Some Thoughts on Euthanasia (By Request)

This is a document that I wrote for an office meeting a few years ago.  I occasionally give it to clients who are struggling with the decision to end their pets life.  One of those clients just emailed a request for me to post it on the blog.

For many,  the  decision to euthanize their pet is a  fiercely personal, brutally difficult experience. 

No laughs in this blog,  just some information, philosophies and viewpoints that I employ to help myself and others grapple with this issue:

Some Thoughts on Euthanasia 

            One of the most difficult situations we run into as practitioners, vet. Assistants, and pet owners is dealing with caring for our furry friends at the end of their life.   Almost daily we struggle with the balance between prolonging treatment of our patients vs. ending their suffering via humane euthanasia.  

            Our clients are usually very confused about their options and come to us for guidance…is my pet suffering?  What would you do if it was your pet?  Am I  a bad owner for choosing euthanasia over the expense of further treatment, procedures?  How will I know when it’s time?  

Here are some excerpts/opinions from various practitioners regarding these questions and how to answer them… 

            Dr. Bernard Rollin, considered one of the foremost experts in animal ethics and distinguished professor of philosophy at Colorado State University was interviewed in DVM Newsmagazine about ethical questions faced by vets.  

            “ I think that an animal can’t value life in itself.  If you and I, God forbid were stricken with cancer, we can say, ‘Well, I will go through six months of chemo hell because it might buy me five or 10 more years.  An animal doesn’t seem to have the intellectual apparatus to form that notion.  It can’t postpone future benefits for current pain”   But humans do.  With it comes the inherent responsibility of choosing the risk/benefits of treatment vs. quality of life. 

            Ultimately, the goal of the vet/staff/owner is to alleviate pain and suffering and improve the patients quality of life no matter which option is pursued.

            Rollins recalls an example.  “A friend of mine came up to me and said, ‘my dog was just diagnosed with cancer .’  He asked: ‘How do I know when to pull the plug? I am willing to spend the money on treatment.’  “I told him to go and talk it over with his wife and family and write down as many happy things that you can about when the dog is happy.  Then, I told them to put it away.  As treatment progresses, pull it out and use it as a measure of whether or not the animal has a decent life.”

            His friend later thanked him because the test made him and his family realize that even though the animal’s quality of life had diminished so greatly, they held on to the emotions that they couldn’t bear to lose the dog.                                                                                                      

             In an editorial in the Journal of the American Veterinary Medical Association, by Franklin D. McMillan, DVM called “Rethinking euthanasia: death as an unintentional outcome”, the following points are made: 

            “Numerous problems stem from the view that euthanasia is an act intended to kill.  The act of taking a life is abhorrent to many, and pet owners often struggle with the issue of whether such an action is right.   Owners may be unable to accept taking such an action against their beloved pet, and owners often fear (or endure) the guilt of having killed their cherished pet.  Many pet owners feel that euthanasia is unnatural and that natural death is better.  Many faith groups within Christian, Muslim, Jewish and other religions believe that life is a gift from God, and because God gives life, only God should be allowed to take it away. …Owners feel like they have no right to “play God”.  

In his essay, Dr. McMillan offers the proposition that the objective and desired outcome of euthanasia is not death.  Rather, death is strictly a by product of the true objective, which ultimately is to alleviate pain/discomfort/suffering.  

Dr. McMillan notes that as Vets, our therapeutic interventions are designed to block the experience of discomfort.  Some examples are given like blocking the source (removing an allergen, or removal of foreign object, taking out the bladder stone, etc), we block discomfort at the point of origin (like using antihistamines to block itch response), or relieve discomfort by interrupting the transmission of the stimulus to the brain before it reaches the mind and becomes a conscious experience (nerve blocks, etc) and finally at the level of the mind (narcotics, NSAIDS, anti-vomiting drugs, antidepressants, anti anxiety meds).   

“Unfortunately, even when using interventions to block discomfort at every level, we’re not always successful.  When we are unable to prevent discomfort from reaching the mind, we adopt a different approach all together.  We put the mind in a protected state– we interrupt consciousness.  When this is done on a temporary basis, it’s termed anesthesia.  When it’s done on a permanent basis, it’s called Euthanasia.    Euthanasia is the last effective tool we have, and use, to stop the discomfort.” 

