As veterinarians, we need to rethink what a meaningful and spiritual honor it truly is for us to oversee and minister compassionate euthanasia services for beloved pets. First of all, we need to avoid using negative self-talk words and phrases such as kill, take a life, put down, put to sleep, playing God, etc. Using these words contributes to ethics fatigue and compassion fatigue. Instead, we should strive to always use positive words and phrases, such as help, transition, escort, lift, give back, kindness, gift, cross over, peaceful and painless passing, etc. Mother Nature versus domestication Put forth this very earnest philosophy for our clients: “When animals became domesticated, they gave up the ability to separate from their pack when it is their time to die.” Wild animals in decline will fall behind and become prey or they separate themselves from the pack and lie under a bush. Mother Nature’s quick hand, through harsh elements and her laws of predation, cause a frail animal’s life to end quickly. There is rarely a prolonged, lingering phase at the end of life for animals in natural habitats. Frail animals in the wild do not linger on death’s doorstep for long because the sick and debilitated can’t keep up their daily routine for survival, and they are not protected. When humans domesticated animals, we took up the ancient contract of the good shepherd. It is our duty to help separate our end-of-life pets when their quality of life declines to a low level or if they begin to suffer relentlessly. When our pets’ lives are no longer worth living for them, it is our responsibility to help them depart with a compassionate, quality death. As the good shepherd, we must keep our ancient contract and separate our beloved pets from the pack and help provide them with the gift of a loving euthanasia as we escort them over the Rainbow Bridge. Explain to your clients that our pets totally rely on us, as their keepers, to help them transition. Inform and counsel your clients that if their pets were in the wild at the end of life, they would have separated themselves from their pack to await Mother Nature’s quick destiny. Counsel clients that their loyal pets deserve their loving final gift of a peaceful crossing. Our domesticated dogs, cats, horses, and pocket pets must now depend on our kindness and wisdom to separate them and to help them transition when it is their time. Of course, it is sad and regrettable to have this responsibility. However, when we ask our clients to rethink they are keeping the ancient contract with responsibility to the end, a compassionate euthanasia may be less emotionally painful for all involved. Our entire profession needs to quit feeling so bummed out and burned out about compassionate euthanasia. We must rethink our role in providing a bond-centered euthanasia, reconsider it a privilege similar to a minister conducting a sacred sacrament. Instead of it being a total “sinker” of our collective professional well-being, euthanasia can be considered a last-rite ceremony. It can be considered parallel to a sacrament that is compassionately and professionally delivered by our veterinary clergy to assure pets a peaceful and painless passage. Providing a compassionate euthanasia (with candles, flowers, and poems) should be considered a “balloon” or a “lifter” and an opportunity to alleviate a heartbreaking event. Gear your entire veterinary team to rethink their feelings about euthanasia. Guide your associates and veterinary team to start rethinking euthanasia in this uplifting way. Teach them to feel better about themselves and to elevate their blessed role knowing their compassionate work with clients regarding euthanasia is keeping loyal to the most difficult aspect of the ancient contract of the good shepherd. The main role of veterinary medicine is to help our patients medically during all stages of their lives. At the end of life (which should be a separate stage of life), we are duty-bound to provide palliative care to treat symptoms and alleviate pain. When that is no longer effective, we are duty-bound to spare our patients’ relentless and unnecessary suffering with the gift of a well death. We should feel honored we are serving society’s needs by offering our decision-making and counseling to help pet lovers through this emotional and difficult time. Provide your clients with the H5M2 (HHHHHMM) Quality of Life Scale for dogs and cats. It helps carers evaluate the seven criteria to help guide decision-making for the final call. (Download the Quality of Life scale from pawspice.com.) The chaplain role For personal resilience and professional endurance, we can rethink our esteemed and powerful role in the euthanasia process. We need to visualize ourselves and our role in a more positive light, as being similar to an honored and respected minister, a spiritual guide, a chaplain, a rabbi, a priest/priestess—certainly not an executioner. Our role as chaplain is to comfort and assure our bereft clients they are giving the most meaningful gift to their end-of-life pet. That gift is a quality death with a bond-centered euthanasia. We should describe euthanasia for them with its literal meaning, which is “good death.” We should use phrases such as “We will escort your beloved pet over the Rainbow Bridge with a peaceful and painless passing.” How do we provide a bond-centered euthanasia? Don the chaplain/minister’s hat. Never separate an end-of-life pet from the family to place an IV catheter for the euthanasia procedure. Light candles, bring in flowers, and turn down the bright lights. Be sure everyone is in agreement with the decision for euthanasia. Explain to the family you will use a two-step procedure to help assure a peaceful and painless passage. Administer a sedative by injection (intramuscular or subcutaneous) to allow the pet to fall asleep in the presence of the family. Explain some pets will take a breath after they are deceased. Provide the final injection that will cause breathing and the heart to stop. Cover the pet with a towel and instruct the family to massage their pet’s head and neck. Under the towel, listen for the heart and then administer the euthanasia solution into the heart. You may prefer to palpate for a kidney and inject the kidney or the liver or to give an intraperitoneal injection. This may take longer before the heart stops. Some practices prefer to place a catheter after sedation. Pronounce the pet’s time of death when you are unable to hear a heartbeat. Document it in the chart. Invite the family to stay with their deceased pet for whatever time they need. Let them know this special time is a wake. Validate their decision as being the right thing to do under the given circumstances. Ask the carers to blow out the candle as a symbol when they leave their deceased pet with us for afterlife care (e.g. cremation, pawprint, pictures). Read poetry such as “The Rainbow Bridge.” Afterlife care: The funeral director role Make arrangements for cremation or burial. Never let your staff ask the horrible question: “How do you want to dispose of the body?” Send a sympathy card with a personal notation. Call the family in a couple of days and ask, “How are your heart and soul doing?” Offer further pet-loss counseling and recommend the family call a pet-loss counselor or a chaplain to help process their grief. Make a donation to a special cause in the name of the pet. The good shepherd role Veterinarians can counsel, comfort, and enlighten heartbroken client carers and ease their burden of guilt by reminding them of their responsibility to the ancient contract of the good shepherd. Because society domesticated and loves its companion pets, it has a tendency to overprotect and hang on to them when it is not in their best interest. Our goal is to counsel and ensure caring families that their beloved pets don’t have to suffer needlessly at the end of life. Last words On a final note, veterinarians have many occupational stressors that can cause depression. Rethinking compassionate euthanasia should alleviate the negativity surrounding our part in this particular event. As we elevate ourselves into the chaplain role and our clients into the good shepherd role, we can join forces as the honored compassionate escort for our beloved patients, as we help them cross over the Rainbow Bridge. Alice Villalobos, DVM, FNAP, is president emeritus of the Society for Veterinary Medical Ethics. In addition, she is director of Pawspice and Animal Oncology Consultation Service in Southern California. She may be reached by e-mail at pawspice@yahoo.com.
