6 tips to ensure smooth, compassionate, and respected euthanasia practices
Euthanasias allow veterinarians to peacefully end a pet’s life by easing pain and suffering. No euthanasia is ever easy. But a few steps can help minimize your stress, ensure the patient receives compassionate care, and allow owners to continue the human-animal bond through to a peaceful death.
Euthasnasias are often a thankless yet important service. If your pet were being euthanized, ask yourself what you would want from the vet and staff and apply that to how you practice.
Have you ever received a thank you card or gift after euthanizing a pet? I know I have, and it strikes me as both amazing and heartbreaking. I just ended their pet’s life, and it seems contradictory that they are thanking me.
Yet, I must remind myself that I helped their pet pass from this life, doing so with empathy, kindness, understanding, and words of assurance. I permitted them to grieve, not to rush them out of the room or hurry out myself. I explained the process and how the pet may react, giving the animal and the pet parent what they needed most at a terrible, tough moment.
Step One: Always provide compassion and empathy
No matter how bad your day has been, always approach every euthanasia with compassion and empathy. It may be that you don’t agree with the owner’s decision to say goodbye. You may feel you can help the pet, but the owners do not want to pursue treatment. But all that becomes irrelevant when you go to perform your duty.
Shake off the bad day, your anger over not getting a lunch break, or frustrations that medical decisions in veterinary medicine often boil down to finances. All that becomes immaterial when you start working with a pet preparing for euthanasia.
You need to provide the owners and pet with your full attention, a few soft-spoken words, and do so with benevolence and sincerity of heart.
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Step Two: Provide sedation or pain management for the pet1–3
Gone is the time when no pain meds or sedation is an acceptable practice. We took an oath to do no harm, including all throughout their lives and assisting our patients in passing from this life over the rainbow ridge.
Whether you have an IV catheter in place or choose to do a direct venous stick, providing pain medication, or an appropriate sedative before euthanasia maintains the procedure’s humanity.
Whether you use an opioid premed, then place the IVC, or use propofol and then euthanasia solution, gone are the days where using only euthanasia solution remains acceptable.
Sedation provides many benefits. Calming the pet down, relaxing the pet, and minimizing stress and fear. Additionally, it gives a quiet time for owners to spend time with their pets while not overly stimulated. Then when we provide the euthanasia solution, the process appears seamless and as if the pet is “falling asleep.”
Make sure to communicate the sedation plan to pet owners
What isn’t ok is when owners aren’t informed their pet will be sedated before they are brought back to them to spend some time. Some vets sedate with a premed and then put in a catheter.
Owners need to know if the pet will be sleeping, barely alert, or simply “feeling good” from an injection. People often tell me that they’ve had an experience where the pet was sedated and wasn’t advised to expect it nor asked if it was ok. It was just considered part of the practice’s process.
An owner’s dog went in wagging its tail or still giving kisses, but because a sedative at a high dose was given before the pet was returned to them, they couldn’t get that one final kiss. This isn’t acceptable.
Whether you give a sedative premed, like butorphanol or another opioid, or use propofol prior to euthanasia, some type of sedation should be administered to make the pet’s transition seamless and painless. However, ensuring that owners are properly informed remains key.
Further reading: “How do I know if it’s time?” Advising pet owners on when to euthanize
Step Three: Take steps to minimize stress and anxiety
We should all strive for a fear-free approach to practicing veterinary medicine. Sure, restraint, muzzles, sedation, and other modalities may be needed, but using them in ways that minimize a pet’s stress and prevent harm and anxiety, especially in a pet’s final moments of life, is paramount.
Taking steps to minimize stress and anxiety applies to measures taken to handle and prepare the patient for euthanasia but also includes interactions with owners and staff.
Euthanasias are stressful for all involved, and emotions run high. Owners are filled with a flood of emotions anticipating loss and anxiety over what euthanasia will entail and how the pet will fare. They do not want to be judged for their actions and need time to process grief and understand the process.
How can we minimize stress and anxiety for all involved?
- Have set procedures in place. All staff, from the client service representatives to the kennel staff, need to know their roles and responsibilities
- Ensure a separate, private, comfortable place to perform euthanasias or a place where owners can spend quiet time alone with their pets to say goodbye
- Have a doorbell or other signifier that the owners are ready either to be present for the euthanasia or to leave the pet in your care
- Explain the procedure to anyone present – Discuss what medications are being given or at least their function and what the pet may experience. Explaining ahead of time that they may not close their eyes, may go to the bathroom, or may even take a breath or two after the heart has stopped as the diaphragm relaxes, prepares them for the what-ifs
- Providing sedation and or pain management before the euthanasia gives owners time with their pets while still with them and lets the client know that we care about the pet’s well-being even up to the end
- Offer owners a clipping of the pet’s fur to take home. Many owners treasure this simple gesture, though many also say, “I have plenty of fur at home.”
