Dysthanasia: a newer meaning to a relatively new word

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If you’ve been practicing veterinary medicine long enough, you’ve likely had the misfortune of witnessing a euthanasia gone wrong. You may be the unfortunate one who facilitated it. Such a euthanasia rattles us and hijacks our thoughts, and we tend to relive it over and over. As caregivers, our euthanasia mission is to provide a gentle death, which is exactly what our clients want. How haunted will they be, and what will be the lasting memory of their pet’s life, if they witness pain or great distress during their pet’s last moments?

As the Companion Animal Euthanasia Training Academy (CAETA) director of education, I have received emails and letters from clients about their harrowing experiences. They tell me how much they are hurting and how devasted they feel, using words like “atrocity,” “egregious,” “horrifying” and “devastated” to describe what their beloved pet endured and how they felt. One woman described herself as a hollow shell, lost and alone.

Veterinary personnel also reach out, asking me if what they saw (e.g., a strange reaction to a drug, a slow death) was normal, or acceptable, according to malpractice standards. Often, drugs and protocols we have used confidently for years suddenly become ticking time bombs, rendering veterinary professionals unsure about how to proceed safely with their next euthanasia appointment. To legitimize these situations, we need a proper definition—a word that will call us to action to support our clients and prepare us to manage such cases. If euthanasia equals “a good death,” what is its opposite?

What should we call a bad death?

When we pull from the Greek language, as we did for euthanasia (eu meaning good, thanatos meaning death), we come up with dysthanasia (dys meaning bad). A newer word found in only a few sources, dysthanasia has been described as “the practice of prolonging the life of terminally ill animals, and allowing suffering without palliative care, or necessary euthanasia”—in other words, an end-of-life experience without palliative or hospice care, and lacking proper caregiver guidance that could prevent neglect during such a delicate time.

I suggest we call this scenario something aligned with a lack of proper veterinary care before death. Euthanasia pertains to the act of taking life, so dysthanasia is a suitable word to distinguish taking life in less than ideal ways. According to CAETA, dysthanasia is the opposite of euthanasia, and many are beginning to use the term in practice. While the two words have numerous comparisons and differences, the following illustrates the concept:

Euthanasia:

• The animal feels minimal to no anxiety, pain or fear.
• Proper technique is delivered.
• The procedure is in line with professional and societal animal welfare expectations.
• Observers feel safe and supported.

Dysthanasia:

• The animal feels unacceptable pain, anxiety and/or fear.
• Improper technique is used.
• Observers experience distress and anguish.
• Support among the patient, client and veterinary team breaks down.

While I recognize that defining dysthanasia leads us to a slippery slope, euthanasia itself is difficult to label clearly. What exactly is “unacceptable” pain, anxiety or fear? Many, including those providing similar services in the same cultures and demographic regions, may define “unacceptable” differently. Nevertheless, naming a bad death experience enhances a veterinary team’s ability to target and address the negative situation. When a dysthanasia occurs, and is labeled as such, a clear resolution plan can be set in motion. We cannot undo the procedure itself, but we can change how we manage the situation.

Dysthanasia best practices

Consider this case example. A veterinary team has decided what equals a quality euthanasia appointment. They have put protocols in place to deliver a pleasant euthanasia for the pet and a gentle experience for the client and their team. During the appointment, however, things go awry: The technique of choice doesn’t work and the euthanasia becomes an unpleasant, drawn-out ordeal for all involved. The client is visibly upset, and the team is shaken. Now what?

Label it

Management is clear. According to the established protocols, the appointment is labeled a dysthanasia, and the next step is to address what happened, first with a team debriefing to discuss what went wrong and troubleshoot solutions to prevent future occurrences, and then, of equal importance, reaching out to the client to show your sympathy and discuss what happened.

Talk about it

Talking about a dysthanasia will never be easy, but connecting with clients afterward, to answer questions and allay fears of the unknown, is always necessary. People have a tendency—in my opinion, perhaps—to misinterpret a good euthanasia, let alone a bad one. Gently and compassionately reviewing the facts helps put things in perspective and calm fears.

Families should be called no later than 24 hours following dysthanasia. Lead with a gentle message of sympathy and support to assess their feelings. Your team does not need to begin with a declaration of frustration but should simply ask how the client is doing. The client may perceive that everything went smoothly and be grateful for your caring words. If they were obviously angry after the appointment, your role is to be a sounding board. Let them talk about their concerns and ask questions. Lead the conversation with, for example: “Yesterday did not go as we all expected. While some things are beyond our control, I want to thank you for your patience with the process and for allowing me, and my team, to move forward in the best way possible. What questions can I answer for you?”

Clients have the right to be angry after a dysthanasia, regardless of whether the patient’s death experience was largely out of your control. Allow them to grieve in their own way. Hopefully, by reaching out to them, you show that you recognize their feelings, which may allow them to heal, and help them understand that you did your best.

Learn from it

Professionally, we must forgive ourselves, learn from the experience, and use the dysthanasia as a legacy for improvement. Some hospitals, especially those with a large euthanasia appointment volume, hold rounds focused on euthanasia, or at least discuss successes and challenges each time they meet. Dysthanasia begs talking about, not only to address the technical issues, but also to provide space for team members to share their thoughts and experiences. Team members commonly internalize both primary traumatic and secondary traumatic stress during dysthanasia—a double whammy and a catalyst toward compassion fatigue. Confident delivery of euthanasia procedures has been increasing for years, thus reducing the incidence of dysthanasia. And as veterinary teams develop stronger euthanasia protocols, they will be more likely to prevent those gut-wrenching “what just happened?” incidents. We all can devote our time and resources to learning how we can do it right the first time, but no matter how much we prepare, dysthanasias will sometimes happen.

My advice? Define the experience as a dysthanasia, address it with the team and protect the client’s mental health. You’ll always be grateful you did.

The three C’s

I’ll close with the most reliable way I know to protect the euthanasia experience—by embracing the three C’s:

• Provide compassion. Things may go wrong, but you can always fall back on your desire to love and serve.
• Portray confidence. Setting this tone increases trust in your ability to handle the situation.
• Maintain control. Do what you can to keep the process moving forward, or make the delicate call to postpone the process until issues can be resolved.

Practicing with compassion, confidence and control will protect you during any dysthanasia experience.

Dr. Cooney is founder and director of education for the Companion Animal Euthanasia Training Academy (CAETA). She teaches the Good Death Revolution, advocating for proper technique, while protecting the mental health and wellbeing of all involved. To learn more about the CAETA program, visit caetainternational.com.