The Euthanasia Conversation: Communicating with Grace, Dignity, and Support

Whether to euthanize a beloved companion animal can be one of the most difficult decisions many clients will ever have to make. The decision is often accompanied by feelings of betrayal and/or guilt,¹ and clients often look to their veterinarian for affirmation and support through this arduous time.²

What a veterinarian does and says can vary according to the timing and circumstances surrounding the decision to euthanize. Veterinarian–client discussions can take place before euthanasia, at the immediate time of and directly after euthanasia, and sometimes days or weeks afterwards. How much time to spend discussing the event depends on the urgency of the situation, client readiness, and the veterinarian’s skill and confidence in broaching the subject.

Ideally, end-of-life discussions start several days to weeks before the euthanasia in an attempt to prepare clients for logistics and to make it easier for them to make end-of-life care decisions. However, sometimes the veterinarian does not have the luxury of time to proactively discuss end-of-life care, and because of the urgent nature of the situation, the conversation is conducted at a faster pace. This article describes how some of these conversations may take place and offers tips on how to make a difficult time a little easier for the veterinarian and client alike.

Before Euthanasia

Ideally, the veterinarian would bring up the topic of euthanasia and its associated decisions several days to months before the impending day.³ More specifically, clients expect discussions with regard to the decisions they need to make after their pet receives a terminal diagnosis but before euthanasia.⁴ Discussing euthanasia in advance minimizes the stressful decisions the client will have to make on the actual day, when it can often be difficult for them to think clearly due to overwhelming emotions. Will a client possibly start crying during these preparatory conversations? It is very likely that many will, but with the veterinary team’s support and guidance, the client will have the necessary time to think about answers or be able to take a list of questions home so various family members can also be involved in the decision.

What types of issues/questions may need to be addressed in these preliminary conversations? The first questions often pertain to helping the client come to terms with the fact that it is time to start making final preparations for their companion animal. For some clients, you may need to help them recognize the signs that are prompting you to have this discussion in the first place. Let the client know what you are seeing medically and how it is affecting their companion animal’s quality of life.⁵ Try to help clients make informed decisions⁶ while avoiding being trapped into answering, “What would you do if it were your animal?” With some long-time clients, you might feel comfortable answering that question, but with most clients, it is best to guide them into making the decision themselves by sticking to the medical facts.

Making the decision for them may prompt future resentment toward you from some clients and could potentially exacerbate their grieving process.⁷ To aid in decision-making, it is often helpful to send clients home with quality-of-life questionnaires, such as those on the Lap of Love website (lapoflove.com), which can help them make a more objective decision, rather than one based on emotions alone. You may also discuss the signs and behaviors to look for. An initial conversation about end-of-life care can provide clients a framework on which to reflect and help them prepare further questions to ask and prepare them for the euthanasia event itself.

After the client has decided to proceed with euthanasia is the time to verbalize support and reassurance in their decision. Being treated with warmth and kindness has been identified as especially valuable for clients deciding to euthanize their pet.² You may be the only one from whom they will receive such support. At this time, shift the focus from quality of life to quality of death and the questions that accompany that conversation. Questions to be discussed should include whether the client and/or others would like to be present during the procedure, care of the body after euthanasia, and options that can be offered (BOX 1). If the client opts to take the body home for burial (if allowed in your area), it can be recommended they bring a box, blanket, or other item to place the body in if the practice does not provide these resources. Many practices offer to create mementos such as clay paw prints, ink nose prints, or package locks of hair. Some clients will want mementos and others will not. Other issues include whether the client would like a postmortem examination and whether the patient (mammals only) has bitten or scratched anyone in the past 10 days (which may entail a discussion about rabies testing). Because all of those questions can be too numerous for a client to remember, it can be helpful to provide a list that can be taken home to be pondered and/or discussed with other family members, if needed. Although still difficult for clients, providing those questions ahead of time will make it easier for the clients to answer when the day of euthanasia arrives.

