Validating Pet Euthanasia ?
DISCLAIMER: The following discussion mirrors my opinions and viewpoints. It contains extremely controversial subject matter that is completely contrarian to the accepted views of veterinarians and the pet caretaking public.
In my many years as a veterinarian and especially now that I work exclusively with elderly pets, there are three phrases, and one, two or all three of them enter into nearly every conversation I have involving end of life. I finally realized that pet caretakers, as well as veterinarians, use these phrases to give themselves permission to end an animal’s life. The phrases certainly echo the views of the veterinary community and are found all too frequently on the internet when searches involve a terminal condition, and they are certainly more often used when the discussion centers around the elderly animal. The use and belief in them, although wrongly placed in my opinion, are what allow euthanasia to be an acceptable part of veterinary practice and the pet caretaking community. What are they?
- “I don’t want my pet to suffer, or my pet is suffering,”
- “My pet’s quality of life (QOL) is not good.”
- “I don’t want to be selfish and keep my pet around for me.”
I would like to examine each from my own personal perspective. Please understand the following viewpoints are based on my experience and research. These views are not reflected by any other veterinarian that I know of, nor will they be found in any search of the Internet. Before I get into the discussion about each phrase, I think it’s important to understand the meaning of euthanasia.
What Is Euthanasia?
This is an important starting place for the rest of the discussion. The definition of euthanasia as stated in numerous dictionaries is: “An easy or painless death, or the intentional ending of the life of a person suffering from an incurable or painful disease at his or her request.” Of course, this is the definition as it applies to humans, but the same definition applies to euthanasia of animals: an easy or painless death. However, the interesting part of the definition, for me, includes the last 5 words: “at his or her request.” A person, unless incapacitated, can make their own decision. If they are “incapacitated” there would not even be a discussion to end their life unless the person was being kept alive by instrumentation. It must be understood that an animal’s reality makes them conceptually incapacitated, for our creatures cannot voice whether they would or would not choose euthanasia. For them, in almost every case, there is no oversight, no one to stand back and ask if euthanasia is truly necessary at the time unless their caretaker decides to wait. The decision is often made because of an ominous diagnosis, or because the pet is “old,” or related to any other reason, sadly, that makes ending an animal’s life seem appropriate.
Now, let’s look into each of the aforementioned phrases from my perspective:
I Don’t Want My Pet To Suffer or My Pet Is Suffering
Suffering is an interesting term that is used, I believe, inappropriately, to end the life of a pet. The definition of suffering says, “to suffer,” and is followed by the word or words, “pain, and/or pain of disease.” But as you delve deeper into the actual meaning, it is not the feeling of pain as we think it, but rather it’s the pain of misery and/or despair. It’s more involved with psychological pain, something our creatures do not experience, or at least it’s never been shown they do. Our pets are not concerned or worried about what is going on inside, they adapt to the changes and take care of themselves by listening to what their body is telling them. Honestly, it’s the people associated with the pet who suffer when their pet is diminishing for whatever reason. That’s a completely different problem than what the pet is experiencing.
Veterinarians take an oath when they get their DVM (or equal acronym) degree that says in part: “to relieve and prevent suffering.” Of course, this applies to the creatures we treat, so it’s understandable that our approach to euthanasia necessitates that we use what we consider to be suffering to allow us to end an animal’s life. That was certainly what I was taught and that was my approach for the greater part of my veterinary career. It’s only been the latter part of my journey in veterinary medicine that I’ve looked at this approach from a different viewpoint.
My Pet’s Quality Of Life Is Poor
QOL is a human term to describe one’s satisfaction (or dissatisfaction) with the conditions under which one lives or exists. It is a subjective viewpoint or one from within, but, unfortunately, it’s used as an objective view of how an animal is doing. As with suffering, QOL does not apply to an animal’s existence as they are not concerned with their “lot in life.” They are in the moment and adapt to their particular state of being. Each moment is a new normal for them. Unfortunately, QOL is used, in too many cases, to determine life or death for an animal. This is especially true for quality of life check off lists. They are used as an objective tool to determine what is thought to be the subjective feeling of the animal. A number is assigned objectively to how the caretaker feels an animal is doing in each category. The total then determines if an animal lives or dies. In one list developed by a well known veterinarian, if the end total is 34 or below, the animal gets to live. If the total is 35 or above, the animal gets to die. In my view, QOL check off lists become recipes for euthanasia.
