His name was Smokie. I guess most practices have at least one black Lab by the same name. Without question, Smokie’s euthanasia was the most difficult one of my entire career, competing with the loss of my own dogs through the years.

Smokie had been one of my first patients in the early days of my practice. His owners brought him in as an 8-week old puppy for the routine examination and vaccinations. Little did either of us know at the time how frequent a visitor Smokie would become, but within the month his owners returned with him, not for his next shots but for severe vomiting. It turned out to be an intestinal blockage, one of many complications Smokie would have over the next ten years. A combination of a jinxed pet and excellent owners made Smokie one of the clinic’s most regular visitors.

I can remember as vividly as though it were yesterday, the day Marti, his owner, brought him in for his last visit. I even toyed with asking one of my technicians to conduct the procedure but decided that Smokie and I had come this far; we’d walk the last few steps together as well.

The decision to humanely end the life of an animal, whether it’s a dog, cat, horse, or an exotic pet is never an easy time for

either the veterinarian or the owner. The human-animal bond seems to connect most strongly heart to heart.

Sometimes veterinarians try to cope by becoming callous about the act of euthanasia, hiding behind an air of professionalism. True, we are expected to be professional, to not break down emotionally, to be there to support our client as they make the difficult decision. The challenge is to find that middle ground of professionalism while allowing ourselves to be human as well.

At no time during the client-doctor relationship is our role more important than in these last days of the pet’s life. Often, we must wear multiple hats; diagnostician who will, as accurately as possible, determine the problem and the prognosis; counselor and friend, to be there to listen to the client as they struggle with the decision, and finally the executioner, to carry out the final act.

As Charlene Douglas, psychologist and assistant director of People, Pet, Partnership, a public service activity of Washington State College of Veterinary Medicine, point out, often our clients may have unrealistic expectations.

“They feel like they’re playing God. Who are they to make a decision whether this animal should live or die? They want someone to tell them when. It’s very difficult for them to be immersed in the emotional trauma that they are going through, to actually make a decision as to when to, more or less, pull the plug.”

Often struggling with this decision results in the question, “What would you do if it were your pet?” Most of the time, this is a question only the owner can answer. Sally Walshaw, associate

professor of small animal clinical science at Michigan State College of Veterinary Medicine, suggests that unless it’s a clear-cut choice, ask the owner what’s important to the pet. Does it still have happy moments? Help the owner to come to the decision that is right for them.

Douglas agrees. “I try very hard not to manipulate my client into what I think might be best for the animal. What I think might be best doesn’t really have anything to do with anything.

“The role of the veterinarian,” says Walshaw, “is to provide as complete and thorough medical support as we can so we can answer the medical questions. But once you get by the medical questions, I feel that we have a role as a friend to the animal, and as a caring supportive person for the owner.”

Many times, the client needs the veterinarian to simply be a sounding board, as they work out the decision. To illustrate the point, Walshaw tells the story of a farmer who gets his tractor hopelessly stuck in the mud. When he realizes he can’t get it out, he calls a neighbor over. After perusing the situation, the second farmer shakes his head and says, “I don’t think I can get it out either, but I can at least sit down in the mud with you.”

“Sometimes that’s what we can do,” says Walshaw. “We can be there with them during one of the most important moments for them as an owner because it’s a time when they are making a really important decision and it’s a time when they are saying goodbye to a beloved friend.”

Laurel Lagoni, co-director of Changes, Support for People and Pets Program at Colorado State University, suggests that veterinarians start to talk about the option of euthanasia as early as the pet owner can hear it.

Lagoni suggests that it helps to describe the procedure. Once the question is raised, the owner is then able to begin to

accumulate all the information they will need to make the decision, including, what their options are, what the euthanasia procedure will look like, who should be involved, and what they will want to do with the animals remains.

Veterinarians are learning that euthanasia is more than a medical procedure; it’s also an emotional experience, one which owners have a right to participate in if they choose. “We describe the procedure in very human terms,” says Lagoni, describing the procedure at the teaching hospital. “You can sit down on pads on the floor with your animal. You can hold her head or talk to her during the whole procedure. We make it very real so people have an image in their mind of what this death will be like. They see that it will be a peaceful, painless death, and that helps them approach the time of euthanasia with a little less anxiety.”

Over the years, many clients have started wanting to take a more active role in the euthanasia procedure. As a result, the procedure is changing.

“We’ve not really altered it substantively,” says Walshaw, “but refined it a little bit. Whereas in the past it was done without the owner present, now with the owner wishing to be present it is one of those situations that can be stressful for the veterinarian and staff. The veterinarian doesn’t want to leave anything to chance, such as finding a vein for the injection, so the dog may be taken to a treatment room where an intravenous catheter can be placed in the leg.”

According to Lagoni, one of the common complaints she hears from pet owners is that “they don’t really feel empowered to make their

own decision when it comes down to euthanasia or how they want it to be handled.” As a result, clients are starting to “shop around” to find where their wishes can be met. The more veterinarians can be flexible and fulfill on their clients’ desires, the stronger the client-doctor bond will be.

