Veterinary Euthanasia Techniques

A Practical Guide

Kathleen A. Cooney, Jolynn R. Chappell, Robert J. Callan, Bruce A. Connally

• Publisher: Wiley-Blackwell
• Year: 2012
• ISBN:
  9781118335550
• Edition: 1
• Topic: Medicine
• Subtopic: Veterinary Medicine

Veterinary Euthanasia Techniques: A Practical Guide provides detailed guidance on euthanasia procedures in a wide variety of species, including dogs, cats, exotics, horses, and production animals. Based on the current AVMA guidelines, the book offers step-by-step descriptions of the recommended methods of euthanasia, giving all the information needed to perform these techniques with confidence. Veterinary Euthanasia Techniques helps practitioners, students, and technicians expand their knowledge base and provide competent, compassionate euthanasia services.

Including information on client considerations, equipment, positioning, sedation, and aftercare, the focus of the book is on providing detailed procedures for correctly performing euthanasia. Veterinary Euthanasia Techniques presents complete information on euthanasia, offering specific advice to improve skills and aid in decision making.

Chapter 1

Client Considerations

Making the decision to end an animal's life can be extremely difficult for a client. Understanding the full scope of the reasons behind euthanasia before passing judgment as to whether it is ethically right or wrong is very important. Veterinarians can help clients determine if euthanasia is the best option for everyone. Veterinary training should provide the necessary tools to assess the animal and determine what physical changes the animal will endure as the end of life approaches. Age, disease, species, financial reserves, beliefs, etc., can all play a role in the decision to euthanize. The client may be considering euthanasia as the only possible option and it is the veterinarian's role to identify suffering and make sure all options are explored. Clients typically understand their animals very well, especially pertaining to quality of life, and their contributions to the conversation are crucial. The trick is not to let fear of the unknown be the guiding factor, but rather have logical reasoning and education as the prevailing rational.

The best way to approach end-of-life care is to set up the type of relationship with a client that has the best interests of the animal in view as the goal of treatment (Rollin 2006). This can be done early on in the veterinarian's communication with the family, long before a terminal diagnosis or any other reason for euthanasia presents. The client must feel safe talking to the veterinary staff regarding their fears, hopes, and plans for their animal's future. Professionalism and respect for the situation go a long way in demonstrating compassion. When death becomes imminent, except maybe in pure crisis situations, preparations and mutual understanding should already have been established. Suffering by the animal and client can hopefully be better avoided. With respect to this final decision, euthanasia is the treatment to end suffering (McMillan 2001).

Suffering is a very subjective term and difficult to define for any one situation. We must take all factors into consideration to help determine if suffering is occurring, and once recognized, how it can be lessened or stopped altogether through euthanasia. Many people look at suffering as the presence of constant pain that cannot be managed. Others view suffering as the inability to do what the heart desires. Both concepts are viable and can further be classified as being physical and/or mental in nature. Suffering tends to remain a quality-of-life issue, regardless of the species.

Whether the animal in question is client owned or is kept for production-based purposes, the client will need to consider the following factors regarding disease before deciding to proceed forward with euthanasia:

• Is the animal free of pain?
• Can pain be controlled enough to make the animal comfortable and maintain a reasonable quality of life?
• Is the client willing to care for the animal in its current state of health?
• Is the animal maintaining good body weight and normal hydration?
• Is the client able/willing to finance procedures that would heal or at least improve the animal's condition?

Opening up dialog early in the end-of-life discussion is important so that everyone involved works together as a team and trust is established. Euthanasia is a viable option and should be addressed rather than skirting around the issue to avoid sadness by the caretakers. When euthanasia enters the discussion, the hope is that the client will feel safe talking about it and the veterinarian will understand their needs. In addition, it needs to be introduced delicately so that they do not feel that the veterinarian has given up prematurely (Cohen and Sawyer 1991). Ultimately, it is the disease or extenuating circumstance that is taking the pet's life. Veterinarians facilitate death when it is necessary and no other reasonable options are available. Once the decision to euthanize the animal has been made, it is time to talk to the client about the process. They may have very specific questions regarding the euthanasia that need to be addressed:

• What should I know about euthanasia?
• Can or should other animals be present?
• Where can euthanasia be done? (At the clinic, farm, in the home, etc.)
• Is euthanasia painful?
• Do I have to be present?
• How do we handle the body afterward?