- For owners receiving private cremation, inform owners of the wait time, so they know when they will see their friend again
- Before proceeding with any injection, ensure owners are as ready as they can be
Always ensure you explain all that will be happening from start to finish. From the time an owner makes the decision to enter your building to start the process until the pet is taken in the back or nurses come in to put in the catheters, up until the point when you inject any medications, and continuing as you listen to the heart and let them know their pet passed.
By explaining that the euthanasia injection (regardless of what sedative you gave) provides an anesthetic state and permits loss of pain sensation and consciousness in addition to suppressing (stopping) the heart and lungs. With this loss of consciousness comes a loss of pain or perception of what is happening, allowing the process to be peaceful and pain-free and occur within a few short minutes or less.4
Reflections on loss and grief after Covid
Step Four: Reassure owners
Assure owners there is nothing to feel guilty about.
Even if you think that the pet shouldn’t be euthanized or that there are other options, reassuring owners that their decision isn’t a mistake goes a long way. Many owners repeatedly say I am sorry, but assure them they have nothing to be apologetic about. Euthanasia ends suffering, allowing for a peaceful, non-painful passing.
To stay or not to stay is a very personal decision and varies from individual to individual. Never judge owners who don’t stay with their pets for the euthanasia process. Instead, ensure staff who handle those pets where owners will not be present with the same respect as those who remain.
It is not our place to judge whether an owner can be with their pet or not. Not staying with their pet doesn’t mean they loved them any less or deserve to be treated differently. Some owners want to remember the pet alive and at their best; others cannot fathom the process, and still, others simply can’t bear to witness the event.
If owners do not want to stay, that is ok! Assure them that their pet will be well-taken care of and respected and someone will be with them when they pass.
Step Five: Respect your patient at all times
Respecting your patients at all times makes sense.
We are taught and take an oath not to commit intentional harm. But that doesn’t always equate to ensuring pets are comfortable, calm, and unafraid. However, that needs to be our goal. While this should be something we strive for 24/7, it is especially critical during euthanasias.
On grief and grieving: An ER vet’s tale
Step Six: Take time out for self-care
Whether you have known the patient since puppyhood or this is your first time seeing it, euthanasias aren’t easy. Often times we have mixed emotions when performing them. Some people remain aloof and detached, while others may get very emotional even with patients and owners they have just met. Neither reaction is incorrect nor unexpected.
Some euthanasias will hit home harder than others. Your state of mind, the type of day you’ve had, the case itself, the pet itself, and other factors interact, affecting your emotional response to each individual euthanasia.
Regardless of if you had no reaction or broke out sobbing after the euthanasia, before heading into your next appointment, doing your callbacks, checking bloodwork, or evaluating a post-op patient, give yourself a few minutes. Reset. Not only is this appropriate, even expected, but it gives you time to process loss.
What does self-care for veterinarians look like?
This will vary from vet to vet but may include taking a few minutes and
- Eating a piece of chocolate
- Drinking some caffeine or your favorite (work-acceptable) drink
- Meditating for a few minutes
- Diaphragmatic breathing
- Taking a peek at some of the animals in the hospital, even getting some pet lovies
- Checking in on your pet(s) – I have a few tagged photos of my 4-legged daughter on my phone that I will take a gander at, or I’ll even take a peek at her on my doggy cam.
- Talk about the pet, the case, the disease process, or what-have-you with colleagues or staff, debrief
- Crying or laughing
Take the necessary action to give yourself time to comprehend the loss. Giving yourself a few minutes to be in the moment before moving on allows your mind to settle and gives you time to reflect on this loss and your actions, consciously or unconsciously.
Practicing appropriate pre-euthanasia measures, including providing a suitable sedation pre-euthanasia injection, using Fear-Free animal handling techniques and practices, and ensuring clients remain informed and comforted aid in securing a seamless transition for both pet and pet parent.
In closing
Sadly, euthanasia is an inevitable but valuable service. Human physicians often note that they wish they could provide their patients with this very option. Ending suffering, while it can seem like a curse, also can be a blessing. Saying goodbye to a pet will never be easy or desired.
However, being able to do so in a tranquil, quiet setting while showing respect and empathy enables owners to bid farewell and end any suffering or poor quality of life with respect and compassion.
References
- Gardner M, McVety D. Handling Euthanasia In Your Practice. Today’s Veterinary Practice. Published January 11, 2016. Accessed September 12, 2022. https://todaysveterinarypractice.com/practice-management/handling-euthanasia-practice/
- Leary SL, ed. AVMA Guidelines for the Euthanasia of Animals: 2020 Edition. 2020 edition. American Veterinary Medical Association; 2020. Accessed September 12, 2022. https://www.avma.org/sites/default/files/2020-02/Guidelines-on-Euthanasia-2020.pdf
- Compassion Understood. The euthanasia procedure. Compassion Understood. Accessed September 12, 2022. https://www.compassionunderstood.com/page/the-euthanasia-procedure
- Eirmann L. Facts About Euthanasia (Small Animals). Cornell University College of Veterinary Medicine. Published June 5, 2017. Accessed September 12, 2022. https://www.vet.cornell.edu/facts-about-euthanasia-small-animals