Tips for managing behavioral euthanasia conversations

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Behavioral euthanasia is an emotionally charged, nuanced decision. Every individual who participates in conversations about euthanasia for behavioral reasons— whether as a veterinarian, pet owner, caregiver from a rescue, or trainer—has a unique perspective that is shaped by their own past experiences and beliefs. During a session at the 2024 Fetch Coastal dvm360 conference in Atlantic City, New Jersey, Christopher Pachel, DVM, DACVB, CABC, of the Animal Behavior Clinic in Portland, Oregon, provided his tips for discussing these difficult and often highly emotional decisions for aggressive dogs with pet owners.¹

The road to behavioral euthanasia conversations

Although euthanasia is commonly performed for medical reasons, there are key differences in the decision-making processes for medical and behavioral euthanasias. In the case of medical euthanasia, we are often navigating a progressive disease process that will result in death without any intervention. This situation is often viewed as a prevention of suffering.

But when it comes to behavioral euthanasia, many of these pets are young and otherwise physically healthy. Whether to euthanize these pets becomes a more active decision. Behavioral euthanasia is often considered because of a safety concern for either the pet itself or the humans and/ or other animals in the pet’s environment. It may also be a consideration if a pet’s quality of life is deemed poor because of the severity of a behavioral condition, such as severe phobias and anxiety that can result in self-injury.

Conversations around behavioral euthanasia may come at the beginning, middle, or end of the treatment process. They often occur after an incident or escalated concern for patient or family safety. Sometimes the conversation is proactively begun as part of a discussion of potential interventions. In other cases, it may be discussed as an alternative to adoption or rehoming of an aggressive animal.

Pachel noted that behavioral euthanasia should not be thought of as a punishment or consequence of “bad” behavior. “In essentially every case I’ve been involved with, the individuals are wrestling with the desire to be merciful,” Pachel stated, citing one definition of euthanasia as “direct administration of a lethal substance to the patient by another party with merciful intent.” He continued to say, “In the cases where euthanasia is the chosen outcome, it is a gift that we can provide to end the life of an animal with dignity and respect.”

When is behavioral euthanasia the appropriate next step?

In Pachel’s opinion and experience, “there isn’t a formula that is applicable to all cases.” Each case has specific factors that must be considered, including the individual patient and pet owners’ skill set, finances, family structure, relationships, and environment. Ultimately, the pet’s caregivers must define what their acceptable level of risk is.

“As a veterinarian or consultant, [the acceptable level of risk] is not mine to determine,” Pachel stated. It must be determined by an animal’s caregiver. However, in the event that an owner’s acceptable level of risk potentially exposes a vulnerable population—which includes individuals with immune or cognitive compromise or children—or public safety to excessive risk, veterinarians can reach out for support. In these cases, “my job is to enlist help [from] those who advocate for these populations,” Pachel said, but it is not to enforce his beliefs on a pet family.

When performing a risk assessment with a caregiver, the following 4 factors should be considered:

• Animal size, which includes not only the physical size of the animal but their size relative to other animals or humans in the environment (ie, children, small dogs, cats)
• Bite or incident history, which is evaluated retrospectively and includes both the frequency and severity of past incidents
• Predictability of behavior
• Frequency and manageability of exposure

This information is used to determine whether the animal can stay in its current environment safely or whether there is an alternative environment where the animal can be managed safely. If the answer to both questions is no, then “humane euthanasia becomes the remaining safe outcome,” Pachel said.

In some cases, caregivers will not consider euthanasia even if the pet’s behavior is beyond the acceptable level of risk that they have determined. Pachel said that the caregivers are moving forward at this point with the knowledge that the situation is inherently unsafe. He manages the client’s expectations about what can be accomplished with intervention in the context of their available resources and may have the client sign a waiver of risks.

Communication tips for behavioral euthanasia conversations

These conversations are emotionally charged and often lengthy. It is essential that veterinarians remain nonjudgmental and do not make assumptions of what the caregiver is thinking. We must balance the discussions to consider both what options are available and which are accessible to a pet family within their individual context.

“Choosing to make the lifestyle adjustments to manage a patient safely is hard. Choosing euthanasia is hard,” Pachel stated. Clients must choose which hard path to take. Pachel sees our role as veterinarians as providers of information and perspective. “There is value in assisting the caregiver in taking ownership of their decision and not making the decision for them,” he said.

Because these conversations often occur following a bite or other incident, emotions are particularly high and clients may not be making a thoughtful decision. Pachel suggested offering a pause. This means asking whether there is somewhere the animal can safely stay to give the client time to process the decision. “I’m not trying to talk them into one [decision] or the other,” he said. “I’m trying to give them time and space to make a decision without emotional clouding.”

Pachel shared that he often hears clients ask, “How could I consider behavioral euthanasia when [my pet] is wonderful so much of the time?” In these cases, Pachel discusses the predictability of the behavior, which helps clients assess the risks and the potential emotional costs going forward. If a behavior is unpredictable and the caregiver doesn’t know when it might occur, they must always be watching for it. This results in a much higher stress level than when behaviors are predictable and can be more easily anticipated.

Caring for those involved

Pachel noted that both pet caregivers and veterinary team members are affected by the emotional weight of these conversations and decisions. He encourages veterinary teams to ensure clients have a support system to lean on. If they don’t, we can refer them to someone who is equipped to help, such as a veterinary social worker.

But Pachel also stressed the importance of having strategies for processing these emotions as veterinary professionals. “We are underequipped as a profession to navigate what we are asked and what we choose to take on,” he said. We must remain aware of burnout and emotional fatigue and seek support to process these cases as well as the many others that weigh on us as veterinary professionals.

REFERENCE

1. Pachel C. Behavioral euthanasia considerations: bringing the conversation out of the shadows. Presented at: Fetch Coastal 2024; October 14-16, 2024; Atlantic City, NJ.