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A veterinary blog for pet lovers, vet voyeurs and the medically curious...
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Discussing euthanasia is stressful for any veterinarian. Having to refuse it can be doubly so.
It’s an uncomfortable position many vets find themselves in for a variety of reasons.
The most oft-mentioned scenario? A healthy animal is presented to the veterinarian. Euthanasia is requested for a vague reason, disapproved-of reason, or for no reason at all.
Under these circumstances we can all agree that a veterinarian charged with the humane treatment of animals and as general guardian of their welfare is granted discretion in refusing a request like this.
“Gimme a good reason,” is typically all we ask.
Did he maul someone? Does he have a non-obvious life-threatening disease?
I won’t prompt the client. The good reason’s got to come out unguided. Trust is everything here—and sometimes we won’t know these clients from Adam.
When I worked emergency hours serving clients I’d never met before, refusing euthanasia was not rare for me. If the animal was healthy (which didn’t happen often, it’s true) I’d tell them to wait to see their regular vet.
“It’s not an emergency,” was my party line. And it worked.
Recently, I had cause to discuss this very scenario with a surgeon at a large, regional referral hospital. She described the discomfort of having to refuse euthanasia whenever clients realized they could not afford a procedure:
“If I euthanized every dog with a broken leg whose owner couldn’t afford definitive treatment I’d feel like Dr. Death. My job is to fix things, not to kill fixable animals when owners can’t afford me. It’s the regular vet’s job to take care of these euthanasias after discussing all options thoroughly. What’s more, it’s considered rude for me to euthanize someone else’s regular client in a non-emergency situation.”
She has a point. But it still unnerves me to consider sending an injured pet out the door whose owner’s next stop could be the Everglades (animals are dumped there routinely as a cost-effective solution to their owners’ complaints against them).
But it’s still our prerogative to deny death when our conscience tells us we must, isn’t it?
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"The greatness of a nation can be judged by the way its animals are treated."
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- Mohandas Gandhi
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He'd spent several years at ASPCA, when they were taking in 20,000 cats a year and finding homes for 2,000. Also euthanizing most of the dogs, but it's the cat numbers that he quoted to us when we brought in our very sick kitty, got a very scary diagnosis, and asked if it were possible or realistic to save her. He did not want to EVER euthanize an animal again.
So our kitten was hospitalized, and survived and recovered, to live to a decent age of fifteen, when cancer got her.
But we never forgot how the vet looked, and sounded, when he talked about euthanizing all those cats in New York. We'd been comfortable with what needed to be done for our kitten, even knowing it had a low chance of success. (Hey, low chance isn't no chance, and she recovered!) But sometimes, with other pets, we'd not be comfortable with what they'd have to go through. In those cases, we'd go to another vet, and get a second opinion. If the likelihood of success seemed great enough to justify what our pet would have to go through for that chance, we'd go back to our trusted vet of many years for treatment.
And if it didn't, we'd have the other vet do the euthanasia. Because we just couldn't ask our regular vet to do that. No one better to go to when there was still a chance, but not the person we could look in the eye and say, "it's the end. She's suffering, it's not going to get better, and it's time to stop putting her through this."
Basically, we had an excellent but somewhat traumatized vet, and we worked around that.
Do you or any vets you know ever offer to take the animal and turn it over to a rescue group if the family cannot afford care? Sticky situation, yes, but it's the right thing to do for the animal's sake. Do most vets offices know rescue's phone numbers to contact in situations like this?
When applying to veterinary school, she planned (for her interview) how she'd describe developing an adoption program for any unwanted animals. Naive or not, her goal was to never kill an otherwise salvageable animal.
Shortly after becoming a working veterinarian, she admitted to me that she didn't realize how much killing there'd really be. Within a year or so, she was ready to look into a new career.
She stuck it out, though. Buying her own clinic helped, I think. And while she has some wild stories to tell me, from time to time, heartless owners routinely requesting the deaths of their dogs is not even a category for discussion. She's lucky, I guess, in that if it does happen, it seems to be rather rare...with HER clients, anyway. More common are clients trying to get treatment for free or at a significantly-reduced discount...as though her costs are completely at her discretion.
I remember working as a veterinary technician myself, many years ago, while I was in university, deciding whether to go into veterinary or human medicine. (I ended up in an entirely different field.) One family will always stay with me. It was easily over twenty years ago, but I can still picture their aged Golden Retriever.
The dog hadn't been ambulatory for some time, and had numerous, open pressure sores. Yet, mentally, it was still alert and aware. They'd made the herculean effort to bring the dog in for euthanasia (had they known a veterinarian would be willing to go to their home for that, it would've been better). But they were still waffling. They took the dog out to the parking lot, and set the dog and blanket down, and played fetch (by tossing the ball directly to the dog's head, and she'd excitedly grab it, with total glee on her face). They were in tears.
