Treat or euthanize: determining which patients can be helped (Proceedings)

Behavior problems are frustrating, emotionally taxing, and often dangerous to the animal or those around the animal. They can also pose a huge financial burden in terms of potential liability and resources for attempted resolution of the problem(s). Owners of pets with behavior problems have four possible solutions: 1) Live with the problem as it is, 2) attempt to rehabilitate the pet, 3) rehome the pet in a more suitable environment, or 4) euthanize the pet.

Due to the numerous variables that affect the development and maintenance of behaviors, outcome predictions for behavior problems are often less reliable than for medical issues. This makes it difficult to give owners solid prognostic information.

Pets are an important part of family life in most American homes. While the level of attachment that any particular owner has to their pet varies, even those owners that appear to have a low level attachment can have great difficulty in making the decision as to whether they should euthanize the animal. The clinician should never underestimate the degree of emotional attachment to an aggressive animal even if the owner is the target! Euthanasia is a very personal and very permanent intervention and the recommendation should never be made lightly. The advances in behavior therapy in animals and humans in the past few decades are sizeable. If owners have any inclination to pursue therapy, or they are having difficulty deciding whether to treat or not, they should be referred to a behavior specialist.

Each animal with a behavior problem is a case study of one. The factors that affect the risk:benefit analysis will be unique to each individual situation. Factors that must be evaluated include those related to the client, the animal's environment, the animal itself, and the behavioral presentation.

Client factors

One of the most important factors is the client's perception of the animal and the issue. How the client feels about the pet, the problem and the likelihood of the problem improving will impact their dedication to the behavior modification program. Sometimes there are "warring factions" in the home with regard to how the animal and the problem should be handled. This divisiveness will reduce the effectiveness of any program implemented. It is important to know if the client is afraid of the pet and whether anyone in the home has given an ultimatum.

A significant limiting factor to success is the client's resources: financial, emotional and temporal. Working through a serious behavior problem requires repeated contact with the clinician and/or a trainer. Very few problems can be fixed in one visit, particularly for dogs. The client has to be able to dedicate enough training time to the issue and also have the emotional fortitude to persist through the ups-and-downs of the program and the opinions and perceptions of friends, family and outsiders.

Clients also often have physical or emotional issues that influence their ability to implement a program successfully. In discussing the animal's prognosis, the clinician should pay careful attention to whether there are children or seniors in the home, as well as any individuals that have mental disorders (which can create chaotic or unpredictable behavior) or substance abuse disorders. Senior citizens often have physical limitations that affect their ability to control unruly large dogs.

Environmental factors

The environment plays a huge role in the onset and maintenance of behavior problems. Likewise the environment can play a large role in resolving them as well. Features of the environment that are critical include: the presence of another animals, children or elderly in the home, and the layout of the home and property. Routine care issues are important. Where does the client have to walk the dog for exercise and elimination? How does the pet behave in the car? Are there other animals in the home that also have behavior problems or whose behavior in some way contributes to the issues of the patient?

The client must be able to control the environmental impact. If the client cannot at all control the pet's exposure to trigger stimuli, then the program cannot be implemented safely and effectively. The prognosis for improvement will be poor.

Patient factors

Behavior is, thankfully, malleable. However there are characteristic of the patient that will make altering a behavior easier or more difficult. The patient's size will certainly affect the ability of the owner to control the animal and may impact the severity of an injury the animal could inflict. The patients signalment, including breed, will also factor into the situation – sometimes merely because of public perception.

One can never divide genetic influences from environmental ones; these are always intricately intertwined. Research does show that we can alter genetic expression with environmental experience; however, the animal's genetic template is set and this will influence the types of behaviors expressed as well as the approach to resolving them.

The pet's developmental period, most importantly the socialization experience, has a crucial influence on future behavior. Certain training during this time can greatly reduce the likelihood of behavior problems, but some practices will actually induce behavior issues. As with humans, an animal's juvenile and adolescent periods have a profound impact on the animal's behavior. This is the most trying time when raising a pet and a time when most owners reach the limits of their knowledge and fall short of their obligations as a responsible pet owner.

The pet's medical history, including diets, supplements and medications will affect their behavior. These conditions and medications may also put limitations on the success of a program.

Behavioral factors

Behavioral elements are the most important of the factors, mostly because the characteristics of the behavior problem determine how important that other factors will be in the resolution of the issue.

