CONVENIENCE EUTHANASIA, BUT AT WHAT COST TO ALL INVOLVED?

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1 Vet Times The website for the veterinary profession CONVENIENCE EUTHANASIA, BUT AT WHAT COST TO ALL INVOLVED? Author : ALEX AVERY Categories : Vets Date : May 20, 2013 ALEX AVERY discusses euthanasia of the painful animal as well as the healthy one and the effects on the practitioner of carrying out the procedure daily NO one signs up to five years study, followed by a life spent in the consulting room, to euthanise animals. The nature of the job, however, means that, on a fairly regular basis (and during some weeks this basis is more regular than others), animals are presented at the end of their lives, or suffering from an intractable disease and are euthanised. It is generally not a decision made lightly by any of the parties involved, but can be seen as a great privilege that we are able to bestow on those placed under our care. While we understand it is a task that needs to be performed, it is also often one of the most stressful jobs we are asked to undertake for a number of reasons, which relate not only to our patient, but also to its owners and the individual beliefs held by the vet. This article was prompted by the presentation of six 12-week-old puppies and their mother for euthanasia due to an inability to find them homes and a lack of funds to keep them. While this was my first confrontation with convenience euthanasia, it has not been the last and it is such demands that force you to start asking questions about your beliefs and planning how best to handle the situation in the future. As such, I hope to explore some of the issues surrounding 1 / 10

2 euthanasia in general, but also its application in healthy animals, by which I mean those that are either disease-free or are easily treatable without great expense. It is quite likely you may disagree with some or all of the points raised, but regardless of this, I hope to stimulate reflec-tion and debate of this emotive issue in how it affects our-selves, but also those practice members who work alongside us every day. Good death The term euthanasia is derived from the Greek words eu, meaning good, and thanatos, meaning death. This good death has evolved to a modern meaning that has been defined by a House of Lords select committee on medical ethics as a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering. While a given when considering the topic of euthanasia in humans, this definition nonetheless provides a good description of what most vets would consider as a perfectly suitable situation in which to undertake this task. Even in this accepted situation and using methods that are, by their nature, designed to cause an absolute minimum of pain and distress, the act of euthanasia is ranked by many as one of the most difficult and stressful tasks in veterinary practice. The reason is that, as vets, we do not have the luxury of considering our patients in isolation the owner s agreement and participation in the decision-making process is absolutely essential. The decision to euthanise an animal cannot be made without considering what other options are available, influenced by theoretical knowledge, practical experience and costs. Once the decision has been made it then becomes our responsibility to ensure the act is carried out with the highest degree of respect. While we as practitioners face the prospect daily, signing that consent form is a massive step in any pet owner s relationship with their other family members and the vet. The result is often an emotionally charged consulting room that needs delicate management and organisation. We each have our different approaches to these situations, but anecdotally, a good job is generally done. After all, how often does a card or token of thanks arrive after an act of euthanasia compared to the healthy return of the pet following a serious illness and spell of hospitalisation? Stressful situations Everyone has his or her different coping mechanism for dealing with the stress of the situation. An understanding of the welfare and ethics behind animal euthanasia can certainly help ease any feeling of guilt or failure people may experience. 2 / 10

