Dealing with euthanasia

[mnb4nj]

Hey guys,
Today I'm bringing back the time-honored classic question: how does everyone deal with euthanasia?
I am supposed to start vet school this fall, and I am seriously freaking out. I work at a small animal clinic (though my passion is equine), and I am finding it harder and harder to deal with the amount of death and euthanasia we see on a regular basis. I can count on one hand the number of days this year that I have been at work and nothing has died. Sometimes it's 3+ in a day. (For context, I work in a clinic that works as a hybrid GP/urgent care model). When I first started at this job and for the first several months, euthanasia didn't bug me very much. It was sad, but I went home at the end of the day and wasn't weighed down by it. Now the cases are getting more frequent, and I sometimes wonder if some of the euthanasia we see is ethical and necessary. I am finding myself taking work home with me and crying A LOT. I don't know if the situation is different in equine, but I seriously worry about my ability to cope with seeing this much death for 30+ years. It's making me wonder if I should turn around and not go to vet school.
Most of my coworkers just don't seem upset by euthanasia. I'm the only one who ever cries seeing the grief of the family (everyone else views that as unprofessional/unacceptable), and I feel totally alone and like I am just too weak to handle it. I really like vet med, and it was my dream to become an equine vet. But as things are now, I cannot see myself pursuing this career if I don't figure out how to better deal with euthanasia. Does anyone have any advice for learning to cope?

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[WildZoo]

This might get rambly...bear with me

One important thing to remember is death is part of life. And yes, you will see a lot of it in this profession. Maybe less in some areas (dermatology, radiology), but there will always be death, whether by euthanasia or by succumbing to disease. I don't think it's unprofessional to be touched by it, or by the emotions of the family, as long as you can maintain your composure and do your job, it's ok to cry with them in my opinion. Most of the time I can get through a euthanasia appointment just fine and go on to the next thing, but I think for most people there will be some cases that hit you hard. I remember the first euthanasia I was a part of. I remember the first one where I was the one pushing the euthanasia drug. I remember my first one that went poorly. And I remember the ones that seemed unfair...the young dogs with sudden and rapid decline, the cats with FIP, the ones that I worked so hard to save but had to let go. I don't think it ever gets easy, but I think in most cases if you think about it as relieving current and future suffering, it helps.

Euthanasia itself, having that option available is a blessing in my opinion. Our animals give us so much, for me it is wonderful to be able to give them a peaceful end. And you should, and do, have the option to determine which animals you will euthanize and where you will draw the line. If I feel there are other options still available I'll talk to the owners, see what they are willing or able to try. There are so so many examples of cases that fit into that category that I won't get into here, but it is important to figure out where your lines are and stick to them to avoid moral stress.

I don't know if that is helpful. I'm also gonna tag @twelvetigers because I think she might have some good thoughts.

 

[CalliopeDVM]

I'm the only one who ever cries seeing the grief of the family (everyone else views that as unprofessional/unacceptable), and I feel totally alone and like I am just too weak to handle it.

Don't be too sure about how the other vets and staff feel -- because they don't show it to you doesn't mean they don't feel it. However, you do need to develop a way to deal with sadness but still continue working professionally.

 

[MixedAnimals77]

I am by no means experienced compared to many on here who are in practice or even clinical year. I euthanized my first animal this semester-said animal didn't have an actual owner which in some ways made it easier, but it is always sad even if it is relieving pain and suffering. Like WZ, I view euthanasia as a blessing. I also think unfortunately as an equine practitioner you may see just as much if not more euthanasia especially with considerations for financials when it comes to "treatable" conditions in the equine. Euthanasia methods are also varied in the equine because we usually have to be much more conscious about barbituate use and that may impact your views on euthanasia as well as the emotions of the owner regarding the choice of euthanasia.

I'm not sure where you'll be going to vet school, but at my school we do euthanasia simulation labs during human animal bond month in February so if your school offers anything like that I highly recommend participating if you can. There's also other opportunities that might be available to you like CAETA training at SAVMA symposium. Nothing I would say quite prepares you for your first time, but these trainings give you a toolbox and foundation to pull from. Something that's super important for euthanasia and just for vet school in general is self care- Taking time to debrief with your team if needed. Acknowledging the pet's life. Talking to a mental health professional.