“ Euthanasia has two outcomes: ending discomfort and ending life.  For many medical and emotional disorders, we don’t yet know how to separate these outcomes.  We lack the ability to achieve the outcome we want–ending the discomfort–without also being forced to accept the outcome we don’t want–ending a life.”   Basically, separating the outcomes hinges on technology…can you believe there was a time that dogs with Demodectic Mange had to be euthanized b/c there were no treatment options.  Ultimately, the only way to relieve the dog’s suffering (desired outcome) from chronic, painful, itchy skin was to euthanize it (undesired outcome). 

Regarding the money issue: “Monetary considerations play an important role in many euthanasia decisions.  However, this doesn’t change the basic thesis of the argument.  The relevant issue is unrelievable discomfort, and euthanasia as the method of ending the discomfort.  Money limitations are merely one of the constraints in achieving effective relief of discomfort (the other major constraint being limits of medical knowledge”)  

“ …In other words, the term euthanasia that originally meant a painless peaceful death now means an act to end suffering, with death as an unwanted effect.  “                  

            ”Euthanasia is widely accepted by the veterinary profession as a beneficient act to help the ailing animal.  That we are not attempting to cause death when we practice euthanasia is a view that may help put many animal owners minds at ease and allow them to be more comfortable with this choice.”  ( OK…so it’s all about phrasing, but it does help clients wrap their minds around the concept)                                                                                                        

 What about Hospice Care? 

 Ya know, there are some people who will absolutely not euthanize their pets.  They have philosophical/religious/whatever reasons for it.  They will not change their minds.  They shouldn’t have to (when I was younger, I did try to change some minds, and I think the clients forever regretted their decisions, because in their hearts, it wasn’t right for them). 

I think our job isn’t to force people to put their pet to sleep because we think it’s the right thing to do.  Our job is just to make the pet as comfortable as possible while the owner figures out what’s the right decision for them.  (I mean…if the cat’s been cut in half by a fan belt…well that’s pretty cut and dry…I’m referring to more the terminally ill types).  To some people these pets are their children and they want to be with them to the very (natural) end.  We can’t judge these folks as long as they’re taking measures (and we help them with this) to relieve their pets pain/suffering as best we can.  

There is a website : www.pethospice.org with really good info on the subject.  I’m not going to get into it b/c my fingers are getting tired but check it out if you’re interested. 

 The goal of veterinary hospice care is to: allow the pet to spend quality time at home with the care giver, under adequate sedation for pain control, until such time as the care giver decides to euthanize or until death occurs. 

                                                            Quality of Life Scale

 The goal here is to provide a guideline so that pet owners can maintain a rewarding relationship that nurtures the human animal bond.   Please rate all of the quality of life issues regarding your pet  on a scale of 1 (terrible) to 10 (the best).  A score above 5 on most categories is acceptable to maintaining an end of life (hospice) program (Adapted from Vet. Practice News Sourcebook 2006, article by Alice Villalobos, DVM) 

Rating:                                             Quality of Life Parameter:                              

Terrible      Ok         Great/Wonderful

1  2  3  4  5  6  7  8  9  10                                    Hurt: Rate your pets pain level (with pain meds if needed)   Adequate pain control is first and foremost.  This includes pet’s ability to breathe properly.  Most folks don’t realize that not being able to breathe is ranked at the top of the pain scale.   Oxygen therapy can help breathing patients (even at home).  Pain control may include oral, transdermal or injectable medications.

1  2  3 4  5 6  7  8  9  10                             Hunger: How does your pets appetite rank?  Has he always been a food hound?  Where is he now?  If a pet  is not receiving adequate nutrition willingly by hand or force feeding, then consider a feeding tube.  Malnutrition develops quickly in sick animals when the caretakers are not educated.  Owners can use a blender or liquid diet to help their best friend maintain proper nutritional and caloric intake.    