3 Death is not a welfare issue has become a popular phrase quickly summarising some of the issues surrounding this topic. Some of the reasons behind this lay in the fact it is not thought animals possess the cognitive ability to rationalise the concept of life or its end. Following this logic, an animal cannot, therefore, trade off the benefit of protracted treatment under conditions of some discomfort with the benefit of future life. It is for this reason we must always ask whether a treatment or procedure that can cause discomfort, pain or distress is in our patient s best interest, as for it there is no apparent light at the end of the tunnel. This thinking also means what is best for the animal is not always best for the owner, as he or she may be willing to undertake a treatment plan that we as vets would not consider in the animal s best interest. Just because something can be done does not mean it should be. Of course, the ethical dilemmas posed by euthanasia are seldom black and white, but rather shades of grey with each case inherently unique. Thrown into the mix is also the question of money. A large number of people have little understanding of the true costs of advanced medical care and, while often wanting the latest treatment options they themselves may have been subjected to at the local hospital, at the same time they are constantly pushing for a bargain or way out. This way out may be euthanasia and so you, as the vet, end up handling an emotional situation as well as having to compromise your medical decision-making all to save money if plan A (and B and C) is rejected. To euthanise So how does so-called convenience euthanasia tie in to all this? The term euthanasia is distinct from slaughter and pest control as the latter are performed for reasons other than to relieve suffering. Although stretching things a fair bit, could this suffering also take into account that of the owners? Some people are legitimately struggling financially, especially in the current economic climate, and so may either not physically be able to pay a bill of any scale or, in doing so, would seriously compromise their own welfare. In this case can the term euthanasia be legitimately applied? Finance aside, why is it the thought of euthanising healthy animals is so repulsive? We then have to ask if death causes harm. While the lack of cognition has already been discussed, some have argued that since you are denying any potential future pleasure, harm is, in fact, done. It is this that may stimulate our in-built moral intuition that euthanasia of the healthy is wrong. We may also be able to morally condemn such an act on the basis it is initiated by the sort of character that, as a society, we do not wish to encourage, even if no harm is done and, ultimately, the welfare of the animal is not compromised. 3 / 10

4 The flip side of this could be the suggestion that the animal s welfare is actually improved by the act of euthanasia on the basis that it is saved from a potential future of distress under the conditions it could find itself in were it to continue to live unwanted with its current owner. Rehoming and adoption would, however, be far preferable to such a drastic measure, and a view shared by many is that an adoptable dog should never be put down. Whatever the reason for the killing of a healthy pet, why is it some people believe it is an acceptable course of action? Has the fact that, as a society, we have become used to the concept and practice of euthanasia at the end of an animal s life led us to fundamentally devalue the life of the healthy to such a degree they can be disposed of if unattractive, badly behaved or inconvenient? Traditionally, animals have also been regarded as property, something that i s owned, and in today s disposable culture, even dogs can be regarded as status symbols and fads that come and go looked on as objects rather than individuals. Could it also be that we as vets are partly to blame for our continued use of the word euthanasia when applied to healthy animals? By definition, this act is actually a killing or slaughter, yet we continue to refer to it as euthanasia probably in part to reduce the stress of the act personally, but also to avoid offending the owner and steer clear of confrontation. A difficult situation Whatever the theory and reasoning behind convenience euthanasia, there will still be a time when we are presented with such a situation. While we may try our utmost to change an owner s mind or explore other avenues such as rehoming through an animal shelter it may be that no compromise can be reached. As his or her property it is quite within an owner s right to insist on euthanasia. No vet in general practice is obliged to kill a healthy ani-mal, but, of course, reality is not so clearcut. The RCVS Guide to Professional Conductmakes it clear that, where, in all conscience, a veterinary surgeon cannot accede to a client s request for euthanasia, he or she should recognise the extreme sensitivity of the situation and make sympathetic efforts to direct the client to alternative sources of advice. However, this advice follows the point that clients are capable of making up their own minds and that to refuse an owner s request for euthanasia, therefore, may add to the owner s distress and could be deleterious to the welfare of the animal. Despite this get out clause, as individuals we may decide to follow the owner s wishes. Some may believe the unwanted animal is better off being professionally euthanised compared to the prospect of letting the owners take it to someone else, be abandoned or be subject to abuse. Others may feel that by refusing to carry out convenience euthanasia they are simply passing the buck to another vet down the road a position they would not appreciate were the roles reversed. 4 / 10