I have a colleague who is extremely empathetic. If you're crying they are usually right there with you crying. If you're on neutral ground they're right there too. It's who they are. They've learned to embrace it. The days where it's multiple euthanasias is emotionally taxing for them, but doing that self care keeps them going and not burn out. Another colleague once told the other vet they were working with "I can't do this when my soul is full" (they were supposed to do a euthanasia)- So the other vet performed the euthanasia for that appointment. -Just some examples to give you that are hopefully helpful.

-was also going to tag twelvetigers because I think they'll have some good thoughts but WZ beat me to it

 

[SocialStigma]

It sounds callous but, you get used to it. The first few times I euthanized an animal, I cried every time. Now I never cry unless I am particularly attached to that patient/the clients. I've only worked in ER/referral hospitals though, so I see a lot of death. I'm fortunate that I'm in a specialty where I rarely have to euthanize (few times a year), and when I do, it's typically because of intraoperative findings with a grave prognosis. However, I've had times during my rotating internship where I euthanized 10+ animals in a single shift. I see euthanasia as a gift. The cases where young animals with treatable conditions (foreign bodies, blocked cats, etc) are euthanized due to financial reasons are sad, but ultimately you can't save every patient and it's better than letting them continue to suffer in their current condition. Remember that you do have a choice as a veterinarian and if you feel very strongly that a certain patient shouldn't be euthanized, you can say no. I've refused to perform convenience euthanasias (eg. owners moving to a rental that didn't allow pets, dog was "old" but no medical issues, etc) in the past.

 

[Lupin21]

I actually still cry at most of them. I take that moment, I also make sure that my emotions are appropriate for the situation however. This is about the owners and their pets. You can acknowledge that love, as it is one of the more pure forms of love there is. But I also don't let it consume me. I think this is more natural for some than others. It can be learned, and has to of course if you are a practicing veterinarian. You just have to find what works for you, but that means being open to emotions and change, which can be conflicting. Leaning on others for advice and help is key no matter what though.

That was probably not tangible help, but that is how my philosophy works. lol

 

[mnb4nj]

I actually still cry at most of them. I take that moment, I also make sure that my emotions are appropriate for the situation however. This is about the owners and their pets. You can acknowledge that love, as it is one of the more pure forms of love there is. But I also don't let it consume me. I think this is more natural for some than others. It can be learned, and has to of course if you are a practicing veterinarian. You just have to find what works for you, but that means being open to emotions and change, which can be conflicting. Leaning on others for advice and help is key no matter what though.

That was probably not tangible help, but that is how my philosophy works. lol

Did you have to train yourself to not let it consume you? If so, how did you do it?

 

[mnb4nj]

This might get rambly...bear with me

One important thing to remember is death is part of life. And yes, you will see a lot of it in this profession. Maybe less in some areas (dermatology, radiology), but there will always be death, whether by euthanasia or by succumbing to disease. I don't think it's unprofessional to be touched by it, or by the emotions of the family, as long as you can maintain your composure and do your job, it's ok to cry with them in my opinion. Most of the time I can get through a euthanasia appointment just fine and go on to the next thing, but I think for most people there will be some cases that hit you hard. I remember the first euthanasia I was a part of. I remember the first one where I was the one pushing the euthanasia drug. I remember my first one that went poorly. And I remember the ones that seemed unfair...the young dogs with sudden and rapid decline, the cats with FIP, the ones that I worked so hard to save but had to let go. I don't think it ever gets easy, but I think in most cases if you think about it as relieving current and future suffering, it helps.

Euthanasia itself, having that option available is a blessing in my opinion. Our animals give us so much, for me it is wonderful to be able to give them a peaceful end. And you should, and do, have the option to determine which animals you will euthanize and where you will draw the line. If I feel there are other options still available I'll talk to the owners, see what they are willing or able to try. There are so so many examples of cases that fit into that category that I won't get into here, but it is important to figure out where your lines are and stick to them to avoid moral stress.

I don't know if that is helpful. I'm also gonna tag @twelvetigers because I think she might have some good thoughts.

That is helpful thank you. I try to view it as a kindness, but it seems like some of the cases where the wellbeing of the animal isn’t the deciding factor seems to be coloring the way I see the “obvious” euthanasia cases. We’ve been getting a few cases that end with what I am tempted to call “convenience euthanasia” and it makes it harder to view the procedure as kind and merciful. I’m trying really hard not to become so negative because I know it often times is for the best, but I’m struggling

 

[Lupin21]

Did you have to train yourself to not let it consume you? If so, how did you do it?