At the Time of Euthanasia

The day of euthanasia has its own communication challenges and nuances and deserves special attention (BOX 2). Veterinary team support during euthanasia procedures has been found to be one of many predictors of client grief severity, in that clients who perceived the veterinary team to be unsupportive were more likely to experience severe grief than those who felt adequately supported through the experience.^7,8 If the euthanasia is scheduled in advance, it may be recommended to have the client give their companion animal anxiolytics/sedatives before coming in, which can help decrease stress for the client as well as the patient. Regardless of whether the client opts to stay with their companion animal, quickly usher them to a quiet, private room where you can ask necessary questions, obtain consent, and perform the procedure (if they wish to be present). If practice policy is to have clients pay the bill the day of the euthanasia, it is best to have them do this ahead of time as emotions after the procedure are often overwhelming. To allow the client some privacy, the clinician or a staff member may offer to be the runner between the front desk and the client during fee collection.

How to perform euthanasia varies according to personal clinician preference; however, it is vitally important to explain to the client what will happen leading up to, during, and after the euthanasia procedure. Veterinary clients whose companion animal has been euthanized have described that they expect the veterinary professional to discuss the procedure and aftercare.⁸ Use client-friendly terminology to avoid any surprises for them. If young children are present, try to avoid using phrases such as “go to sleep” or “I’m giving them medicine,” which can be frightening as those same phrases are used with regard to the children themselves, albeit for different circumstances. Having described ahead of time what they may see their companion animal do during the euthanasia process (e.g., eliminate bodily excrements, not fully close eyes, take agonal breaths) will make it easier to remind them of previous discussions if something does disturb them, rather than trying to have to explain what is happening in the heat of the moment. All of this should be done in a quiet place, sitting or standing at eye level with the client. A lowered tone and slower rate of speech are also helpful. Adjusting nonverbal communication (e.g., tone, rate of speech, positioning, eye contact) can communicate warmth and empathic understanding to the client.⁹

After Euthanasia

What happens immediately after the euthanasia can also vary (BOX 3). This is not the time to rush a client out of the room. It can be helpful to ask them ahead of time if they would like to be alone with their companion animal afterwards, and if so, how much time they would like. If they want to leave immediately afterwards, help them leave through the least busy exit as possible. If they ask you to sit with them after the procedure, this is a good time to be supportive, reminisce about their companion animal, and ensure that they are actually okay to leave and drive home safely when they are ready to go.

Providing empathy is a valuable element of supporting clients during the entire process as well as validating their decision and associated emotions (e.g., relief, peace, guilt, sadness).^7,8 Placing a hand on the client’s shoulder or forearm can be a nonthreatening way to show support. For most clients, it is best to not initiate a hug, but do reciprocate a hug if the client initiates it. Remember, you are there to support the client, and each client’s needs are unique. Following the client’s lead on what is needed at the moment is more helpful than having a standard approach for every client. In addition, be alert for those clients who may need to have a friend or relative contacted to drive them home or come provide additional support. Ask questions about who could be there for them during and/or after the procedure.

Ensure that all staff members control their noise level when a client is in for their pet’s euthanasia and that they speak to the clients in a respectful tone. The same respect is also required whenever a staff member is speaking with a client on the phone or in person about scheduling euthanasia for their companion animal.

Last, a condolence card signed by staff members and sent afterwards is often much appreciated by clients. Additional remembrances some practices offer are flowers and memorial gifts of various kinds. Given that companion animal loss often receives limited societal support and recognition,^2,10 the veterinary team may be the most prominent voice in supporting and acknowledging clients’ loss and grief.

Summary

Euthanasia is, unfortunately, an important aspect of being a practicing veterinarian. However, handling it with grace, dignity, and support can be one of the best gifts veterinary team members can offer clients. Keeping that in mind can make it a fulfilling part of the job as well.