An educated decision regarding a pet's life cannot be made without a thorough description of the problem behavior. What IS the problem? What is the frequency and intensity of the behavior? The predictability of the problem is essential. Owners often report that a problem behavior is unpredictable, but with careful questioning the clinician can often determine that the problem is highly predictable in when it will occur and what triggers it. (When the behavior won't occur may be less predictable.)

Does the behavior pose a danger to other humans or animals? Is the animal self-injurious? Determine how many triggers there are for the behavior and, in the case of aggression, how many targets (these are not always the same).

With aggression cases, two important factors are bite threshold (how easily is the animal triggered to use its mouth) and bite inhibition (when the animal does bite, how severe is the injury). Animals that show frequent aggression but do little to no damage are often much better candidates for rehabilitation than animals that bite infrequently but do considerable damage when they do. In general, the animal's "next" bite is likely to be similar in severity to the previous bites. It is not necessarily true that a dog's bite severity will escalate over time. The severity of a bite depends on the animal's "bite socialization" (did the animal have the opportunity to learn mouth control when it was young), the context of the episode (how severely provoked was the animal), and the behavior of the victim (did the victim pull away and thereby increase the severity of the injury). The predictability of the aggression and the level of warning the animal shows before escalating to biting should also be evaluated and considered when estimating a prognosis.

In general, factors supporting a more positive prognosis include:

     1. There has been no previous intervention for the problem.

     2. The animal gives considerable warming before actual biting

     3. The animal demonstrates good bite inhibition in most or all episodes

     4. The owner can successfully implement management steps and control the animal's environment.

     5. The owner is dedicated and compliant.

     6. The owner has realistic goals and expectations.

Relatively poor prognostic factors for anxiety disorders include:

     1. The trigger stimuli are such that the animal's exposure cannot be controlled (e.g. storms).

     2. the animal's anxiety is causing self-injury

     3. there is severe property destruction

     4. The owner "requires" immediate resolution.

Less favorable prognostic factors for aggression cases include:

     1. The attacks are truly unpredictable.

     2. There is little to no warning given beforehand. This means the animal is truly not giving a warning, not that the owner is just failing to recognize it.

     3. The bites are causing moderate to severe injury the majority of the time.

     4. The owner is the target and the owner cannot control the animal, or his /her contact with the animal. (The owner can not/will not take steps to avoid altercations with the animal.)

     5. There are multiple triggers for aggression and/or multiple targets.

     6. There are young children in a home with a resource guarding dog.

     7. The targeted victims are elderly, handicapped, or ill.

     8. The owner is unwilling or unable to make environmental changes.

     9. The owner is unwilling or unable to make changes in his/her own behavior around the animal.

Prognostic factors are an assumption, not a foretelling. Each case must be evaluated as an n=1 because no two situations are exactly identical. Broad generalizations should not be used to determine the value of an animal's life.

A conundrum with aggression cases is that the only way to be 100% certain that an animal will bite is when the animal actually does bite. For this reason, we cannot "test" the success of the behavior program with biting as the measure. Similarly, it is unfair to the animal, the owner and a potential victim to set up situations that purposely trigger barking, lunging, growling, hissing, swatting or snapping in order to "test" the animal. This means the success of the program must be measured in more subtle and, often, less definitive ways.

Helping owners with the decision

Take a complete and thorough history. Evaluate the animal as much as safety allows. Evaluate the owner's relationship with the animal and how they interact with each other. List the favorable and unfavorable prognostic factors. Give clients permission to elect euthanasia without judgment especially in cases where the patient poses an injurious risk to other animals and people. Take in to consideration the patient's welfare as well. Animals that are showing frequent anxiety or aggression are living highly stressful lives. Animal do not enjoy feeling threatened and getting into altercations all the time.

If the client is unsure whether they can implement a plan, but do not want to euthanize the animal, then set a finite treatment goal. Have the client dedicate 2-4 weeks to the program. At the end of that time frame, evaluate the situation. How hard was it for the client to implement the necessary safety management steps? How much time was the client able to spend on the training exercises? How stressful was it for the client to live within the bounds of the program? Does the client feel he/she could maintain that intervention long term? Was there any change in the animal's behavior during that time? Was it better or worse or some of both?

The answers to these questions will help the client to decide whether to push on for another month or to stop the program and euthanize the pet.