Sheer volume will train you.

 

[TheGirlWithTheFernTattoo]

Still a student, so much less experienced than the DVMs posting, but I've spent a lot of time thinking/talking about this topic with friends/classmates/coworkers so here is my thoughts. I've also spent a lot of time working ER so I've been surrounded by plenty of death.

I often will tear up a bit when owners are breaking down and telling me how much their pet meant to them and how they are losing their best friend/a family member. Seeing people suffering always hits me a little, and I've lost pets so the empathy is there. I don't really know how to work through that except tear up a little in the appointment, be sad for a minute or two after, and then get distracted by being thrown back into the crazy of the hospital. I guess that is compartmentalization. I think the human suffering is significantly harder for me than the death itself.

On regards to patient death: how much natural death have you seen? I've found the more natural death I've seen, the more grateful I have become for euthanasia in our toolkit and the more I understand the benefits that it offers to the patient. In fact (tangent), the recent expansion of MAiD in my country fills me with relief since natural death might not be something I'll be forced to endure myself (or my loved ones will have to watch) when I get to the end of my life. Death is usually not pleasant, and I've seen enough animals in severe distress to never want that to be how they die. Yes, those patients that get euthanized with kidney disease/cardiac disease before treatment is attempted might have had more time. However, euthanizing them today guarantees they will not suffer in the future, which they would be more likely to do if they didn't have an owner who was 100% dedicated to their well-being. Quality of life is more important than quantity of life.

The cases that haunt me are the ones that we send home that I know are going to die, and the owners aren't going to bring them in when it is time. This past summer we had a dog congestive heart failure dog come in in severe distress; even furosemide wasn't enough to make it comfortable without flow-by O2. The dog had been rescued in crisis by furosemide in the past, and the owner was not ready to say goodbye so he wanted to try his luck to see if the dog made it at home. He insisted on leaving, and took his dog. That dog very likely drowned in its own lungs within an hour or two of leaving our ER, and we sent it home to do that. I had dreams/nightmares about it for a night or two after and still feel a pit of guilt in my stomach when I think about the case. (Yes we did call the SPCA but it was a weekend and even normally they wouldn't have been able to do anything in the timeframe the dog was going to be alive for).

 

[TheGirlWithTheFernTattoo]

That is helpful thank you. I try to view it as a kindness, but it seems like some of the cases where the wellbeing of the animal isn’t the deciding factor seems to be coloring the way I see the “obvious” euthanasia cases. We’ve been getting a few cases that end with what I am tempted to call “convenience euthanasia” and it makes it harder to view the procedure as kind and merciful. I’m trying really hard not to become so negative because I know it often times is for the best, but I’m struggling

I would recommend letting the vet know you are feeling uncomfortable/having trouble coping with the euthanasia of a specific patient and would like to know their rationale behind it so you can understand and be at peace with it (but be careful that you don't come across as accusing them of euthanizing a patient they shouldn't have). It may be the vet has knowledge of the disease process you aren't aware of that makes euthanasia a better option for the patient than you realized. I would never be upset if a colleague asked me why I euthanaed a patient and asked me to explain so that they could feel better. I would be upset if one of my staff thought I was doing convenience euthanasia but never asked me my reasons.

 

[DVMDream]

We have a very unique position in veterinary medicine where it isn't just about the animal's health when it comes to euthanasia. I know that seems like an odd statement, but we are dealing with 1. The pet's health 2. The owner 3. The pet/owner bond 4. The owner's ability to do/afford treatment. 5. The owner's health.

There are so many compounding factors when it comes to euthanasia. Certain things can seem like "convenience" but if you really think about the complexity of the entire scenario, it isn't "convenience".

Here's an example: Owner brings in a 13 year old dog. Dog is generally healthy minus some mild arthritis. For the last few months dog has become incontinent (both fecal and urinary). Owner is frustrated because she is having to constantly clean up urine/feces from the dog. Dog knows it shouldn't go in the house and is distressed by having accidents. Owner agrees to full work up- bloodwork/urine/fecal/radiographs/ultrasound/etc.-- no underlying cause found. She tries medication which helps the urinary incontinence some but not the fecal incontinence.

She is frustrated. The constant cleaning is impacting the relationship she has with her pet. She can't hide/mask the frustration and the pet picks up on her frustration. The bond is being broken/damaged between the two the longer this continues.