I took a few moments away from my duties to chat with them. I let them lead the conversation. After all, my opinion of the "right" time for their dog to die wasn't especially relevant. They'd be the ones who either felt good about, or haunted by, their decision. It was a difficult choice. The dog was clearly still so happy to have its owners' attention and affection. The dog was on pain medication, so that wasn't too, too bad. But clearly, the pressure sores made it evident the people weren't keeping up with the minimum standards of care for immobilized patients.
They decided to euthanize the dog right there, in the sunshine, with the owners gathered around. I think it was a good choice. I think it was the right time...whatever that means. I hope the owners feel that way too. They obviously loved that dog and wanted to hold on as long as possible...but when it was clear it was no longer "possible" they let her go, without pain, peacefully. We should all be so lucky.
It's too bad there are actually people who throw dogs away, like they're shoes that are no longer in fashion. I'm glad there are so few vet's willing to accommodate them.
Now, ahem Dr. K., can we move off maggots & death for a few posts? How about: "Which are the cutest: kittens, puppies, or wittle bunny wabbits?". :-)
AVMA ethical guidelines , your oath, and also the statutes in every state are there to govern. The majority of states (although legislation is going forward to change this in some) consider animals, companion or not, "property" . Like it or not, their value is no more than a toaster, car, or any inanimate object.
Healthy companion animals are euthanized every day (I forget Oprah's statistics) , because they are simply unwanted---a horrendously sad fact of society.
"Do no harm & relief of suffering" are part of ethical standards. There are many, many pet owners that do not have spare 100's or thousands $$$ hanging around, nor have ability for credit. And on the flip side, there are many pet-owners that do not value their pet anymore than a broken appliance.
I see this dilemma presents many varied and unique situations, and this may be one where voluntary relinquishment may be a viable answer. On the other hand, I would have been *very* upset if I was not able to "pay" (via personal credit) for the expense of Pearl's spinal surgery to relieve a very painful condition and had requested euthanasia and was refused. (see pet hospital)
Every animal deserves a HUMANE death, and not to become coyote or alligator lunch, or abandoned to the elements.
The dog's owner brought the dog in to the reception area, told us who he was, handed me the leash, and left without a backwards glance at his dog. The dog was incredibly sweet, and we (the receptionists) tried to keep him behind the desk with us until it was 'time'. The dog was quiet and stood next to me leaning against my leg. Meanwhile a long-time staff person was negotiating with the vet. She was asking the vet to call the owners, and tell them that if they would call off the euthanasia, she would personally adopt the dog.
The vet called the owners, and the owners were furious to be asked whether they would consider not euthanizing. Meanwhile, another staff worker became annoyed at us for keeping the dog behind the reception desk, so the dog was unceremoniously shoved into a cage in back. When I walked by the dog's cage I saw stress-drool hanging from his mouth.
The dog was euthanized - not with caring owners present, but in a back room, without any sentiment, and after a few hours of feeling very stressed. I didn't cry at work but I cried when I got home, and I felt sick about it for a long time afterwards. I no longer work at the vet's office (I didn't quit because of that incident, I left later for other reasons). I really can't imagine facing these kinds of situations in your day to day work life, knowing that it won't get any easier and that you won't be able to avoid having to deal with situations like that until you retire.
I think the vet should refuse when he/she doesn't feel right about putting an animal down. The problem is, the owner is likely to move on to a less discriminating vet and will probably be able to find someone else who is willing to do it. Or they might do something even worse with the animal. There are no easy answers.
On the other hand, I've seen many a vet perform euthanasia for owners who simply don't give a crap or who find their pet's condition too bothersome to treat - not as a manner of finances. That always bothered me, too.
Then again, I think pet owners should have a right to provide their pet a good death. I don't necessarily think there's any shame in euthanizing a pet who is suffering, even if the condition is treatable, when the owner simply doesn't have the resources. For example, a broken limb w/nerve damage that keeps getting traumatized as the pet drags it on the ground almost certainly warrants amputation - if the owner can afford it. If not, who's to deny that owner the opportunity to do the best they can for their pet - a peaceful end? Yeah, it'd be nice if they had an emergency credit card of pet insurance, etc., or if they hadn't taken on the financial responsibility of the pet in the first place. But that doesn't matter now as it can't be changed.
All in all, I guess I just don't think euthanasia is that bad of a thing. If done properly, the animal isn't stressed and doesn't know what's going on, and it happens quickly and uneventfully (usually). Of course, it still doesn't make it any easier for the vet.
