Handle With Care: How To Deal With Euthanasia Conversations In Practice

Let’s not sugarcoat it – euthanasia appointments can be tough.

Though euthanasia can end the suffering and pain of a pet, it can also be emotionally challenging for vets to deal with.

According to research, euthanasia frequency in practice has a positive correlation with depression ¹. This has massive implications for a profession already dealing with a lot of stress.

In this article, we talk about how you can deal with euthanasia in practice. Drawing from the advice of a seasoned end-of-life vet, Dr. Emma Clark, we give you a few tips and tricks you can use to handle euthanasia with care.

How To Deal With Euthanasia In Practice

Work With The Client – Not Against Them

While euthanasia is always difficult to talk about, it doesn’t have to be emotionally detrimental to handle.

Many vets (at least, according to research) become emotionally distressed when making euthanasia decisions, more so than during the procedure itself ².

This highlights the importance of proper euthanasia training. If you know how to handle clients, the process can become a lot easier – for everyone involved.

There are several ways you can do this.

Broach The Topic First

While vets do not relish these conversations, it’s the clients who can be most unwilling to talk before the time is right (or in many cases, after the time is right).

Although you may have reservations about initiating the conversation, especially when a pet is in the grey area between the ‘definitely doing fine’ and ‘definitely in trouble’ zone, doing so can be the kind thing to do. The guilt of ‘playing god’ can weigh heavily on a client’s mind, making them hesitant to come into the clinic or talk about euthanasia.

Being the first one to broach this barrier, therefore, can be a great source of relief for a client. In effect, the decision to euthanize a loved pet becomes a shared burden. It may also be necessary to broach the subject if the client is overly optimistic about the condition of the pet. This can be after diagnosing a life-limiting condition or a surgery designed to partially remove an aggressive tumor (debulk).

In such cases, especially when it comes to older animals, if a pet’s quality of life is seriously diminished, bringing up the subject may fall to the clinician who has to take the lead in opening this discussion.

De-escalate Emotional situations

Not surprisingly, conversations around euthanasia can become quite emotional. According to Dr. Clark, you should always approach these subjects gently.

‘There is no single right or wrong way to approach the euthanasia conversation’ she says.

‘It’s a good idea to put yourself in their shoes and consider, how would you like to hear bad news?’

She recommends always giving the client options and time to consider.

‘Sometimes, people don’t want to come into the vets because they dread what they might be told.’

Allow the client to have breathing space (if the situation allows it) when you deliver bad news. If you find that a client is especially angry or upset, perhaps let them have a moment to themselves before the appointment continues or give them time away from the clinic with their pet to consider their options.

In many cases, euthanasia decisions can be planned, so sending them away with analgesia and some time to think can create enough space for a client to come to terms with what is happening. This will also help with the grieving process after the euthanasia has occurred, as no one has been rushed into a decision before they were ready.

The grief reaction in clients can become amplified when support does not meet their expectations. Often, veterinary professionals are the primary source of counsel for distraught owners, who may not receive the same understanding outside of the clinic ³.

Therefore, being compassionate can de-escalate emotional situations and help pet owners move into and through the stages of grief.

Balance Your Client’s Needs

While your patient is the utmost priority, you should always consider the needs of your clients as well. Good vets learn to balance this tough equation.

Some people come into the clinic clear about what they want, but it may not be a view that aligns with the vet’s opinion. We as clinicians may be aware of, and keen to pursue, the surgical and medical options available. But sometimes, the client is not, and a professional may become blinkered by the pursuit of a cure, leading to more aggressive treatments than the pet owner is seeking.

The phrase ‘just because we can treat an animal, does not necessarily mean we should’ is one all vets should keep in mind.

Doing so keeps us open to the many different needs of the pet and family which also include financial, cost, emotional, and physical constraints. The clinical picture is only one part of the puzzle to be considered when helping pet owners to decide on euthanasia.

In these cases, vets can try and talk owners out of putting their pets down. This may not sit well with an owner who has made up their mind, says Dr. Clark.

