilt some clients may feel, wondering if they made the right decision, or if they rushed it.
As veterinary professionals, it is up to us to take away some of the fear of the unknown when it comes to euthanasia. This fear is because the client may not know what happens during a euthanasia, the planes of consciousness or the bodily reactions or even the speed at which the patient dies.
Pre-euthanasia handouts are a good source of support, giving the client the information they need before the loss so they are prepared. It should explain what they can expect from the practice and the process of euthanasia. Let the client know if there is support in the practice or who they can turn to if they need help, such as pet bereavement counsellors or the Blue Cross pet bereavement support service.
Ask the client how they want to stand with their pet, can they hold their pet? If not explain why someone else may have to do so and whether a staff member has to raise the vein for the pet. Talk to the client about the steps you are taking and ask them if they are ready to go ahead. No one is ever ready for the loss of their pet, but it is courteous to ask.
Explain the need to place a catheter and why this may be done away from the client. Explain why there may be a need for sedation and the possible side effects this may cause, and what we will do if they occur.
Explain the possibility of involuntary excitement; this can look quite distressing. It may look like the pet is fighting the euthanasia and this is a cause of concern and guilt for many clients. Explain what happens once the pet dies, that their eyes do not close and that sometimes they may gasp, and explain what this means. Discuss the process of cremation and other options, numbers of crematoriums, whether the client can take their pet there directly or the time scale for the pet to be taken and cremated.
We do not always have time for a lengthy consult and we may not always have the time the client needs. But we can do our best to plan ahead and book the appointment at the best time for all concerned, giving the client some time with their pet before and after when possible.
Having all you need to hand will save some time; having the room set up prior will also save time. Make sure the table or floor is comfortable, with plenty of bedding and incontinence sheets. If the pet is comfortable then they are less likely to want to move around. Have some tissues to hand on the corner of the table so the client can take one when needed. When you take the equipment that you need into the room, please try to put it in a small basket. It looks less clinical than a kidney dish or other metal container.
Having a separate room for euthanasia is ideal if there is space. Low lighting, a couch, blankets and plug-in diffusers will calm and soothe the patient. The clients could have some time alone with their pet in this room and not feel rushed to leave if another client is due and the room is needed.
If a client doesn’t ask for something, it may not be that they don’t want anything but they may not know that there are options to ask for. Ask them if they would like a paw print or a lock of fur. If they do, ask them where they would like the fur taken from and put it in a small envelope or a voile bag (put it in a plastic bag first so it doesn’t poke through the bag). Ask them if they want to keep the collar or send the bedding with the pet for cremation if possible.
Supporting the client pre- and post-loss is vital to reducing client attrition. There are many reasons why a client may not return to a practice after the loss of a pet, but poor or lack of support must never be one of them.