A few years ago, I had the honor of having a lady whose dog was a quadriplegic as a client. Not only could the animal not move on her own, but her dog mom had to express the dog’s bladder twice daily. The dog weighed about 45 lbs so not a tiny animal one could move easily. The lady was chastised often for not choosing to euthanize her beloved pet. She would not, and I appreciated that, because the dog was always animated when I came for a visit. The dog ate well and just seemed to be at peace with her situation. Nobody else was, but the level of care the dog received was above reproach, and I was fine with it. In the end, after almost 3 years of care, the dog passed peacefully in her bed one morning.
That client and her lovely dog taught me a lot about the resilient nature of our pets and the commitment of people to care for them in the worst of our perceived circumstances of quality of life.
I Don’t Want To Be Selfish And Keep My Animal Around For Me
An important consideration, from my perspective, is, “how can prolonging a life be selfish?” Life is a precious commodity and each moment is a miracle. The argument will always be strongly made by the majority that you have to decide on euthanasia because the animal is “suffering” or has a poor quality of life. I say you are not being selfish by wanting your pet to be by your side for as long as possible. I think it’s important to note that if we can mitigate or relieve pain and if the animal is not concerned at all about their quality of life, then doesn’t it make sense to allow them to live if they aren’t in distress? Of course, the point will be made that if the animal is having significant problems or has been given a terminal diagnosis, doesn’t that put them in distress? My response is that in most of the cases that I deal with, the animal is adapting extremely well, but the people around that animal are in “distress” watching the diminishment of the animal’s health. I reiterate, you are not being selfish by allowing your beloved pet to live longer.
Concerns Involving Euthanasia Done Too Quickly
Following is one of hundreds of cases I have seen where euthanasia was a foregone conclusion, and yet, with treatment and care, the animal lived a longer and comfortable life in spite of the diagnosis. The one that I relate may be the most egregious case I have been involved with during my many years as a veterinarian, but it illustrates a very important trend that chooses euthanasia over life.
About 10 years ago as I was just getting started with my mobile practice, I received a frantic phone call from a young couple who needed to have their cat euthanized that day. As I always do, I asked why they needed an emergency approach to end a life. They related that their cat was hospitalized at a specialty veterinary hospital, and the attending veterinarian, a well known veterinary neurologist, told them that she would not release their cat from the hospital unless the couple had an appointment scheduled for in-home euthanasia that day. Fortunately, I was available and made the appointment for later in the day so they would have enough time to retrieve their kitty from the hospital and get back home. When I arrived, both of the kitty’s parents were in tears, and the patient in question, Hedwick, took one look at me and ran, not an unusual thing for a cat to do when a stranger enters their environment. As we were discussing the reason the doctor had required the couple to make the appointment, Hedwick came back into the room, sat down and started grooming himself. I was puzzled because this was not the usual appearance of a cat near death. Further discussion revealed that Hedwick was having rather severe cluster seizures earlier in the day and that was the reason for the hospital visit. The veterinarian was sure that Hedwick had terminal brain cancer and saw no reason for treatment, but rather felt that euthanasia was the best and ONLY approach, hence her medical directive that required euthanasia. I was dumbfounded, as no MRI was done to confirm the cause and Hedwick was barely into the geriatric age group. Long story short, we started Hedwick on anti-seizure medication and an injectable steroid. He never had another seizure and passed away from an unrelated disease EIGHT years later.