 1  2  3  4  5  6  7  8  9  10                            Hydration: Your vet can teach you how to assess this.   Subcutaneous fluids are a wonderful way to supplement fluid intake.  

1  2  3  4  5  6  7  8  9  10                            Hygiene: Is your pet still grooming himself?  Is he lying in his own stool/urine?  Does he allow you to groom him?  Is the coat matted?  Pets, especially cats with cancer can’t keep themselves clean so they get demoralized quickly.   The odor associated with necrotic oral tumors can be offensive and cause social rejection by family members.  Antibiotics help reduce foul-smelling infections, and using a sponge dampened with very dilute solution of lemon juice and hydrogen peroxide (to mimic the gentle stroking action of “a mother’s tongue” on the face , paws and legs) helps soothe and clean cat’s fur.   Dogs love this type of grooming too. 

 1  2  3  4  5  6  7  8  9  10                            Happiness: Is the pet able to experience any joy or mental stimulation?  It’s easy to see that our pets communicate with their eyes.  They know what’s going on.   Is the ailing pet willing to interact with the family and be responsive to things going on around him?  Is the aging cat able to purr and enjoy being on the bed or in one’s lap?  Is there a response to a bit of catnip?  Can the cat bat at toys and look or follow a laser light?  Can the ailing pet enjoy the upbeat greetings And petting of loving family members?  Can the pets bed be moved close to the family’s activities and not left in an isolated or neglected area?  Is the pet depressed, lonely, anxious, bored or afraid?  

 1  2  3  4  5  6  7  8  9  10                            Mobility: Is the pet able to move around enough on its own or with help in order to satisfy its desires?  Does the pet feel like going out for a walk?  Is the pet showing central nervous system problems like seizures or stumbling?  Can the pet be taken outside or helped to the litter box to eliminate with assistance?  Will a harness, sling, or a cart be helpful?  Is medication helping.  The need for mobility seems dependent on species and breed.   Cats and small lap dogs can and do enjoy life with much less mobility than large and giant breed dogs.   If the pet is compromised and is only able to lie in bed, is there a schedule to change the position of the pet and rotate their body at least as often as every 2 hours.   Lung collapse/compression and bed sores must be avoided.  The nursing care of large,  immobile dogs is very demanding.  Is the bedding material soft enough?  Can an egg crate mattress be used and set up properly to avoid bedsores?  Is there a role for a pet mobility cart or Evans standing cart?  These items really make a difference in the quality of life for the pet that has limited mobility yet is alert and responsive. 

 1  2  3  4  5  6  7  8  9  10                            More Good Days than Bad: When there are too many bad days in a row, or if a pet seems to be “turned off” to life, quality of life is compromised.  Bad days are filled with undesirable experiences such as vomiting, nausea, diarrhea, frustration, seizures, etc.  Bad days could be from profound weakness caused by anemia or from the discomfort caused by an obstruction or a large, inoperable tumor in the abdomen. 

 The Final Decision: It is very difficult for families to make the final decision to end a beloved pet’s life with euthanasia.   The decision to euthanize can be made clearer to clients if this quality of life scale is utilized ahead of time and reevaluated every couple of weeks or few days as the situation requires. 

            If a pet is slowly passing on with a peaceful tranquility, “hospice care” at home, using the quality of life scale as a guide,  may be a satisfactory situation. 

            People often want their pet to pass on naturally at home or in their own bed.  That’s ok as long as the pet is just weakening steadily and not suffering to death. 

 *                      Animals live in the here and now, they only understand what’s happening at that moment.  They don’t understand their own mortality, they don’t know their pain and suffering is or isn’t temporary. 

 *                      It’s up to us to make sure the pet isn’t suffering (via pain meds, diagnostics, surgical cure, etc). 

 *                      Euthanasia can be viewed as a sort of “treatment option”, where the only way we can alleviate the pet’s suffering is to end it’s life. 

 *                      Hospice care is an option for those who are totally anti-euthanasia, for those pets who aren’t totally suffering.

*                      The quality of life scale may help clients figure out when their pet’s level of suffering warrants euthanasia.

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