And it kind of bothers me, to read the statement about it being "expected courtesy" to send the animal back to the primary care vet, as if it all boils down to the last "fee" involved. This (statement) probably is not intended to be interpreted that way---but from the posts, it seems like it might be giving the regular vet a break (emotionally).
Euthanasia to relieve suffering is a "gift" that veterinarians possess; it should not be withheld without great consideration of the potential consequences.
And as for asking rescue groups to take the animals... most rescue groups are so strapped for cash that taking in animals who need expensive treatments just isn't possible. All you'll do by asking them is just make them feel guilty, too! :-)
A year later and he is still going strong - sometimes it pays to listen to a vet's decision.
But when my cat got old and sick, had fits, became unconscious, I had to ask the vet to put him down. He didn't come out and offer it, although there was no hope of recovery for the cat.
>> very adoptable it is sometimes surprisingly difficult to get the owner's consent.
Barb - this is surprising to me, but I suppose an owner could "know" or feel that an animal is at the end, even though it might not be medically obvious. I've never had to face the situation with a pet, but have with human loved ones. At least 4 doctors between a nursing home and a hospital advised me to let my Dad 'go' after a stroke and bad pneumonia. That was 5 years ago, and he's still with us today and loving life.
My only point being that end-of-life and quality of life issues seem to be one of the murkier areas of medicine and ethics. I suppose this points in the direction that if the owner seems competent and there is good reason to end the animals life than their wishes should be respected.
So I guess that contradicts what I posted before. But I still believe the vet should have the final say do only what they can live with. Which means I contradicted myself again and I'm going to stop posting now. :)
Once I was boarding my cats at the vets for a trip, and while I was there, a woman was in the lobby with her lovebird and her lop-eared rabbit, requesting that they be euthanized because she was moving.
????
One of the assistants offered to give the lovebird a home, and practically had to BEG this woman, who seems to REALLY want them killed. She was very reluctant and griping about signing the bird over. Then the staff went to work for the rabbit. They said: "Let us just make a call to this great rescue we work with . . . " The woman grumbled and starting saying how she didn't have time . . . she wanted the rabbit put down. The rescue agreed to take the rabbit, the staff member announced happily. The woman refused to drive the rabbit there, even though it was only 15 minutes away.
Even though I was running a little late (headed for a plane), I offered to drive the rabbit, because the rescue was more or less on the way to the airport. Again, the woman seemed very reluctant -- like she was being publicly peer pressured into signing these animals over but she really wanted them killed. They were beautiful, young healthy animals. So I said, "Really, no problem, it's on my way." She asked me if my car was air conditioned, saying she would NOT agree to let me drive the rabbit to the rescue if my car was not air conditioned, because rabbits are temperature sensitive.
????? She was about to have the lethal pink juice pumped into him for NO reason, and she's asking me about climate control in my car for the 15 minute drive to the rescue?
I assured her that I DID have air conditioning, but she still hemmed and hawed and was not happy about signing the rabbit over.
The GOOD news is that the rescue was SO horrified by the story (as the vets staff had conveyed to them what the story was) and was so happy to get the rabbit. Within 48 hours he had a new home in one of the wealthiest zip codes in our area. Apparently his new owners could not believe their luck getting him because his breed of rabbit is apparently pretty special -- I'm not so sure exactly, he was really big with long drooping ears and and fabulous fur and apparently pretty prized -- by his new family.
That lady clearly had mental issues.
And then there were the people that relinquished elderly or sick Scotties, that they should have cared enough to provide loving, humane euthanasia, but just wouldn't. The biggest heartbreak were the physically healthy but mentally irrepairable dogs.
After my experience with Pocket, a dog-friend drove around with a note in her purse, written by her vet, that stated her elderly, sick Scottie may need euthanasia (while her vet went on vacation) and to please honor the request without "pressure of treatment". My friend was very nervous that she wouldn't be "strong" during her time of emotional turmoil and grief with a personally "unknown vet".
Killing a pet, especially a problem pet, is a difficult decision. To make that decision at all requires a huge effort on the part of the average owner. When they've finally made that decision, they tend to distance themselves from it, so it won't hurt as much. That is why so many people just walk away -- emotionally, they CAN'T stay and watch their pet die.
When you at the vet's office react with horror, you are telling them that they've made an unforgiveable mistake and that their whole thought process was stupid. People get angry when their hard decisions are so blithely negated by someone who did not have to make their decision. And that is why they react as they do when someone offers to "adopt" that pet.
They're having to give up something they're attached to, and you are effectively telling them their feelings don't matter. Of COURSE they get mad. Altho you seem to think they should be relieved if a new home appears, that's just not how most people work, emotionally. That new home is seen as their humiliation for their "bad" decision that was so hard for them to make.