Veterinarians recommending euthanasia before the animal’s ending time is not unusual. Euthanasia has become a treatment instead of being used for the purpose of ending a pet’s life when all treatments have been tried, but the animal is still in significant decline. Even then, I have seen many animals rally when no one thought they would.
Another significant concern of mine involves medications used to treat various problems in the elderly pet. The immune systems of elderly creatures, including humans, have been compromised by age, and elderly animals do not tolerate medications as well as they did when younger. The important point involving medications is that people may think their pet is at the end of its life because of symptoms related to the drug or drugs the animal is being treated with. See below for more information.
How Can I Determine If Euthanasia Is Appropriate For My Pet?
First, and foremost, euthanasia is a choice and it should not be forced on you by your veterinarian or outside voices. You can decide to end your pet’s life, but you don’t have to. A natural death is really more appropriate than euthanasia. Death is the end of the beginning. Every living thing will experience it at some point. Allowing life to progress to death is the way things were set up in the beginning. It does not have to be associated with any belief, but permitted to happen without interference. However, because choosing a natural death for one’s pet is fraught with extremes of emotion, you may want to decide that euthanasia is the best course. Following are some thoughts on making the decision to euthanize:
- Inform yourself with quality information. This is made difficult because there is so much misinformation about how animals actually experience death. I have heard from clients many times that their veterinarian told them it would be “a horrible death.” This is simply NOT TRUE! Animals die just like their human counterparts do, and maybe easier because the animal is not emotional about it. Death can be visually and emotionally difficult to watch, but the animal, or human, has no cognition of what is going on because the neurological system has “built-in” protective mechanisms to take the being out of pain and awareness. It’s actually a peaceful process from within, although there may be outward symptoms that people associate with pain and/or distress. We know it is a peaceful process because of the thousands of documented cases of “near-death” experiences. There is never a mention of pain or distress, but just peace. In fact, many people that have experienced this wish they hadn’t come back.
- Inform yourself about the medications your pet is on and their possible side effects. This is important because I have seen many cases where people call me for end of life because the medications being administered are resulting in symptoms that the caretaker thinks require euthanasia. I will continue to mention how devastating Tramadol can be for dogs, and it’s been proven conclusively that it does not relieve pain, and that is the reason for which veterinarians dispense it. Gabapentin if given 2-3 times daily can affect the animal’s ability to function, especially if there is weakness in the back legs. Antibiotics can cause nausea and decrease the appetite. Heart medications can decrease the appetite, and cause significant electrolyte imbalances resulting in mobility problems. Corticosteroids cause atrophy of the muscles and can result in significant weakness even with short term usage. A pet should never be euthanized because of medication, but, sadly, it happens too often in my world.
- Do not base the decision on “eating.” Having a person’s pet not eat even one meal (terminal situations) often results in a phone call to make an appointment for end of life. In humans, nurses know that when their patient decides to stop eating and drinking, that person will usually pass in 5-7 days. This is generally true for our pets, too, but It’s not so simple in the animal realm, and it’s important to understand the differences. If an animal stops eating AND drinking the time frame is about the same as with humans. However, many animals may stop eating, but if they continue to drink and remain hydrated, then the process can take a long time. One of my clients had a dog not eat for nearly two months before she was finally able emotionally to let me help her dog transition. I’ve had many clients with pets that did not eat for several days, and when given Pepcid AC to diminish acid build-up, started eating again. Hydration allows the body to deal with lack of food until there are no reserves left. Cats present another problem when they don’t eat for 72 hours or longer. Those cats that are overweight or have adequate body condition scores can develop hepatic lipidosis or fatty liver syndrome, which can make them quite ill. In many instances, this condition can be treated, but is somewhat difficult to diagnose (beyond the scope of this missive). In cats with low body condition scores (skinny), not eating becomes the same situation that dogs and humans experience. It’s also very important to understand that not eating along with not drinking is not a painful process, and hospice nurses have related to me that it’s a peaceful way to pass on.
