There are few services we veterinarians provide more personal or emotional than the act of euthanasia. From the Greek, ”good death”, that is exactly what we are expected to provide and should provide. But administering an injection of the euthanasia drug is not all that is required or expected, indeed it is not the part requiring the most skill or sensitivity. Instead, it is the other parts, the human and humane parts that command the most expertise and sensitivity.

We veterinarians are privileged to participate in this most intimate of family moments by dint of our skill at performing euthanasia, though in all likelihood, if it was physically possible, I suspect most families would choose we not be there. After all, as close as we may be to our clients, we are not their family, certainly not like their pets are.

It is therefore critically important to our clients, though they generally could not express it in words, that euthanasia be conducted with a maximum of professionalism, dignity and sensitivity. The injection is the least of the matter.

What do I mean by “conducted with a maximum of professionalism, dignity and sensitivity”?

Whenever possible explaining the mechanics of the procedure well in advance of having to actually do it. Even before that, explaining how the client will know it’s the right time. Many, many clients express fear and anxiety that they will wait too long, that the pet will suffer more, because of what they may see as their own selfishness or fear. They need to know, in the context of their particular pet and its age or disease or circumstances what to expect, what the likely outcomes may be and how to recognize that an outcome has arrived. Explaining their options for “aftercare” and how the mechanics of those options work (Example: cremation, cremated remains returned in 1 week, a month, etc.) also ease anxiety.

During the procedure being aware of the emotional state of the client and anyone else present that the client may bring with them: sometimes the “guest” poses more challenges than the client him/herself (“My veterinarian does x, y or z…) by creating anxiety for your client. handling these situations deftly without ego or perceptible annoyance is critical. It’s not about us, the veterinarian, at all!

Each portion of the procedure needs to be explained, reassuring a client that it is not painful or how your actions will reduce pain. Often the placement of an indwelling intravenous catheter allows a smoother procedure than trying to place a butterfly catheter (“winged set”) or enter a vein with a simple needle with an awake, possibly uncomfortable or agitated patient. To a client, struggling by the pet, even against simple restraint is anxiety producing for the pet and for them. Pre-placement of an indwelling intravenous catheter obviates the need for much restraint, indeed the pet may be able to sit in or on the owners lap during the procedure with out risk of loss of venous access.

The likely appearance and reaction to the pet of the drug should be explained in advance. Saying “She may vocalize” as she goes under “anesthesia” may help explain the dysphoria and vocalization that some pets exhibit, and keep the client calm. You want to avoid creating circumstances in which clients may say “Is she in pain?” or “You’re hurting her!”

Explain in advance that pets, like people, don’t close their eyes most of the time when they die. And why urine or feces may be excreted when muscles relax or that muscles may twitch and movement may be seen for many minutes after death has occurred.

After death, gentle handling of the pets body, allowing the client unrestricted quiet time with the pet’s body and calm, reassuring words go a long way to comforting a grieving pet owner.

If the client has planned to bury the pet at home, advise them to prepare the spot in advance, including digging if indicated. When the pet is deceased, it is not comforting to shove a pet into a plastic bag. There are newer, better products in which to carry a deceased pet to its final resting place, Pet Knap being one. PetKnap is a quilted, zippered, water tight and attractive pet burial sack which makes pets look comfortable. That matters to clients and to me. No one wants to think of their pet balled up in a plastic bag.

Once the client has left, creating a paw or nose print of the pet in clay (Clap Paws and similar products), to be given to the client when they pick up the cremated remains or stop in, is a gesture that shows you understand what that pet meant to that family.

A telephone call to the client in the evening or the next day to express your condolences one more time is appropriate. Preparing a condolence card personalized for the pet and perhaps making a donation to a veterinary research charity are also gestures that help comfort grieving pet owners.

A word about condolence cards: Today’s marketplace offers many nice choices with kind words and poems within, however, nothing is better than kind words from the pet’s doctor which convey the pet’s special qualities and that the family’s grief is, in part, shared by others who knew the pet. Simply signing: “With condolences, Dr. Smith and staff” leaves a lot undone.

A better option is more like this:

Dear Mr. & Mrs. Jones and Family,
I just wanted to offer my condolences on the loss of Fluffy one more time, and let you know that all of us here will also miss her. She was a special cat and I know your family will miss her very much. I want you to know that your devotion to her needs was outstanding among pet owners and I’m certain this played a role in her having a long life. It was also brave of you, once it was clear nothing more could be done for Fluffy, that you made the decision for euthanasia, despite knowing how difficult her loss would be for you and your family. Again, please accept our sincere condolences.
Sincerely,
Dr. Smith and Anytown Animal Hospital staff: Susie, Jane and Betty

There’s a lot to anticipate and consider when euthanasia is to be performed, and while it may be unpleasant or anxiety producing in us sometimes, the memory of a poorly or insensitively conducted euthanasia lingers forever in a clients mind. We veterinarians have it in our power to make it beautiful, or allow it to be ugly. Why leave someone with a memory like that?

(originally posted at PetDocsOnCall.com, March, 2011)

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