Euthanasia attendants in modern practice

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In times of sadness, we need someone we can rely on to carry us through. During a euthanasia appointment, various personnel commonly interact with the client and patient, but rarely is there a consistent person who will be there for the duration. Yet a trusted, reliable friend can help navigate the
appointment and make the experience feel safer. In modern veterinary practices, this “friend” can be a devoted euthanasia attendant, whom clients can rely on to help them through one of the hardest days of their life.

In servitude to protect the human-animal bond, a euthanasia attendant is an appointed member of the team who will chaperone the appointment from start to finish. This person can be a nurse, assistant, social worker, or even the veterinarian. They are the client’s point person, there to answer questions and provide emotional support as the appointment progresses. The attendant also is the liaison among all other team members, making sure everything runs smoothly. Ideally, this person comprehends the magnitude of pet loss and naturally conveys love and compassion.

Without an attendant, the appointment will be managed by many members of the team. In this author’s experience, it is common for front-desk personnel to lead the client and patient to the room. While the client completes paperwork, a nurse enters and takes the patient to the treatment area for intravenous (IV) catheter placement. The patient returns to the room with the nurse or with the veterinarian who will perform the euthanasia procedure. After the patient’s passing, any one of these—front-desk personnel, nurse, or veterinarian—may return to check on the family and help them exit the building.

Meanwhile, behind the scenes, numerous conversations are happening among staff about what the client and patient need, which can lead to miscommunication and missed opportunities to meet expectations. Having 1 person, an attendant, hearing all details increases efficiency while reducing mistakes.

This procedure offers no do-overs, so getting things correct the first time is a game changer.

Modern euthanasia includes providing pre-euthanasia sedation or anesthesia drugs to patients and keeping the client and pet together without separation. Medical personnel can administer sedatives, place IV catheters, and in some states, facilitate euthanasia. Nurses are often tasked with acquiring the necessary drugs and preparing bodies for aftercare services, such as cremation or aquamation. For these reasons, nurses may be the best suited for the attendant position. In hospitals employing veterinary social workers, they are perfect for the role, too.

Euthanasia attendants need not be experts in euthanasia, although understanding the complexities is beneficial. They do, however, need to be strong communicators, empathetic, and organized. Of course, if the veterinarian is the euthanasia attendant, as is often the case in small practices with only a few team members, then they need to be highly skilled in the procedure itself.

An attendant’s direct tasks may include the following:

• ready the room and supplies;
• review client and patient notes, such as emotional record and preplanned requests;
• greet client and patient at the entrance and direct to the room;
• provide water and similar comforts;
• listen to needs and requests and relay them to necessary personnel;
• remain present during the procedure;
• offer privacy before and after;
• ensure all requests are carried out; and
• prepare the pet’s body for aftercare.

An attendant’s indirect tasks may include the following:

• create a sympathy card and memorial items, if applicable;
• update medical records;
• notify veterinarians and paraprofessionals of the death;
• answer phone calls pertaining to end of life;
• include euthanasia topics in meetings/rounds; and
• advocate for self-care.

Attendants are not expected to be with the client/patient during every moment of the procedure. Privacy and alone time are still highly encouraged to provide space for clients to reflect on the loss of a dear friend. This means that in between appointments and during client privacy time, the attendant is afforded time to handle more indirect tasks. If end-of-life phone calls can be triaged to the attendant, the burden of switching between life-and-death calls at the front desk is greatly reduced.

Regardless of one’s professional position in a hospital or practice, not everyone is well suited to the role of euthanasia attendant. Those whom this work appeals to already gravitate toward euthanasia. They are often the first to sign the sympathy cards or make memorialization items. They may talk about end-of-life cases more than others and want to handle aftercare arrangements. On the other hand, those who avoid euthanasia or prefer not to be part of the appointments any more than necessary should not be forced, although proper euthanasia training may improve moral around the procedure.

It is advised to have a staff meeting to discuss the attendant position and ask who is interested in helping. From there, management will need to monitor attendants for euthanasia-related stress, as they should for all personnel involved in death care. It has been shown that veterinarians benefit from having colleagues at work who discuss cases and provide mutual support during and after euthanasia.¹

The goal is to leverage the team as it is without adding more personnel to an already stretched labor force. Some hospitals have a high euthanasia volume and may need more than 1 designated attendant per day.

Euthanasia attendants can also facilitate self-care for themselves and for the team on their designated day, ordering comfort foods and snacks for the team, playing soothing afternoon music, making sure everyone takes their breaks, providing calming scents, and more.

Euthanasia attendants, first advocated for by the Companion Animal Euthanasia Training Academy, can fill a vital team role to support grieving clients, manage appointment logistics, and make sure the busy workday still puts emphasis on caring and compassion—where it belongs. Just as important, they are masterful listeners.

A euthanasia attendant can improve client, patient, and team support. Discussion about euthanasia services can also stimulate dialogue within the team about boundaries and preferences toward death—who wants to do more, who wants to do less—and find balance for the team. This includes identifying strengths and gaps in emotional intelligence and resiliency, which are both so important in end-of-life work.

Kathleen Cooney, DVM, CHPV, CCFP is the founder and director of education for the Companion Animal Euthanasia Training Academy and chief medical officer for Caring Pathways USA. She is a strong advocate for best practices in all aspects of end of life for animals. Cooney can be reached at kathleen@caetainternational.com

Reference

Knesl O, Hart BL, Fine AH, et al. Veterinarians and humane endings: when is it the right time to euthanize a companion animal?. Front Vet Sci. 2017;4:45. doi:10.3389/fvets.2017.00045