- Be concerned about a speculative diagnoses from your veterinarian, and do not make a decision because of that possibility: “Oh, She/he’s just old and can’t get up because of arthritis. I think it’s time.” “He/she’s old and probably has cancer. You need to think about euthanasia.” Life and death decisions should not be based on “maybes.” That is neither fair to your pet or to you.
- Do not base your decision on what you read on the internet, especially with quality of life check off lists. The same should be true with a veterinary assessment of QOL. Reread the above information if you have questions.
- If your pet is in respiratory distress and cannot get into a comfortable position where their breathing is improved, then you certainly should consider helping them to transition.
- If your pet has severe cognitive dysfunction that cannot be eased with medication and he/she is keeping you awake at night, then you have to realize this is not a sustainable situation and it will not improve. You then become the most important part of the decision as sleep deprivation can be devastating to your health.
- When you (and your family members if there are any) are 100% resolved that euthanasia is the most appropriate end for your pet. There should be no vacillation. If there is, then it is “not time.”
- Do not base it on a bad day or a bad night. I recommend (in most cases) that you allow a longer period, typically 72 hours, before you decide. The reason for this that I have seen hundreds (or maybe thousands) of animals rally and get back to their “normal” behaviors within that 72 hour period.
You are intuitive about your pet. That may be the most important aspect of the decision. Unfortunately, intuition is often clouded by emotions and outside influences including veterinarians, neighbors and family members living outside the home where the pet lives. Intuition often works best before the actual diagnosis is made. Pet moms and dads can often tell that their pet is “off” before their little one actually shows symptoms that require a visit to the veterinary office. I have seen this numerous times during my career, and learned to listen to the pet caretaker that something was amiss even though I found nothing alarming on the physical examination. Further testing often elucidated the problem, but sometimes, it took more than one visit to determine what was going on. In other words, for you, it is vitally important to listen to that “little voice” inside that says something isn’t quite right.
Deciding to euthanize your pet is a choice, not a requirement. However, many if not most, veterinarians will tell you that you have to choose euthanasia to end your pet’s life, and preferably sooner than later if your pet has any kind of a potentially terminal illness or is elderly. From my experience, a significant percentage of these animals with an ominous diagnosis can live comfortably, and for a longer time with our help. When it finally comes to the end, veterinarians, along with the majority of pet caretakers, believe a natural death for an animal is terrible and inhumane. That is not the case. I have coached numerous clients on how they can allow their pet a natural death and I have not had any of them regret it. Remember, you are in command of the decision. It should be yours, or you and your family’s, alone. You should not allow anyone to influence your choice, except through good information presented in a nonjudgemental way. I would recommend you not go on the Internet and do QOL check off lists, or be influenced by the misinformation often presented there.
I am often asked the question, “How will I know it’s time?” You will know when you are 100% emotionally resolved that it is the correct decision and the right time. As mentioned earlier, if you are vacillating, then it is not time. I also try not to give any symptoms because each pet is different and each illness or end of life situation is unique. As to length of time, I do not make that judgment, nor should any veterinarian, although many will give an expiration date. I believe setting a time line adds to what is already an incredible emotional burden. Days are counted off and the stress level climbs. I just don’t think that is a healthy approach for you. Your pet doesn’t care, so it doesn’t really involve them unless they are in some kind of distress that cannot be helped with medication. In that case, the decision will be clear, and I believe euthanasia becomes very appropriate. To be clear, it is important to understand the difference between distress that is real and distress that is emotionally (for you) motivated by misinformation. For me, severe respiratory difficulty becomes real distress. Seizures that come in clusters and cannot be controlled with medication lead to distress even though the animal is not aware they are having a seizure. Severe cognitive dysfunction or dementia where the animal cannot stop pacing or vocalizing no matter what is done is another non sustainable situation that may not be distressful (due to lack of cognitive recognition) for the animal, but is extremely stressful for the pet caretakers.
Your reality with your pet is unique to you and your situation. You are the one to make the decision no matter how difficult it is. Don’t let anyone else make it for you. Please call me to discuss.