Mechanics of Euthanasia

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We can either do great good or cause great harm, depending on how well we communicate with clients about the euthanasia of a pet.

Owners often do not understand the terms we use and can be easily confused about procedures leading up to euthanasia.

Careful and detailed explanations are essential.

To learn more, see Helping Clients Deal with Grief and Loss.

Individualizing Euthanasia
For scheduled euthanasias, you have an opportunity to discuss how owners would like to proceed. Some clients will need to ease into this last goodbye, while others will be anxious to “just get it over with” and will appreciate it if everything is arranged before their arrival. Regardless, try to move clients out of the lobby as soon as possible. Grieving owners may have difficulty watching happy scenes shared by other clients and pets, and it is simply too much to have to bear the innocent “What brings you here today?” questions from other clients.

Some clients may come alone while others bring family or friends. Some will want to be alone with their pets as much as possible, and others prefer to have the veterinarian or someone from the staff, such as a particular technician or assistant, remain with them before and/or after the procedure. We mourn communally.¹ Clients seem to know this instinctively and look to us for the support of witnessing this transition.

One thing that can be helpful to clients is to offer a chance for reminiscence. Depending on the circumstances, you can ask, “What do you remember about the first time you saw Spot?” Most clients have a fond story to share, which also serves to remind us that the work we do is good and valuable and in support of an irreplaceable and extraordinarily special bond.

Explaining the Procedure
Before proceeding with the euthanasia, clarify clients’ current understanding and listen for any information they may want to share or questions they may have. This applies whether this is the first or the tenth euthanasia with which the owner has been involved. For instance, explain intravenous catheterization (see IV Catheterization During Euthanasia below), how it is placed, what it will look like, and why it is so important.

If a pre-euthanasia sedative or tranquilizer will be used, explain how it is administered, and how the pet will likely look and act after the sedative takes effect. If owners will be present for administration of a sedative, let them know if it might sting (eg, as occurs with Telazol intramuscular injection). Explain how the euthanasia solution works and how quickly it can take effect. Explain what may happen with bowel and bladder, muscles, breathing, and movement. Use simple words and short sentences; speak slowly, and give clients plenty of time to digest information.

Be cautious about insisting that every pet be sedated or tranquilized before owner-present euthanasia. Clients often expect that sedation will make a pet relaxed and less anxious while remaining fully alert and able to interact. Clients often feel it is important for their pets to know they are companioned until the end. Also, some people’s spiritual beliefs hold that the pet must have complete clarity until the moment of death in order to “transition” optimally. Clearly, there are times when sedation is the more humane or even necessary option. Explaining why sedation is necessary or recommended and what to expect will help prevent disappointment, guilt, and animosity. Always give consideration to owners’ wishes as much as possible. (For more, see Tips for Communicating with Pet Owners About Euthanasia).

IV Catheterization During Euthanasia
The use of an IV catheter for drug administration during owner-present euthanasia is critical. It ensures appropriate delivery of the euthanasia solution and allows different “staging” scenarios for how clients and staff can be physically positioned during the procedure.

Owners may envision holding their pets in their laps or lying together on the floor, and instead the pet is surrounded by veterinary team members holding off veins and administering medications, leaving owners feeling “shouldered out” of their own pet’s euthanasia.

While you may not have ever had a problem, avoiding even one “euthanasia gone wrong” is worth it. Any unexpected and traumatic experiences can complicate a client’s mourning. For instance, what would have otherwise been an expected euthanasia experience can become a traumatic death1 because a vein blew or was “lost,” only part of the euthanasia solution was administered, and the pet displayed a “stage II” anesthesia reaction (vocalizing, thrashing, urination, defecation, etc).² This would then be the client’s last memory of his or her pet.

In addition to ensuring that the euthanasia solution is going where it is intended to go, use of an IV catheter allows staff to maneuver out of the client’s way and limit staff intrusion into this last intimate moment owners share with the pet. Do not discount intraperitoneal injections of euthanasia solution in certain circumstances, as this may be the best alternative for a given patient.

The "Surround"
Most practitioners are very sensitive to providing a comfortable, quiet environment for euthanasias. Dim lighting, quiet rooms, and quieter times of day outside the “rush” of appointments can all be helpful. The sound of laughter and loud conversation outside an exam room can be upsetting and may be disrespectful to clients, especially if the disturbances are coming from staff.

Take a moment to intentionally disengage from anything other than this client, with this pet, in this moment. This will help us “catch” the subtle questions or needs that clients might be conveying, even unconsciously. Due to changes in emotional and cognitive functioning at times of loss, clients may not be aware that they are stating unconscious needs.¹ Our ability to listen, acknowledge, and accommodate the often subtle but important needs will allow for truly individualized and more meaningful final partings.

Partings
Our companionship and skill during euthanasia can provide a memory that comforts owners long after their pets have died. Our preparation, attention, presence, and skill are all integral to our clients’ experiences. As difficult as euthanasia can be for us, too, it provides an opportunity to review what is important, what is not so worthy of worry and upset, and what can serve to remind us of the deep, deep value of our work.

Recently, I euthanized a dear friend’s cat. In a missive she wrote to supportive friends, she spoke of euthanasia solution as “sacred medicine.” Comfort and gratitude may go well beyond what we might ever imagine. | EVT  

Mechanics of Euthanasia Carrie La Jeunesse, DVM, CT, CCFE

References
1. Grief Counseling and Grief Therapy, 3rd ed. Worden JW—New York, Springer Publishing, 2002, p 51.
2. Death & Dying, Life & Living. Corr CA, Nabe CM, Corr DM—Belmont, CA: Wadsworth, 2008, pp 242-244.