Understanding and dealing with pet loss (Proceedings)

Veterinarians are faced with the short life spans of their patients, providing them a large number of aged patients with chronic conditions and requiring special care. A veterinarian serving a family for a few decades sees several generations of pets come and go and grieves with the clients' family during the time of the animal's death. A high proportion of the deaths are by euthanasia, bringing emotional loss and upset to the veterinary staff as well as the family. The veterinarian's role in these occasions has shifted in recent decades toward being more of a counselor and psychologist providing comfort, as well as the emphasis on the mechanics of administering the euthanasia.

Caring for aging pets

Veterinary clients tend to provide a high level of care for their animals. With the growing options for treatment, a growing proportion of animals live into their elderly years in which they may be blind, deaf, arthritic, and incontinent—conditions requiring more effort in their care (Hart, Dorairaj, Camacho, and Hart, 2001; Hart, Hart, and Bain, 2006). Veterinarians can educate their clients in methods to simplify the additional requirements for care, helping to make the effort less overwhelming. In this regard, the model from human hospice is most valuable in stating philosophical goals. For example, the perspective is that the hospice team deals with all aspects of the family's experiences—medical, social, psychological, and spiritual. They treat the whole person, and the treatment extends a year and a half beyond the time of the patient's death. While this model does not directly transfer across to work with companion animals, it offers a framework for valuing the entire family and their experience in the process of the animal's decline.

Veterinary hospice is a well-established concept and a periodic conference topic. Veterinarians can be resourceful in assuring that caring support is offered from the practice. Alice Villalobos describes a "sunshine girl" in her office who looks after clients whose animals are in decline or have died. In the United Kingdom, some practices organized to offer specialized training along these lines to their receptionists. The situation for each practice is unique, so these options can be adapted as appropriate.

At such times, challenges with clients who are extremely emotional are more likely to arise. This may also be the case when clients themselves have medical issues or disabilities. These types of situations are addressed in the classic monograph by the

AVMA Committee on the Human-Animal Bond (1995). Consciously preparing for such potentially challenging occasions can facilitate them going more smoothly.

Stress for the veterinary team

Virtually all veterinarians have experienced severe grief with the loss of their companion animals. Despite this experience, they may need to remind themselves that their clients may suffer a similar level of grief. This was highlighted in the classic study showing that veterinarians easily can underestimate the attachment that their clients feel for the animal, and the emotional consequences of losing the animal (Catanzaro, 1988). Understanding what the client is going through perhaps can ameliorate the stress for the veterinary team and position the experience as a loss shared by the client and veterinarian.

It seems self-evident that performing frequent euthanasias carries a burden of stress. Developing methods for addressing this and other stresses is essential for wellbeing. Debriefing sessions among veterinary staff, held weekly at the clinic, are one strategy found useful by many practices. At such times, challenges of various kinds can be discussed to discharge some of the emotion and also develop a joint strategy for addressing the situation in the future. Individually at home, veterinarians do well to adopt healthful strategies of self-care that include optimal nutrition, exercise, social contacts, and good sleep (Hart, Hart, and Mader, 1990).

Stress for the pet's family

During the decline and death of a companion animal, the client becomes sensitive to every aspect of treatment. The client's primary wish first of all to be treated with respect is probably emphasized at such times (Case, 1988). The widespread availability of support for grieving due to pet loss via hotlines (Mader and Hart, 1992) and support groups (Hart, Rivero, Mader, and Hart, 1987) has demonstrated and educated the public to know that people may be seeking relief, support, and solace when grieving or upset concerning a companion animal. Perhaps less understood is the variability in patterns of grieving.

The overwhelming grief from the loss of a companion animal can easily last over a year. In our study of people who had called the University of California, Davis, Pet Loss Support Hotline, we found that some people never get over it. For an elderly person coming near the end of life, it can be symbolic that the good times are only in the past.

Losses can get strung together. A particular tragic episode with an animal may be added to another major loss, unleashing the grieving that did not occur earlier for multiple losses. After losing other family member(s) and then a pet, a person may experience this loss as the last link, as can particularly happen for an elderly person.

