Veterinary euthanasia: the last act of love

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When a pet's quality of life declines so much that the owner is faced with having to make the decision to actively end that pet's life, it can seem impossibly overwhelming. Euthanasia is a difficult discussion topic for both pet owners and pet care providers. The concept of proactively ending a pet's life, regardless of the reason, brings up complex emotions and challenging ethical issues, especially as euthanasia for people is increasingly explored and legalized. After all, where is the line to be drawn when we discuss end-of-life issues? While animal euthanasia is almost universally accepted as humane and necessary when quality of life fades, very similar scenarios are commonly faced and debated in human health care.

Physician-assisted death, or “aid in dying,” is currently legal in a number of countries, including Canada, Belgium, the Netherlands, Luxembourg, Colombia, Switzerland, and parts of Australia and the United States (California, Colorado, District of Columbia, Hawaii, Montana, Maine [bill signed by the governor June 12, 2019], New Jersey [as of Aug. 1, 2019], Oregon, Vermont, and Washington). There is little question that as medical science advances and people are living longer, the progress of disease will change. People will become more involved in decisions about their own right to die, and a greater number of states, countries and societies will create a space for physician-facilitated death owing to physical and emotional pain as well as dignity and quality-of-life issues.

I cannot imagine the difficulty of making this ultimate decision for myself, nor can I imagine actively participating in the death of another human being even if they choose to end their life. And yet, all practicing veterinarians have participated in ending the suffering of animal life.

Of all my professional interactions with patients, caregivers and family members, by far the most emotional have revolved around issues of euthanasia. I have always viewed euthanasia as one of the greatest responsibilities entrusted to our profession and at the same time one of the gifts many veterinarians take for granted. Clearly, we all value the lives and welfare of our patients, but at times our abilities have been exhausted and we must consider the remaining options. After all, our professional oath dictates that our ultimate goal is to relieve suffering for those under our care.

An old friend recently said goodbye to his very special dog. Now, I know all pets are special to their caregivers, but even I cried at this pet's passing despite not having seen the dog in years. As his pet parent (not a term I use often or take lightly) and I shared a tear, he raised the question, “How do you vets do it?”

It never gets easier, I started to explain, and as I spoke I recalled countless euthanasias I had performed over the course of my career. My own philosophy about ending a patient's life is this: “Not a day too soon but not a moment too delayed.” The growing movement in the direction of pet hospice is based on that perspective. Saying goodbye to a beloved pet carries so many emotions and psychological steps that we sometimes gloss over them … until it is our pet and we experience it up close and personal.

For veterinarians, humane euthanasia is a way of ending pointless suffering in animals when all else has failed. It is often a difficult therapeutic option in the best interest of the animal and the family. In fact, we are obligated to consider euthanasia as an option to relieve suffering. It seems there is always another thing that can be done in an effort to forestall pain and death, but to what end? Sometimes it seems rather than extending life we wind up prolonging the death process.

Discussing death: an ongoing conversation

Click here for the dvm360 end-of-life toolkit, which includes articles, tips, handouts, videos and other tools designed to help veterinary professionals have thoughtful, meaningful end-of-life discussions with pet owners. 

While animals are not thought to be self-aware or able to reflect on their own condition, and they cannot balance their suffering against time or pleasure or memories of better days, they are certainly sentient creatures capable of feeling physical and psychological pain. Yet, they are not in a position to make decisions about their own medical care. That responsibility falls on their owners.

For many pet owners, however, even the thought of losing a beloved pet can be too much to process. When a pet's quality of life declines so much that the owner is faced with having to make the decision to actively end that pet's life, it can seem impossibly overwhelming. How many times has an owner told me that they just wanted their pet to “die peacefully in its sleep”? Yet, very few animals die quietly in their sleep and even those pets too often have suffered needlessly until their body simply could not go on. A peaceful death is often only possible with the intervention of euthanasia.

As veterinarians, we are expected to be more objective and should work with owners to decide when euthanasia might be the kindest option, providing permission and support when the time arrives. Euthanasia is sometimes the last arrow in our quiver … the last act of love we can give.

Dr. Mike Paul is the former executive director of the Companion Animal Parasite Council and a former president of the American Animal Hospital Association. He is currently the principal of Magpie Veterinary Consulting. He is retired from practice and lives in Anguilla, British West Indies.