‘If a client wants to put an ill pet down, maybe don’t talk them out of it. Listen to their reasoning and weigh up how committed they are to the euthanasia path. Are they here to discuss it with you further and hear your view, or have they decided on euthanizing their pet? The owner has had this animal for a long time. And trying to talk a person out of it when they have emotionally processed euthanasia may not be the best thing to do.’

What About When They Do Not Want To Euthanize?

Conversely, you may have a situation whereby a client is opposed to euthanasia- even when there are no other good options.

‘You have to consider their standpoint, but be firm if the animal is suffering’, says Dr. Clark.

‘Some people just need to hear it. In this situation, I would suggest some ways to improve the animal’s quality of life but ask the client to consider euthanasia in their own time. Performing a quality of life assessment can help in these cases too.’

Although these situations can be complicated and conflicting, always consider the feelings of the client. This can be difficult, but if you want to help animals, you must also get the owner on board.

‘Sometimes, you have to pick your battles and know which hill you are willing to die on and which you are not. Working with the pet owner rather than steamrollering them is likely to result in a better outcome.’

In such cases, minimally providing pain, infection, and nausea management in the short term can buy some space allowing the pet owner some time, and you to set a ‘line in the sand’ date for the euthanasia to occur.

Advice For Graduates

Euthanasia conversations as a graduate can be challenging.

Many graduates lack practical experience with euthanasia decision-making. This can make euthanasia conversations even more stressful.

Dr. Clark recommends that inexperienced vets give themselves time to make a conversational plan before they speak to the client. Writing down the bullet points of a structure for the conversation can be very helpful.

She also recommends seeking out a mentor. Watching someone else deal with euthanasia, and interacting with the clients can give great insight. There are some amazing training sessions available on this subject.

‘As a new graduate vet, you are put into a lot of new situations which can be hard, but you need to learn about these things.’ she says.

‘In time, with practice, you will improve your ability to hold difficult conversations. And these moments offer the greatest opportunity for a vet to have a positive impact on the emotional wellbeing of a family.’

Don’t Forget Self Care

Despite this advice, Dr. Clark believes every vet should have a good self-care routine away from the practice.

‘Even after 20 years, these conversations are never what I would describe as easy’.

To take care of herself, she indulges in activities she loves, like cooking, running, and socializing. She recommends having some ‘outlet’ – whether that be an activity or a confidant. Effective debriefing in practice can also help. The important thing is not to weigh on these moments and let them sit on your shoulders for too long.

See The Positives

Euthanasia conversations are hard- there is no doubt about it. But it’s not all doom and gloom.

Handling euthanasia cases with proper care can brighten a client’s experience during a difficult time in their life and bring their pet to a peaceful end.

Dr. Clark says that you should think about these conversations in a positive way.

‘You’ve made someone’s life a little better by being kind, and euthanasia conversations done well can make a difference.’

It’s important to learn how to deal with euthanasia and the emotions that go alongside it with a lighter touch. The vast majority of the time, you’ll be doing work with profound meaning and impact. The final decision on how and when we say goodbye is perhaps the most important work of all.

For more help on euthanasia and managing emotions, check out our 'So You're a Vet... Now What' course. The twelve-module training program includes a webinar, toolkit, and quiz on emotional intelligence. To learn more, click here.

References:

1- ‘The distinct role of performing euthanasia on depression … – PubMed.’ https://pubmed.ncbi.nlm.nih.gov/24635739/. Accessed 5 Aug. 2021.

2- ‘Impacts of the process and decision-making around companion ….’ https://pubmed.ncbi.nlm.nih.gov/31409747/. Accessed 2 Aug. 2021.

3- ‘Disenfranchised grief: Why pet owners aren’t allowed to mourn.’ 30 Jun. 2021, https://www.dvm360.com/view/disenfranchised-grief-why-pet-owners-aren-t-allowed-to-mourn. Accessed 5 Aug. 2021.