How pet owners define a “good death”

Euthanasia is a procedure that most veterinarians perform frequently. It is chosen for many reasons, most commonly to relieve pain and suffering when further treatment is no longer in the patient’s best interest. Euthanasia is conventionally defined as the ending of a life that minimizes or eliminates pain and distress. Veterinary professionals, relying on their expertise and experience, aim to perform euthanasia in ways that align with the best interest of all involved.

Studies on euthanasia have helped validate some of the things we have learned and most owners want to be allowed to witness the death of their pet,^1-3 they want reassurance they are making the right choice,^4-6 and they look toward their veterinary teams to provide guidance on deciding the right time.^4,7 Euthanasia is an important procedure, critical not only for animal welfare⁸ but also for the emotional well-being of the owner and owner-veterinarian relationship.⁹

Yet, aside from some overarching generalizations, we know little about how pet owners define a “good” euthanasia vs a bad one (dysthanasia). What is important to them? How does this compare with veterinary professionals’ definition? What’s being provided in practice today?

To help answer this question—how pet owners define a good death—the Companion Animal Euthanasia Training Academy (CAETA) distributed an anonymous online survey to pet owners between December 2021 and January 2022. We want to share with you what we learned.

How pet owners define a good death

We analyzed responses from 1578 primarily White, college-educated, women pet owners. When asked to rate the euthanasia that impacted them the most, most owners reported positive experiences. In fact, on a scale from 1 (worst experience) to 10 (best experience), 14% reported scores between 1 and 5, 27% reported scores between 6 and 8, and 59% reported scores between 9 and 10.

To better understand what predicted a good (scores of 9-10) experience, we asked a series of questions related to before, during, and after the euthanasia procedure.

Location

We began by asking about the location of the procedure. We found that owners were more likely to report having a positive experience if the euthanasia was performed at home (80%) than if performed at a veterinary hospital (43%). We asked what elements of an at-home euthanasia are most important in determining a good experience and found that the things deemed as most important include a veterinarian who comes prepared with all the materials needed, is friendly and provides a relaxed atmosphere, is willing to gather where the pet wants to be (eg, on the bed), and provides private time before and after the euthanasia.

Owners were also more likely to report a positive experience if they had at least 1 day to prepare (66%) vs if it was an emergency (33%). The more time owners had to prepare, the more likely they were to report a positive experience. Relatedly, those who had a preeuthanasia appointment were more likely to report experiencing a good death than those who did not (69% vs 59%, respectively). When asked about elements of the preeuthanasia appointment, the most important element identified by owners was that they felt the euthanasia procedure was explained in a way they understood.

So it would appear that preplanning, and particularly a preeuthanasia appointment, is helpful in creating a positive experience.

Use of sedatives

What else is important within the euthanasia event? The next series of questions explored the use of sedatives prior to euthanasia. We found that owners were more likely to be satisfied when their pet was given a sedative prior to euthanasia (62%) vs when not given a sedative (31%). When asked about the effect of the sedative, owners reported the highest positive experience when their pet was fully asleep (66%) vs relaxed and partially asleep (62%) or relaxed and fully awake (51%). When asked about the amount of time between the sedative and euthanasia injection, we found that longer was better. Although 52% of those with less than a minute between the time of sedation and euthanasia reported a positive experience, this number increased to 64% when the time between sedation and euthanasia injection was more than 3 minutes. Ratings stayed high (64%) when the time between sedation and euthanasia injection was more than 20 minutes. This suggests that even when things take longer between sedation and the euthanasia injection than planned, this is not necessarily viewed negatively by owners. Instead, we found that the most important aspects of sedation to owners in determining a good death include being able to be with their pet when they are given the sedative, that the sedative does not medically complicate the rest of the procedure, that the veterinary team does not need to restrain the pet, and that the impact of the sedative is explained before it is given. The sedative adverse effects most troubling to owners include any seizure-like activity and the appearance of causing the pet pain.