“More veterinarians are realizing that more of their clients are looking for the option of home euthanasia,” says Lagoni. “The veterinarians that I’ve talked to over the years that do a lot of home euthanasias are recognizing it as something that can be a real bonding time between them and their client. They also recognize that they need to charge a little more for it since it takes more of their time and resources. Most pet owners who want the service are willing to pay for it.”

Also, more clients are raising the question of whether their children should be allowed to play a more active role in the euthanasia process. Here, not all the experts agree whether young children should be allowed in the room during the procedure. Whereas some psychologists advise against it, others feel that if the child wants to be in the room, it can help them learn how to deal with death, which is an important part of living.

Lagoni feels that this is a decision for the parent to make, remembering that the parents have their own grief to deal with. One suggestion is that there be someone else other than the parents to help take care of the kids.

“The friend’s job is to be in charge of the kids,” says Lagoni, “so the parents get to say their goodbyes and do the things they need to do without worrying about the kids.

All the experts agree that it’s important for the adults to be honest with children. As veterinarians, we can often help parents by describing to the children in simple to understand language what is happening with their pet.

For young children, Lagoni suggests, besides having another adult present, it’s also a good idea to have an area in the room or waiting room set up with toys and other things for the kids to do since kids don’t have a very long attention span.

If the child is not to be in the room, giving them the option to view the body afterward helps gives them a sense of closure. Many times children like to do something to remember their pet. One suggestion found popular at Colorado State is using sculpting clay to make a paw print of the animal. “They can write their animal’s name in the clay,” says Lagoni, “as sort of a memento of their pet. We’ve found it’s been really helpful for them.”

Large companion animal euthanasia has their own special challenges. As Carolyn Butler, co-director of Changes, points out in the book, The Human Animal Bond and Grief, it’s not unusual for large animal euthanasia to be called for in less than perfect situations.

“Emergency euthanasias are often done in pastures, stables, arenas, show rings or race tracks. The presence of others sometimes puts more pressure on you (veterinarian) to ‘perform’ with compassion and sensitivity; therefore, you must have a repertoire of euthanasia and communications techniques that can be used quickly and efficiently. These methods must be as aesthetically acceptable to untrained observers as possible.”

Other complicating factors of large animal euthanasia are reducing the risk of injury to yourself and others, and the disposal of the body. Although you may be tempted to euthanize a large animal in a stall, it can be hazardous to you and your staff as well as making the removal of the body more difficult.

Says Butler, “The most common place for large animals to be euthanized is in clients’ pastures and stables. Under most conditions, you do not have the benefit of support staff or excessive amounts of time in which to help clients make life and death decisions. It is helpful to try to mobilize clients’ support systems before arriving at their homes…. Having extra support helps you and your clients because it allows you to focus on medical procedures while clients receive comfort from others.”

While euthanasia is neither an easy decision to make nor an easy time for you or your client, it can be a time of bonding you closer to those you work for. Taking a little extra time to show care, compassion and support for your client will go a long way in fortifying your relationship through this difficult time. As many veterinarians are learning, being willing to be flexible and offer the services that clients are seeking, helps to build trust.

“Like all vets I hated doing this, painful though it was, but to me there has always been a comfort in the knowledge that the last thing these helpless animals knew was the sound of a friendly voice and the touch of a gentle hand.”

James Herriot

“All Things Wise and Wonderful”

Copyright 1977, St. Martin’s Press, New York

SIDEBAR: HELPFUL HINTS IN DEALING WITH EUTHANASIA

(From Grief and Pet Loss, by Charlene Douglas of People, Pet Partnership of Washington State University College of Veterinary Medicine)

1. Avoid the terminology “put to sleep”; parents put their children to sleep every night.

2. Explain the procedure fully beforehand.

3. Make arrangements for the remains beforehand – encourage closure.

4. Make arrangements for payment of the bill beforehand (either prepay or bill later).

5. Set aside a time at the end of the day for euthanasia so clients will not be interrupted or rushed. Arrange for a separate entrance and exit for these clients.

6. Allow time with animal alone before euthanasia. Be sure to have tissues available.

7. Offer the family the opportunity to be present.

8. Perform euthanasia with someone else present to not only provide the veterinarian support but also for your client; have a towel present (explain defecation/urination that may occur, explain agonal gasp, consider using a pre-anesthetic and catheter).

9. Allow time with animal alone after euthanasia.

10. Prepare the body respectfully.

11. Use whatever the client supplies or use coffin or box – never use trash bags.

12. Help client to their car – allow them their grief – be supportive. Be sure they can drive safely.

13. Send card/flowers or call next day.

14. Follow up with a client who does not return – for what reasons; no pet, angry over something, or what?

15. Don’t be afraid to do “at home” euthanasias.