Mind Over Miller: When discussing life and death, words matter

The big dog cringed under the bench in the reception area. "He hates to come in here," the old man said. "But he's got this skin problem, and it stinks something terrible."

Robert M. Miller, DVM

The doctor picked up the dog and led the way to the exam room. "I'm going to have to put him down," the young veterinarian said.

"Why?" asked the old man. "Is it incurable?"

"No," said the young veterinarian, "he's too heavy!"

This little story points out the problem of semantics regarding euthanasia. If we say euthanasia or euthanize, many clients don't know what we are talking about. I remember one owner who confused euthanasia with anesthesia. When the doctor said, "Because his back is broken, the kindest thing we can do is euthanasia." The owner asked, "OK, and how long will he be asleep?"

Conversely, I heard a client who came in with a cat with a bad abscess say, "I want her put to sleep." The veterinarian, who did not yet have a policy of requiring owners to sign a euthanasia authorization form, hospitalized the pet and did what he thought was requested. Imagine his consternation when the client reappeared and asked if Queenie was ready to go home.

What do you say? Put her down, probably the most common term used in large-animal practice, and end his suffering are vague. Destroy, kill, do away with him are crass and impersonal.

When recommending euthanasia to an undecided client, I learned to be discrete. I learned this early in my practice career when an elderly client brought his cocker spaniel to me. The dog had terminal cancer, and the owner dutifully brought the suffering pet in every day for analgesia, fluids, and supportive therapy. Finally, feeling that I was not doing a commendable service for either the client or his dog, I said, "You know, the best thing we can do for him is end his suffering."

The old man picked up his withered pet and said, "I came here because you can do things I can't do. If I wanted him dead, I would put him in the garage with the car engine running. I'll find a doctor who is more interested in preserving life than in ending it."

He never came back. I was a young veterinarian, and I never forgot the lesson he taught me. Henceforth, if I recommended euthanasia for humane reasons, I did it diplomatically. I'd say, "I know what I would do if he were mine, but he is yours, so I'll do my best to do what you want."

If they responded, "What would you do if he were yours?" they wanted me to make the decision. So I'd then say, "I would end his suffering. It's the final kindness." This usually elicited tears and a nod. If they did not respond, they weren't ready for euthanasia. I'd drop the subject by saying, "I'll do all I can to minimize his discomfort."

What more can we do? How do you handle one of the most tragic and difficult situations in veterinary practice?

Long ago, I resented clients who insisted on being present when euthanasia was performed. I thought they didn't trust me. I have since learned better. Some people don't want to see the life of a beloved friend end. They prefer that their last memory of their pet be of life. Other people want their pets' last memories to be of their loving owners. Indeed, having lost many dear pets, I want to be there when it happens. I don't want them to be alone or with strangers.

Like so many veterinarians, euthanasia was easier for me when I was young. With age, experience, and having buried many wonderful animal friends of my own, it gets harder to do all the time.

Robert M. Miller, DVM, is an author and a cartoonist, speaker, and Veterinary Medicine Practitioner Advisory Board member from Thousand Oaks, Calif. His thoughts in "Mind Over Miller" are drawn from 32 years as a mixed-animal practitioner. Visit his Web site at www.robertmmiller.com.