Owner isn't happy, pet isn't happy. Sure it is "inconvenient" to have to clean up urine/feces all the time, but it is much more than just inconvenient, it actually damages that owner/pet bond. If you haven't had to clean up after a pet constantly like this, it isn't as simple as "so what just clean it up." It is/can be frustrating. Depending on the individual pet, this could include needing to regularly bathe the pet as well. Plus urinary/fecal incontinence can potentially lead to severe skin issues if not cleaned up constantly and kept on top of. It is exhausting. Some pets also hate being bathed and struggling with a pet like that every day really has a huge impact on quality of life for both the pet and the owner.

So owner decides it is time to put this pet down. They are both stressed/frustrated over this. This isn't a good life for the owner or the pet. This isn't a pet that can just be re-homed either, an older pet with a medical issue isn't an easy re-home, nor is it really fair to the pet.

So someone who doesn't know the owner/full case history could look at a vet euthanizing this dog for incontinence and think that is just a "convenience euthanasia" but it really isn't.


There are so many other situations like this. You have to remember that we are treating a package, not just a pet's health issues. How about a diabetic dog whose owner can't give or can't afford insulin and they decide to euthanize before the pet becomes super sick? Dog is happy, bouncing about, just started showing diabetic symptoms-- do you want to make the owner wait until the dog is vomiting, lethargic, unable to hold its own head up? I try to encourage euthanasia before the pet becomes too sick in all of my cases that I know are heading that way. You want that last memory to be of the pet still happy, not of the pet so dang sick/lethargic they can barely function.


I had a case of an elderly woman with a severely overweight dog at 85 pounds. She could not handle this dog. Her sons flew in from out of state just to help her get the dog in to see me. Dog has blown both cruciate ligaments. Sure there is treatment for this, but not something this 90 year old woman can do. Before an obese dog can have a cruciate repair, you need to ideally try to get some weight off the dog, in order to do that in this case the dog would have needed to be sling walked everywhere. Her sons can't stay just to help mom's dog-- they have their own lives in other states with their own families. Transporting the dog to where they live wasn't an option either. Not to mention they couldn't afford the easily at least $5k it would take to treat the dog. So, yes, I euthanized this otherwise healthy dog that had double cruciate injuries and was obese because it was the best option for that family and that dog given the resources they had.

I would encourage to ask the why (politely) behind certain euthanasia decisions because most vets don't take euthanasia lightly and there is a lot that goes into that decision that isn't super straightforward. I wish it really was just about can we treat/not treat the pet, but it isn't like that. We have to treat/acknowledge that pets are owned by humans and that human factor and the human/pet bond are also very important deciding factors as well.

 

[Minnerbelle]

It sounds callous but, you get used to it.

yup. So true.

I still feel for the family, and I still feel for the pet. And if it’s a patient I’ve gotten attached to, I feel a sense of loss too. I still cry with the family sometimes. Sometimes because I feel for them. Sometimes because I share their loss. Sometimes from the guilt that I couldn’t save that animal. And I put 120% into every euthanasia - like my whole heart and soul. I am religious about ensuring a good euthanasia experience to the extent that I can. If a client or even nonclient really wants a home euthanasia, I’ve gone after my shift unpaid to do that, because it feels like the right thing to do. I feel the human animal bond during euthanasias, and love that I can honor that.

BUT when you do so many euthanasias day in and day out, year after year, it really becomes routine. Like... to the extent that on a busy day where I’m falling behind... when I find out that my next one is a euthanasia, I’m like “hurray!!!!!! **** yes!” Because it’s very predictable. I know I can do a good job. And, it doesn’t take much thought at this point. And compared to a sick animal that needs a workup and treatment plan, it’s quick and easy. Sounds kind of horrible, but it’s true. Most of the time if it’s sad and I shed tears, they’re cleansing tears. It’s the sadness that we experience only because of all of the joy that the human animal bond brings. Not depressing, heavy emotional toll type of tears.

 

[Ariel-Li]

On regards to patient death: how much natural death have you seen? I've found the more natural death I've seen, the more grateful I have become for euthanasia in our toolkit and the more I understand the benefits that it offers to the patient.