5 This is possible, but the other outcome is that by refusing, a strong statement is made that may lead to a more positive outcome. A BVA guide to euthanasia is also available for its members. Staff welfare While we quite rightly worry about our patients welfare, the welfare of ourselves and other practice members often gets barely a second thought. The act of euthanasia, however, is generally timeconsuming and stressful to all involved from receptionist through to the vet. When the act is seemingly unjustified, this stress or distress can escalate. Much work has been done in animal shelters in the US where there is often a very high rate of healthy euthanasia. It has been found people develop their own coping strategies to soften the impact of this stress. People can try to turn off to make the act as mechanical as possible, avoiding any interaction and not even looking the animal in the eye. Some joke about the animal or its owner, while others covertly become very angry towards the owner. For some, this anger was expressed in other areas of their lives. Some sought out human contact while others found it better to isolate themselves with excessive relaxation sought after work that often involved alcohol abuse or a lot of physical activity. A clear correlation has also been found between the rate of euthanasia and staff turnover. How does this relate to the general small animal practice? Being asked to compromise a medical doctor s ethical principles has been clearly shown to cause fatigue and burnout and there is no reason why this should not relate also to veterinarians in their general clinical life. In addition, vets may also have to deal with feelings of guilt, failure, blame, greed, confused morality and more, unique to each situation and individual. We often have another staff member help us hold or restrain the animal and he or she should also not be forgotten as, quite justifiably, he or she may feel like accomplices in the euthanasia and so experience a similar range and intensity of emotions. While we may feel individually unaffected by our role as agents of euthanasia, can the same be said for all our colleagues? Stress can manifest in many different ways, some more visible than others and, in our profession, it is important to recognise the signs in others before it is potentially too late. How about scheduling a euthanasia at the end of a consult slot to allow a few minutes quiet afterwards to unwind before plunging back into clinical work? If your colleague seems to have had more than his or her fair share recently, offer to share the load. Do you always ask the same nurse to assist? Consider giving him or her a rest, or have a chat about things to see how he or she is coping. 5 / 10

6 There are many stresses placed on our day-to-day life, some of which we can mitigate. Awareness of a potential problem is half the battle and I hope that by stimulating reflection on some of the issues discussed we may all be able to lessen the load just a little. Of course, we have to consider what is best for the animals placed in our care, but it is also important to realise we can t healthily sustain a situation where we care for them more than their owners, and it is equally important we look after our own well-being. References AVMA Guidelines on Euthanasia ( Documents/euthanasia.pdf). Baran B E, Allen J A, Rogelberg S G, Spitzmüller C, Digiacomo N A, Webb J B, Carter N T, Clark O L, Teeter L A and Walker A G (2009). Euthanasia-related strain and coping strategies in animal shelter employ-ees, J Am Vet Med Assoc Jul 1, 235(1): Bartram D J and Baldwin D S (2008). Veterinary surgeons and suicide: influences, opportunities and research directions, Vet Rec 162(2): BVA euthanasia guide ( ide.pdf). Harris N M (2001). The eutha-nasia debate, J R Army Med Corps 147(3): Manette C S (2004). A reflection on the ways veterinarians cope with the death, euthanasia, and slaughter of animals, J Am Vet Med Assoc 225(1): Martin F et al (2004). Factors associ-ated with client, staff, and student satisfaction regarding small animal euthanasia procedures at a veteri-nary teaching hospital, J Am Vet Med Assoc 224(11): 1,774-1,779. Owens C E, Davis R and Smith B H (1981). The psychology of euthanizing animals: the emotional components, Int J Stud Anim Probl 2: RCVS Guide To Professional Conduct. Rogelberg S G et al (2007). Impact of euthanasia rates, euthanasia prac-tices and human resource practices on employee turnover in animal shelters, J Am Vet Med Assoc 230(5): Rogelberg S G et al (2007). What shelters can do about euthanasia-related stress: an examination of rec-ommendations from those on the front line, Journal of Applied Animal Welfare Science 10(4): / 10

7 Figure 1. Rehoming the animal is generally the preferred option, but if local shelters are full this can take a huge amount of time and effort. The author s clinic has rehomed more than 45 kittens over the past two years, not including those sent to the local shelter. Knowing some are helped can soften the blow when others need to be euthanised. 7 / 10

8 Figure 2. Euthanasia, while a simple task, can rate as one of the most stressful in general practice. 8 / 10

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10 Figure 3. Various options are available to find new owners, such as social media or the oldfashioned notice board. 10 / 10 Powered by TCPDF (