The method of euthanasia should be discussed with the client before it is attempted. Many people understand the varying techniques that may be performed to achieve death, but just as many will not. Veterinarians can describe the technique of choice given the circumstances and still allow the client to voice any concerns they may have. It is important to reassure those present that the goal of euthanasia is to provide a stress-free and painless death. Explaining each step of the procedure will help ensure that there are no surprises that may be upsetting to the client. Some clients will choose not to be present during euthanasia, so details will have to be discussed beforehand. Honesty as well as thoroughness is the key when talking about euthanasia so that unexpected situations are minimized. Financial concerns, quality of life, and matters of personal importance should be considered.

Companion animals

An animal may be kept for companionship and a person's enjoyment, as opposed to livestock or working animals that are kept for economic or productive reasons. Pets, as they are commonly referred to, are euthanized everyday by the thousands in North America, including species such as dogs, cats, exotics, horses, and so on. Euthanasia is chosen for many reasons, such as debilitating age-related changes, life-limiting disease, financial limitations, safety risks, behavior issues, and so on. In practice, we hope to avoid “convenience euthanasia” as much as possible, and maintain this ultimate act of kindness for the sick and suffering.

Morally, veterinarians must examine all possible options before euthanasia is chosen. On a personal level, are we as members of the veterinarian field comfortable with the decision? Was the decision-making process thorough and were we motivated by proper reasoning? Professionally, did we offer every viable treatment or re-homing option? Are we acting in accordance with the law and feel certain that public opinion would show favorably on the decision to euthanize? Overall, veterinarians and attending staff may harbor guilt and resentment towards their decisions if the answers to these questions have not been well thought out. One may need to ask themselves if their reason for, and method of, euthanasia became public, would they feel certain events played out in the best interest of the animal and family.

Because of client/family dynamics, current medical options, public opinion, ethics, etc, veterinarians are encouraged to reach outside themselves for answers to difficult questions surrounding euthanasia. When appropriate, entire families can be consulted and viewpoints heard before euthanasia is chosen. Staff members can be brought into conversations so that life-maintaining options are not overlooked. Hasty decision-making can fuel compassion fatigue and ‘burnout’, leaving veterinary staff feeling troubled and upset.

When veterinarians and caregivers examine best and worst case scenarios, the goal is to arrive at euthanasia when it is most appropriate and justified. Someone just given a life-limiting diagnosis for their pet may view euthanasia as the worst-case scenario. They choose palliative and hospice care to provide more quality time; to allow the pet to remain with the hospice-devoted caretaker for as long as possible in the face of life-limiting disease. When managed appropriately, their goal might be a peaceful natural death at home. Euthanasia will be chosen when suffering is recognized regardless of strong palliative care, i.e. pain management, oxygen support, etc. While still recognizing its benefits, this family will view euthanasia as the worst-case scenario and endeavor away from it through hospice care as long as possible. Examining euthanasia as the best-case scenario, we might consider someone whose pet is diagnosed with a rapidly progressive incurable disease that is impossible to manage for numerous reasons. They do not have the time, physical ability, or financial resources to support a dying pet. Choosing euthanasia as the best-case scenario ultimately prevents suffering by all involved and allows them to be together to provide love and support for their pet during death. Therefore, they will endeavor towards euthanasia by acting on it sooner rather than later. To fully understand anyone's reasoning behind the decisions they make, veterinarians and support staff should appreciate all philosophical and logistical factors that may be present. It is also very important to recognize that the emotional implications of their decisions may remain with them forever, especially when guilt is involved.

In terms of a pet's disease, it is important to consider the pet's suffering as well as the client's. Can human caretakers safely move a large dog inside and outside for potty breaks? Are they emotionally strong enough to watch their horse worsen from lymphoma when it is the same cancer a human loved one died from? Can they financially handle the extreme cost of treatment for one cow and still provide for the rest of the herd and their client?

Also to consider is how much does the client understand about euthanasia. When euthanasia enters the conversation, the client may have a completely different scenario in mind than what will be done. Veterinarians or support staff can describe the procedure and address concerns of the client. If pain for the pet is the biggest concern, the client may be comforted to know that a sedative will be given first. If they are envisioning a gas chamber or something similar, they might be comforted to learn that it will be an injection, and so on. When euthanasia takes place in a shelter setting, and the client cannot be present, they might want to know standard protocol.

