Euthanasia

Veterinarians and society may be starting to talk more openly about euthanasia. A dark difficult subject at best, it is fraught with the intense emotions of guilt and grief.

Euthanasia is the terminal event of most pet’s lives. Veterinarians claim to be “privileged” that they are “allowed” to do this. The act of euthanasia colours and distorts a veterinarian’s life, adding conflict to healing and life “at all costs”.

A 2015 veterinary presentation on the subject made the claim that euthanasia is not intended to kill – it is intended to end suffering and that death is the unfortunate unintended consequence of this.

This is indeed a weird mental pussyfoot around what we do as humans and as veterinarians. The human term for euthanasia is assisted dying. Death is most certainly intended as the final outcome. That is what is implicitly understood by both terms – we are killing to end suffering is the accepted justification.

Growing up with the constant admonition that Thou Shalt Not Kill may promote our guilt about what we really do as humans to survive, and what is absolutely prevalent in the natural world. I am not saying, run around and kill everything ad lib. But killing is a part of daily life. If you don’t think so, then you are very unaware of where your food comes from.

Socially, I think we have come a long way in reducing violence and unnecessary killing in the world. But we still have to rationalise our way through certain human actions.

Euthanasia is certainly intended to kill. Death is the desired outcome of euthanasia. It always was, and that is why it is such a touchy subject. Death is final. The life is gone and all that is left is grief.

We now openly recognise death should not be an unnecessary or even arbitrary event. The decision to kill is not light. Every life is precious. Veterinarians have moved on from the somewhat callous euthanasia events, now declining what we call “convenience” euthanasia, and only wanting to do euthanasia to end suffering. As pet owners and veterinarians, we are talking about what is suffering, and what really does constitute quality of life and how to make those judgement calls. We are now advocating that we do not extend suffering by performing medical or surgical intervention procedures that may not improve outcome in sick patients.

This is big improvement. Sixteen years ago, nobody was talking. Euthanasia, and the distress we feel around it, was almost a taboo subject. The unspoken, unaddressed grief and mental distress causes much suffering in itself, a major reason for the high depression and suicide rate within the profession; and probably the most stated reason for leaving the profession at that time. Now we are beginning to openly talk about “compassion fatigue”, of which euthanasia is only one contributing factor.

Convenience euthanasia used to be more common. This was the act of euthanasia, death intended, done because the animal was no longer wanted for a multitude of reasons. This started changing with society, when both animal shelters and veterinarians started voicing their distress. I used to tell people that I did not go to vet school just to kill animals.

The toll euthanasia takes on the people doing it is huge. Many clients will voice this – “This must be the hardest part of your job!” Yes, it is, actually. Whilst I say killing is a part of life, killing is never a pleasant act. It is done out of absolute necessity. How we define that necessity is part of our mental conundrum when we are faced with having to kill. Thus we have a plethora of spiritual, rational and irrational arguments around the subject. To end suffering is the most common veterinary justification, and one that appears to be emotionally and ethically acceptable to almost everyone. Humans can choose to die, but we make that choice for animals under our care.

This justification debate still rages in the human medical world – it must. The medical profession is aware of what happened in veterinary medicine, and must do all it can to prevent “convenience” euthanasia becoming a terminal event of a human life. The veterinary profession certainly showed how easy the mental traps were to make this justification! So whilst many people may consider that euthanasia should be an option for people too, we need to be discussing with an open mind the emotions surrounding this whole subject and what are reasonable controls and decision-making tools surrounding the euthanasia decision. Currently, only a few countries in the world are brave enough to be doing this.

Euthanasia intentionally causes death. The aim of euthanasia is a “good death”. What is a good death, then? Most would agree it is painless, stress-free and peaceful; a gentle slip away into oblivion surrounded by loved ones; preferably at home.

When I give that injection, I take a life. The entire day will have been coloured by the decision and the knowledge of what will be happening. I am already grieving and depressed when I give the pre-sedation. There is no going back after that pre-sedation. Watching the cat sink into the sleep is heart-breaking. All that I hope for is that it is rapid, and does not draw out into a woozy drug fight, that this will be a good death.” True compassion”, says Death,” is a sharp blade.” (Terry Pratchett). To achieve that, euthanasia is a skill practiced and honed and adapted for constant improvement on a daily basis.

As the barbiturate IV starts, I have to empty my mind, and accept the leaving life. You can feel the life leave, and there can be nothing more distressing than if it was not peaceful and gentle. The sense of finality is draining. Doing this almost every day leaves me living in a cloud of grief. All the veterinary staff experience this. There is no sadder event. Each time, I will be a little changed, altered. Almost like it is possible to lose a little of yourself; to tend towards a crueler, more callous person; to become inured to what is actually happening. It is important that death and the killing do not become routine, to keep each event unique, that each life has to be honored and cared for.

There is probably not a single veterinarian that went to vet school who is not a caring, sensitive and compassionate individual. This is a tough profession to be in, warts and prickles are inevitable. We are asked to accept the cognitive dissonances of factory farming, slaughter, doing everything we can to save a life, and euthanasia.

We can be talking more about how we feel, listening more to the owners about their euthanasia experiences, and teaching solid coping skills to our colleagues. Frank and open discussions with everyone about euthanasia, including our human medical colleagues, and in particular, what it feels like to be the killer, may help guide us into better procedures, ease the grief, provide better coping mechanisms and support groups, and guide us through the quagmire of ethics behind human and animal euthanasia.

Exploring societal attitudes to euthanasia, within cultures, during wartime, and how much (if at all) we have changed, may be a fascinating if dark topic.

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