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Euthanasia: When is it Time and How Do You Prepare?

By Susan Smith, DVM
angell.org/emergency
emergency@angell.org
781-902-8400
MSPCA-Angell West, Waltham 

Making the decision to euthanize your pet can be one of the most difficult decisions you ever have to make. While we hope our beloved pet will pass away on their own peacefully in their sleep, this rarely happens in reality. The word “euthanasia” is Greek in origin and means “good death.” Veterinarians are trained to provide this form of painless and distress-free death when a pet is facing diminished quality of life. Deciding on euthanasia is often an owner’s final act of kindness and compassion. The most common method of euthanasia involves the injection of a high dose of anesthetic, which allows the pet to fall asleep and pass away peacefully.

When Is It Time?

Quality of life considerations are multifaceted and not always straight forward. Veterinary oncology professionals (those who study cancer) have developed an objective scale to provide owners and veterinary professionals specific guidelines to help determine if a pet’s quality of life is reasonably acceptable. The categories measured are abbreviated “HHHHHMM”, which stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad:

  • HURT: Adequate pain control and ability to breathe properly are vital parts of quality of life. Most pet owners do not realize that not being able to breathe is one of the most painful experiences for an animal, and it is ranked at the top of the pain scale. It is also important to note that our pets can be stoic or not display pain in ways humans may anticipate. Common signs of pain in cats and dogs include restlessness or reluctance to move, excessive panting/rapid breathing, hiding, un-explained aggression, and not eating.
  • HUNGER: Can your pet eat on his/her own? Has he/she lost interest in food? While many animals can survive for numerous days without eating much, malnutrition can develop quickly in sick animals and contribute to progression of illness. Appetite stimulants, hand-feeding, and feeding tubes can help with decreased appetite.
  • HYDRATION: Lack of eating/drinking and external losses (vomiting and diarrhea, for example) can contribute to dehydration. Fluids injected under the skin can be a very effective method to help a pet feel better without being too invasive.
  • HYGIENE: Can your pet be kept clean? Is the coat matted? Is your pet able to move away from stool/urine if he/she has an accident? Prolonged exposure to bodily waste can cause skin scalding, which is very uncomfortable and can lead to systemic infections in severe cases.
  • HAPPINESS: While every pet is different in what they enjoy most in life, some questions to consider include: is your pet responsive and willing to interact with the family? Is your pet able to enjoy food, toys, and the environment around them? Is your pet anxious or afraid?
  • MOBILITY: Is your pet able/willing to go out for a walk? Can your pet be taken outside or helped into the litter box to eliminate with assistance? Sometimes slings and harnesses can help; other times mobility devices such as carts can be considered. Mobility is especially important for large dogs that cannot be carried from place to place.
  • MORE GOOD DAYS THAN BAD: When there are too many bad days in a row or if your pet seems to be “turned off” to life, quality of life is compromised. Bad days are filled with undesirable experiences such as vomiting, diarrhea, frustration, pain, inability to breathe well, lack of appetite, or seizures.

You can help your pet maintain a good day-to-day life experience by using the above scale to regularly measure the parameters that evaluate how well your pet’s basic needs are being met. This scale can also help you clarify the decision for euthanasia, hopefully relieving anxiety and regret about your beloved pet’s end of life. Ultimately, you know your pet best, and if you feel that any above category is being significantly affected, it may benefit you to talk to your veterinarian about your options and whether euthanasia may be an appropriate consideration at this time.

How to Prepare

If it is possible and your pet is stable enough, it may be beneficial to have each family member have some private time with your pet to say goodbye. If your pet is still somewhat active, you may take a day to spend with your pet doing his or her favorite things. If there are children in the family that are experiencing death for the first time, it is important to guide and support them through this process. The American Humane Association recommends books such as Fred Rogers’ When a Pet Dies or Remembering My Pet by Nechama Liss-Levison and Molly Phinney Baskette as a way to provide comfort through this process of loss.

To schedule the euthanasia, you may elect to seek an appointment with your regular veterinarian. You might even ask that your appointment be the last of the day or the first in the morning when the veterinarian may not have as many ongoing appointments or surgeries. In some instances, euthanasia can take place at home with at-home veterinarians which could decrease stress by having the pet stay in his/her familiar environment and avoid transporting him/her to a veterinary hospital. However, there are scenarios where a patient’s suffering is so significant that waiting to schedule an appointment with your regular veterinarian or an at home euthanasia veterinarian is not in the pet’s best interest. You may be encouraged to go through an Emergency Service where they can help you and your pet through this difficult time at any time of day or night as they are often open 24/7.

During the euthanasia process, you may elect to be present or not present. We understand that this is a very difficult time and grief can be processed in many different ways. You may want to be present, want to be absent, or want to be in a waiting area to view your pet after his or her passing only briefly. Likewise, you may or may not want the entire family to be present. In some instances, children who don’t yet understand death may have difficulty respecting your need for quiet and calm during this emotional time. These are ultimately decisions that are up to your personal preference.