Second this. I had greater trouble dealing with euthanasia when I was working at GP than ER (technician at both), mostly because I see the struggles patients have and truly feel euthanasia is a blessing in most of the cases. The other day I had to sit with a gravely sick dog (DKA, mammary cancer, splenic tumor) because the owner couldn't make a decision. She was a DNR. I sat with the dog for 3 hours with flow-by oxygen, fluid and heat support and watched her die an agonizing death. I'm so happy we actually have means to end sufferings like this. It is a beautiful thing.

The cases that haunt me are the ones that we send home that I know are going to die, and the owners aren't going to bring them in when it is time. This past summer we had a dog congestive heart failure dog come in in severe distress; even furosemide wasn't enough to make it comfortable without flow-by O2. The dog had been rescued in crisis by furosemide in the past, and the owner was not ready to say goodbye so he wanted to try his luck to see if the dog made it at home. He insisted on leaving, and took his dog. That dog very likely drowned in its own lungs within an hour or two of leaving our ER, and we sent it home to do that. I had dreams/nightmares about it for a night or two after and still feel a pit of guilt in my stomach when I think about the case. (Yes we did call the SPCA but it was a weekend and even normally they wouldn't have been able to do anything in the timeframe the dog was going to be alive for).

We've had those too. I once completely lost it with an owner who didn't believe in our doctor when she was told her dog is in congestive heart failure and short of aggressive treatment and hospitalization which they could not afford, the other option would be to euthanize. She took a long visit on this oxygen-dependent dog, and when I went in the room to check on them, the dog was neck stretching, dyspneic and purple. She looked at me and said, "she is breathing better, we'll just take her home." I couldn't control myself and told her I thought it was extremely inhumane to leave the dog to drown in the fluid in her lungs, it would be painful and cruel. From what I heard from the staff on the next shift, it took her another couple of hours and a near collapse episode from the poor dog to make up her mind to euthanize. I would have felt terrible if she was sent home to die.

 

[Nigripes]

Here is how I handle euthanasia. In life before vet school, I was a zoo keeper. Euthansia was in the interest in the health of the animal and declining quality of life made by those who were in charge and sometimes involved me in the conversation. Sometimes it was about her management. I was present for many. At first it was difficult because you think there is always something more to be done for the animal to give it just a little more time. That line of thinking I grew to understand is selfish. Now that I am in vet school, have witnessed more euthanasias and performed a few of my own. As a future vet, I hope to provide a good life for my future patients. I also think as a vet I should be able to provide a pain-free and good death as well. I think it is mentally healthy to know that this is going to be hard at first, like the others have posted. Euthanasia is part of veterinary medicine. My school we practice "the talk" with clients a lot. We discuss the ethics of euthanasia and the emotional toll it can take. What about talking to a professor at school about adding a euthanasia discussion group for other students to attend or get a student group to sponsor it and get a faculty member talk to students about it? You are not the only one at your school who feels the same way.

 

[Drjc1977]

Hey guys,
Today I'm bringing back the time-honored classic question: how does everyone deal with euthanasia?
I am supposed to start vet school this fall, and I am seriously freaking out. I work at a small animal clinic (though my passion is equine), and I am finding it harder and harder to deal with the amount of death and euthanasia we see on a regular basis. I can count on one hand the number of days this year that I have been at work and nothing has died. Sometimes it's 3+ in a day. (For context, I work in a clinic that works as a hybrid GP/urgent care model). When I first started at this job and for the first several months, euthanasia didn't bug me very much. It was sad, but I went home at the end of the day and wasn't weighed down by it. Now the cases are getting more frequent, and I sometimes wonder if some of the euthanasia we see is ethical and necessary. I am finding myself taking work home with me and crying A LOT. I don't know if the situation is different in equine, but I seriously worry about my ability to cope with seeing this much death for 30+ years. It's making me wonder if I should turn around and not go to vet school.
Most of my coworkers just don't seem upset by euthanasia. I'm the only one who ever cries seeing the grief of the family (everyone else views that as unprofessional/unacceptable), and I feel totally alone and like I am just too weak to handle it. I really like vet med, and it was my dream to become an equine vet. But as things are now, I cannot see myself pursuing this career if I don't figure out how to better deal with euthanasia. Does anyone have any advice for learning to cope?

Before I comment, would you have trouble euthanizing a rabid animal?

 

[turnandburn]

I struggle more emotionally not with euthanasia, but with neglect cases or animals who are not receiving optimal care because the owner only wants their rabies vaccine.

Also, you can always refuse to euthanize an animal if you are not comfortable with it.