Educating clients about their options and how best to proceed is important so that, if they choose euthanasia for a beloved pet, they know that they are doing so for the right reasons. This will ultimately lessen the guilt and help them achieve healthier mourning (Wolfelt 2004).

Common questions by a client include the following:

• How do I know my pet is suffering?
• What does suffering look like?
• Does he have a good quality of life?
• Is it what my pet really wants?
• Is euthanasia the only option?
• What should I know about euthanasia?
• Is it important to have my kids present? Other pets?
• Where can euthanasia be done? In the clinic, home, or special center?
• Is euthanasia painful?
• Do I have to be present?
• How do I handle the body afterward?
• Will I be able to have a ceremony?
• How will I ever get over this loss?

The answers to these questions depend on many variables: beliefs, prior experiences (of the client and tending veterinarian), education, physical and mental fortitude, community offerings, etc. With regard to suffering, a quality-of-life assessment may be performed to help the client understand the changes that they are seeing in their pet. Factors such as hygiene, mobility, mentation, appetite, etc., are considered collectively to help a client determine how comfortable a dog or cat is in its body and surroundings (Villalobos and Kaplan 2007). If children will be present, they should be gently instructed on how euthanasia will occur and why. Children do remarkably well when introduced to euthanasia in a positive and safe manner (Cooney 2011). The presence of other pets may also be allowed if the client and veterinarian deem it appropriate. The location of the procedure depends on how the practice is designed and by what means veterinarians can accommodate a client's request. If the service can be performed in or near the client's home, they should be informed of that ahead of time. A memorial garden or comfort room may be perfect too.

A big concern for some clients is whether or not to be present when saying goodbye to a beloved pet. Many individuals find the act of euthanasia too emotional and thus feel they cannot be there. Like many of these questions, the answer is up to them. However, if they are leaving because they have a negative perception of the euthanasia procedure, veterinarians and staff can help them to understand exactly what will take place. Taking away the unknown can make the last moments with their pet more memorable and maintain the human–animal bond at its most critical time.

Once the decision has been made to proceed with euthanasia, there are numerous questions that need to be addressed by the tending veterinarian:

• What does the client need to know about euthanasia?
• Where should it take place?
• Who should be present?
• Has the body aftercare been decided?
• Is the person making the decision authorized to do so?
• Should a necropsy be chosen?
• Do we have any financial concerns or beliefs that need to be discussed?

Preparations for euthanasia will be made before the appointment and continue throughout to make sure that things proceed smoothly. The goal of those assisting with the procedure should be to make decisions on behalf of the client that will make their experience less stressful. It is comforting for them to know that the veterinary staff is working together to handle all arrangements.

Before gathering with the client and pet, everything should be ready to proceed. In the clinic setting, all drugs and equipment should be readied, the lights should be set to a comfortable level, and the staff alerted to the time and location of the euthanasia. There are usually many people involved with euthanasia in the hospital setting: receptionist, technician, doctor, and vet students where teaching is performed (Martin and Ruby 2004). In the field, those gathered may simply be the veterinarian and client, as is often the case on house calls. All drugs and supplies should be drawn, drugs recorded, and readied for the pet. If the setting and situation calls for personal touches such as candles, music, etc., everything should be in place. Clients may want to lay on the ground with smaller animals, so providing blankets, etc., can be a welcomed touch. It is important that everyone working in the area is alerted to the procedure, by verbal communication, a marker outside the door or area, etc. When possible, the surrounding area should be kept quiet to prevent distractions.

To allow the client more privacy, appointments can be scheduled during quieter times of the day, and handling payment and having forms signed beforehand can be helpful. More and more practices are gathering information and accepting payment over the phone, so it does not need to be discussed during the appointment. If practice policy is to have aftercare arrangements made ahead of time, such as a time for the crematory to pick up the pet afterward, this can all be done before euthanasia. It is important to be flexible, understanding, and compassionate to the client's wishes and emotions.

If the client chooses euthanasia outside of the clinic, for example, at their home, unique preparations need to be made. The attending veterinarian must carry all supplies with them to the pet being helped. B...

Table of contents

• Cover
• Title Page
• Copyright
• About the Authors
• Acknowledgments
• Introduction
• Chapter 1: Client Considerations
• Chapter 2: Equipment
• Chapter 3: Positioning and Restraint
• Chapter 4: Pre-euthanasia Sedation and Anesthesia
• Chapter 5: Euthanasia Techniques
• Chapter 6: Body Aftercare
• Conclusion
• Bibliography
• Index