Being prepared to conduct euthanasias

The technical details for conducting euthanasia in a manner that is not traumatic for the client and goes smoothly for the animal are available and practices generally have standard guidelines that consider privacy for the client, and enough time for being with the animal's body afterward. Many clients insist on the euthanasia being performed at home or somewhere other than the clinic, and most veterinarians probably are willing to make these special arrangements for longterm clients. Most veterinarians have mastered these aspects by now and attention is focusing more on the emotional aspects of performing euthanasia.

In 1990 when we interviewed veterinarians concerning their experiences in euthanasia, we learned that they had become self-taught in developing effective strategies based on their experiences (Hart, Hart, and Mader, 1990). Details concerning their communications with the client, including family members, offering family to be present during euthanasia, scheduling, handling the animal, performing the euthanasia with sensitivity, discussing the body care, arranging payment, and contacting the client later were all issues they had learned about. None of these topics had been covered in their veterinary education, nor did they have any assistance in preparing to deal with their own stress. By now, aspects of these challenges are included within the veterinary curriculum, and students have opportunities to gain training on pet loss support hotlines to gain experience in dealing with upset clients. The topic of communication skills in veterinary education was highlighted in a classic book (Lagoni, Butler, and Hetts, 1994), and has even appeared as a special issue of the Journal of Veterinary Medical Education (2006). This type of subject matter is one of the most active areas of new veterinary curriculum development, focusing on enhanced communication. One example drawing from human medicine presents data on the enhanced patient satisfaction resulting from improved communication skills and suggests applying similar methods to veterinary medical education (Frankel, 2006).

Memorializing the animal

A fairly new development in the past decade is the myriad of accessible ways to memorialize the animal. Sympathy cards, a special plaque in the back garden with or without burial there, a cemetery or mausoleum memorial with burial or cremains, or a heartfelt memorial on-line at a virtual cemetery have all become commplace methods of remembering and honoring the animal. These practices by now are commonplace, accepted, and even expected.

Corollary practices may include having euthanasia performed at home, and inviting friends to bid farewell to an animal prior to euthanasia. These are logical extensions of people having a dog be a ring bearer at a wedding, or including the animal's image in the annual holiday card.

Conclusions

Dealing with pet loss has been an area of rapid change and improvement in care for the client and the veterinary team. Some resources and search templates that can aid in locating research literature on this topic are available through the UC Davis Program for Companion Animal Behavior: http://www.vetmed.ucdavis.edu/CCAB/main.htm

References

AVMA Committee on the Human-Animal Bond. 1995. AVMA guidelines for responding to clients with special needs. Journal of the American Veterinary Medical Association 206, 961-976.

Case, D. B. 1988. Survey of expectations among clients of three small animal clinics. Journal of the American Veterinary Medical Association 192, 498-502.

Catanzaro, T. E. 1988. A survey on the question of how well veterinarians are prepared to predict their client's human-animal bond. Journal of the American Veterinary Medical Association 192, 1707-1711.

Frankel, R. M. 2006. Pets, vets, and frets: What relationship-centered care research has to offer veterinary medicine. Journal of Veterinary Medical Education 33, 20-27.

Hart, B. L., Hart, L. A., and Bain, M. J. 2006. Canine and Feline Behavior Therapy, 2nd ed. Ames, Iowa: Blackwell Publishing.

Hart, L., Dorairaj, K,. Camacho, S., and Hart, B. L. 2001. Nurturing older dogs: Attitudes and experiences of caregivers. Journal of the American Animal Hospital Association 37, 307-310.

Hart, L. A., Hart, B. L., and Mader, B. 1990. Humane euthanasia and companion animal death: Caring for the animal, the client, and the veterinarian. Journal of the American Veterinary Medical Association 197, 1292-1299.

Hart, L.A., Rivero, C. A., Mader, B., and Hart, B. L. 1987. A pet loss support group: Evaluation of the first year. California Veterinarian 41(2):1315, 26.

Journal of Veterinary Medical Education (2006). Issue theme: Communication skills in veterinary education. Journal of Veterinary Medical Education 33(1), 1-148.

Lagoni, L., Butler, C., and Hetts, S. 1994. The Human-Animal Bond and Grief. Philadelphia: W. B. Saunders Co.

Mader, B., and Hart, L. A. 1992. Establishing a model pet loss support hotline. Journal of the American Veterinary Medical Association 200, 270-274.