“If someone feels euthanasia is easy, then maybe something is wrong” - Veterinary Practice
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InFocus

“If someone feels euthanasia is easy, then maybe something is wrong”

Euthanasia is a fraught subject for vets, owners and animals alike, but animal welfare, compassion and empathy should be the cornerstone in all cases

Countless animals are euthanised as a result of health tragedies and economic catastrophes each year. Annually, around 20,000 dogs are put to sleep in the United Kingdom, and in the United States, shelters kill around 670,000 dogs and 860,000 cats. Increasingly, sick or unwanted exotic species add to these losses. Each numerical digit represents a life and death, and the veterinary clinic likely remains the primary setting in which each story ends.

Animal welfare or owner sentiment?

Unquestionably, an animal’s welfare is paramount to all other considerations. But we must also consider the weight on an owner’s shoulders ahead of euthanasia. After years or decades of companionship, love, care and unwavering dedication to their non-human friend, this is no time to ignore the carer’s needs. They may be fragile, volatile, angry at the perceived injustice of illness or injury landed on their pet, and as a result, not entirely clear-headed.

For some vets, a client’s denial of an inevitable demise presents a real challenge for getting the message across that now is the best time to let their friend go, especially when days, weeks, months or even decades of home nursing have preceded the inevitable. The wrong thing said or done could incur the client’s dislike or even wrath, or a loss of confidence in the clinician. That alone holds potential repercussions for animal welfare because an owner may simply decide you are not worth listening to.

It is worth asking positive questions about an owner’s abilities to provide future care and comfort – regardless of the challenge

However, some owners may be thinking more clearly than you! The client may have a more subtle understanding of an animal’s normal positive and negative states. A client may arrive with an animal they believe has something wrong, but there are no clinical signs – it is simply “not itself”. They know this because they know normal. For some, this insight may imply a more nuanced understanding of real prospects for a “happy life” that goes beyond the brief clinical meeting in a somewhat history-sterile environment. Also, a client may feel pressured by a vet who is making an objective and preventative recommendation for euthanasia on the basis of a poor prognosis. But such a recommendation may not fully take into account the client’s willingness and ability to manage meticulous palliative care. The animal may be comfortable with a life equivalent to eating jelly in a wheelchair! So it is worth asking positive questions about an owner’s abilities to provide future care and comfort – regardless of the challenge.

Another consideration is the financial value of an animal – but to who? Some people don’t want to spend hundreds of pounds treating a hamster, but to others, there is no price on life. Euthanasia should not align with the perceived convenience of disposability.  

Handling, aesthetics and stress

When it comes to veterinary handling of animals for examination, most people probably want their pet treated like crown jewels, especially when it is ill and when euthanasia is on the cards. Routine techniques like scruff-holding a cat or puppy may induce little stress, help with a health check and even make the assessment quicker and easier for the animal, but it doesn’t look nice to an edgy client.

Most people probably want their pet treated like crown jewels, especially when it is ill and when euthanasia is on the cards

For exotic species, of which many possess particularly hard-wired defensive perceptions and behaviours, handling may be perceived as predatory subjugation. Some vets have a habit of handling, for example, turtles and tortoises as if they were potatoes – grasping and turning upside-down or waving them in the air while they chat with a client. Imagine taking your sick grandma to the doctor only to witness her being roughly handled and up-ended for an exam – it’s unpleasant to see and probably the basis of a lawsuit! So why do that sort of thing just because one can? When examining, consider that for some species, such as turtles and tortoises with their highly limited righting abilities, being held upside-down may make them feel more vulnerable than other animals, such as dogs and cats. Getting down to their level and gently raising the animal slightly off the ground for inspection will do just fine.

Some vets may perform euthanasia better when out of sight and under less pressure, but it does not convey confidence or compassion. Gentle offers of inclusion throughout the entire euthanising process invite a caring atmosphere, and advance relaxed conversation describing the process and what to expect – from how the drugs work to how sometimes they don’t –provides an option that can negate the owner’s feelings of guilt that they did not press to be there or wonder if something went wrong behind the scenes. Such ruminative processes associated with grief can be overwhelming.

Treading a fine emotional line

Vets tread a fine line when managing their own emotions about euthanasia. On one hand, who is better placed than a compassionate and empathetic vet to engage with animal and client at a time when both need them most? Compassion and empathy are not mere characteristics of a kind vet – they also allow better insight through incidental critical anthropomorphism. “One sees more because one cares to look deeper.” Recent research shows performing euthanasia can take its toll on vets – especially those performed for economic rather than pure health and welfare reasons (Galaxy Vets, 2023; Veterinary Practice, 2023). And similar concerns have been expressed in the United States and elsewhere, with the cumulative stress of performing euthanasia leading to suicide rates in vets (especially female vets) being several times higher than in the general public. Being too compassionate and empathetic might stop you from being a vet or even mentally and emotionally destroy you!

Whether it’s having better consultation skills or more regularly available psychological counselling, there seems to be a need for wider training on euthanasia preparedness

On the other hand, a relatively dispassionate vet may take euthanasia in their stride and not suffer much themselves. That’s good for the vet, and maybe the same vet will have medical acuity equal to any other, perhaps – but it doesn’t sound good, does it? Whether it’s having better consultation skills or more regularly available psychological counselling, there seems to be a need for wider training on euthanasia preparedness. Discussion and guidance on related issues is useful, but clearly we need to do more.

Compassion and empathy for all

Ending an animal’s life should bring out our best – as a practitioner and as a person – at what, for many animals and their caretakers, may be the worst time of their life. It is a time to treat every animal and person as you would wish for your most precious and beloved friend.

Whether through handling, dialogue, manner or some other indicator of self, a vet’s disposition will likely be portrayed – to the client and, possibly, to the animal alike. Compassion and empathy must, surely, dominate euthanasia, but to the vet bearing these qualities, the personal cost is high – though confirming one’s integrity. If someone feels euthanasia is easy, then maybe something is wrong.

The front and centre of any euthanasia case must be the animal’s welfare. Yet three parties are impacted: animal, owner and vet. Compassion and empathy are, or at least should be, generously shared between each for the benefit of all.

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