The procedure

We next shifted to the euthanasia procedure itself. We found the elements reported by owners as having the largest potential negative impact on the euthanasia experience include not having an opportunity to be physically close to the pet during their last minutes; the pet appearing to be in pain in their final moments; the pet thrashing, making sudden movements, or vocalizing when the euthanasia solution is injected; and the pet appearing scared or stressed (Figure 1). The adverse effects of euthanasia found most troubling to owners include seizures and vocalization.

Figure 1 and Figure 2

Additional factors of the euthanasia procedure that were identified as important to avoid include not allowing owners to be with the pet during the entire procedure; hearing the pet in what sounded like distress when out of sight or appearing to be in distress when they are returned to the room; and not being allowed to spend time with the pet beforehand. Of note is that factors such as the death not going as fast as they expected or the veterinary team having to deviate from the plan but explaining the need for the change were not significant negative impactors.

Overall process

Because we know that many factors beyond the euthanasia procedure are involved with owners’ perception of a good death, we asked a series of questions related to the overall process. For example, we found that feeling their pet’s body was not handled with respect after death or not being offered adequate time or privacy with their pet after their death negatively impacted their perceptions of the experience (Figure 2). Additionally, views about their veterinary team had the potential to make a positive or negative impact (Figure 3). Owners who felt the veterinary team was uncaring, inconvenienced, rushed, distracted, or not open to their questions were more likely to view the experience negatively.

Figure 3

According to CAETA, which started to more deeply define companion animal euthanasia and dysthanasia in 2017, companion animal euthanasia is the proper use of technique in line with professional and societal welfare expectations, wherein the animal feels minimal to no anxiety, pain, or fear and observers feel safe and supported. Dysthanasia can be defined as a bad death, the opposite of euthanasia.¹⁰ This current study reveals owners would define dysthanasia further to include the inability to be present (their pet is fearful without them), lack of preeuthanasia sedation, and any pain or distress observed during the entirety of the appointment, not just the euthanasia method itself.

Companion animal euthanasia should consider the expectations of those who love and care for the pet, including the following:

• Professional, caring staff: The team is willing to accommodate owner/pet preferences, well prepared, and working with a relaxed pace.
• Preappointment education: This option is offered to arrange for important logistics, plus a description of what’s going to happen.
• Preeuthanasia sedation: The pet is in deep sleep, no matter how long it takes.
• To remain with the pet without separation: Owners want the ability to be there for the entirety of the procedure, including all technical aspects.
• No pain or signs of distress before or during the death event: The pet passes quietly and calmly.
• Privacy offered before and after death: Time is afforded to say goodbye, without rushing.
• Respectful body handling: The deceased pet is treated with reverence.
  • Honorable mention: at-home euthanasia and the comfort it provides. This was not included in the definition of a good death because it’s a component that may not be achievable in many parts of the world.

What we learned

This tells us that owners view the euthanasia experience from a gestalt (when the whole is perceived as more than the sum of its parts) perspective. From the preeuthanasia appointment to afterdeath body care, each element is important to owners and impacts their perception of a good death.

This means that focusing entirely on the medical aspects of the euthanasia procedure creates multiple opportunities to fall short in the eyes of pet owners. Only through careful attention to each element of the process can we best meet their needs and, concurrently, the needs of our patients.

The positive news from this study is that most pet owners report feeling extremely satisfied with their euthanasia experience. This speaks to the careful attention most veterinary teams give to each element within the process. Also encouraging is that the factors deemed most important by owners are manageable—most only need minor protocol tweaks and increased attention to detail.

As a profession, we are in the gifted position to offer a good death to our patients. Research studies like this one help us know where to allocate our time, energy, and resources to ensure we meet owner needs in the process.

Kathleen Cooney, DVM, MS, CHPV, CCFP is the founder and director of education for the Companion Animal Euthanasia Training Academy in Loveland, Colorado, and chief medical officer of Caring Pathways.

Lori Kogan, PhD is a professor and psychologist at the College of Veterinary Medicine and Biomedical Sciences at Colorado State University in Fort Collins, Colorado.

References

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