What to Expect

As previously mentioned, euthanasia is meant to help animals pass on as peacefully as possible. If you have never been present for a euthanasia before, your doctor will walk you through the process. You will be able to spend time with your pet in a private area beforehand. At Angell, if you are witnessing the euthanasia, a catheter will be placed intravenously by technicians in the clinic area prior to your pet being returned to you for visiting. If your pet is still eating, you may consider bringing treats (including chocolate or ice cream, etc). So long as your pet is stable, you can visit with them for as long as you would like before the final stage, which is the administration of the euthanasia solution. Most veterinarians use a solution of pentobarbital, a seizure medication. Like anesthesia, this solution will eliminate their conscious awareness of passing before their body shuts down and their heart stops. This will be completely painless, and usually they will pass on within 3 seconds to a minute. The doctor will confirm by listening to your pet’s heart with their stethoscope that they have passed on. Like natural death, your pet’s eyes may stay partially open, they may appear to have one or two more breaths (which is not them struggling to breathe, but is a byproduct of the body shutting down), you may feel them relax if they are in your arms, and they will appear to be in a deep sleep (hence the reason why euthanasia is sometimes called “to put to sleep”). If they are in your arms, a blanket with an absorbent pad will be provided in case of bowel or urinary movements when they relax. If your pet has been wearing a collar for his or her entire life, the collar will be removed after your pet’s passing to prevent stress or anxiety.

Many people are also concerned about how they should act during the process of euthanasia. Know that there is absolutely no judgment during this time. Most veterinary professionals have been in your shoes, and have lost an animal loved one in their past. Crying is allowed, and you don’t need to apologize for it. It is also allowed for you to laugh as you reminisce over the wonderful times that you have had with your pet. No matter what age your pet is when he or she passes, it is important to know that your love and care has made their life better.

Final Arrangements

Understandably, you may be emotionally overwhelmed after the event, and it can be helpful to have the conversation about final arrangements beforehand. Options available include the following:

  • At home burial: You are entitled to take your deceased pet home for burial. At Angell, we can provide biodegradable coffins, and, at your request, staff may help you bring your pet to your vehicle. You may want to check local, county or state ordinances to make sure of the legality of burying your pet. You may also consider a pet cemetery. To determine what pet cemeteries are in your area, you may use the International Association of Pet Cemeteries and Crematories website at https://www.iaopc.com/.
  • Cremation: Depending on the season and where you are, at home burial may not be possible. For this reason, cremation is a popular choice. You may or may not want the ashes returned to you. Angell partners with a reputable crematorium, and, if you elect for the ashes to be returned, they will be returned in a small, polished wooden urn within 5 to 7 days. After the ashes have been returned, you can also bury these, spread them (check local regulations) or keep them as a remembrance of your pet.
  • Necropsy/Autopsy: In some instances, there may not have been an identified cause for why your pet was declining. You can request an additional test in which your pet can be necropsied by a board certified pathologist (in human medicine, this is called an autopsy). In some instances, the cause of decline may still not be identified, but it will provide the most information possible postmortem. In no instance will your pet be used for experimentation, and his or her remains will always be treated with respect.
  • Other Means of Remembrance: At Angell, we can also make paw prints in clay for people as a physical remembrance of their pet. It is also not unreasonable or uncommon for pet owners to ask for a small clipping of fur.

After Euthanasia

Once your pet has been euthanized, you may wish to arrange for somebody (a friend or family member) to be present to support you. Death, both natural and planned, is an emotional event, and it may be beneficial to have a supportive individual drive you home during this time of acute mourning.

Grief is also a very personal experience, and, depending on the situation and the individual, the mourning period may take several months or longer. It is important to cherish your memories of your pet, and it can be helpful to create a legacy to celebrate the life of your pet (by preparing a memorial, making a photo album, writing about them, etc…).  However, it is also important to give yourself time to grieve and to care for yourself during this time. Although it may be tempting to immediately adopt another pet to fill the void, the Humane Society of America actually recommends not jumping into a new pet relationship until you are emotionally ready. It may be beneficial to reach out to trusted friends who have similarly expressed pet loss or even professional grief counselors. Online resources and phone hotlines that are available include the ASPCA Grief Counseling Hotline (not affiliated with the MSPCA) at 1-877- 474 – 3310 or Tufts University Pet Loss Support Hotline at 1-508-839-7966. Angell clients may also use our staff grief counselor.

Final Comments:

Unfortunately, our furry friends and family have a limited lifespan.  When they become very sick, it is natural for family members to feel sorrow, guilt, stress, and even anger. It is important to plan for the end of life before that time arrives. Although it may feel impossible to say goodbye, euthanasia can sometimes be the final act of caring for your pet.

References:

  1. Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN,
    09/2004,for Canine and Feline Geriatric Oncology Honoring the Human-Animal
    Bond, by Blackwell Publishing, Table 10.1, released 2006. https://www.veterinarypracticenews.com/quality-of-life-scale/
  2. American Humane Organization. “Euthanasia: Making the Decision. https://www.americanhumane.org/fact-sheet/euthanasia-making-the-decision/. Accessed December 2018.
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