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Deciding When & How To Humanely
Euthanize a Companion Animal
By Eric L. Nelson, MS, MA and Sharon Zito, DVM

Clearly distressed, tears in her eyes, Margaret said, "I still wonder if there was something else I could have done..." Margaret's feelings and questions are typical for a grieving human who has just euthanized a companion animal. Questions torment, such as "Could a different treatment have been tried?", or, "Would a different pain medication have given a few more days by providing greater comfort?" Such questions raise the possibility that the decision to euthanize was made too soon. For those who languish, this time would be less painful if there was a method to determine for certain when euthanasia should be administered.

There are many factors which contribute to such a decision. Some, such as chronic painful suffering, are clear indicators for an immediate euthanasia. Others, such as stiffness or incontinence are less clear. A system is needed which helps the human companion evaluate a pet's totality of circumstance, and then yields a clear, unambiguous answer regarding euthanasia. 

Methods

Quality Of Life... looks at the overall experience of a pet's present existence.

Pain Assessment... looks for signs of pain and suffering.

Insight... looks into the companion animal's mind, in order to find out what they want us to do.

In this article we present three methods for making a euthanasia decision. All three should be used in order to fully evaluate the pet's circumstances. None of the methods are difficult to use. Two of the methods (Quality Of Life and Pain Assessment) ask questions which correspond to numerical values. The numbers are added, and the Recommendation Table is consulted to determine if euthanasia is indicated. The third method, Insight, uses a thought experiment to look into the companion animalís mind, in order to find out what she wants done. 

The Quality Of Life Assessment is divided into seven categories of life experience such as walking and affection. As an animal ages, or as the course of a disease progresses, the quality of an animal's life experience will deteriorate. For example, a young cat can jump up onto a couch, whereas an older cat with arthritis will reach a point where he can no longer jump. 

The Quality Of Life Assessment evaluates a companion animal's decreasing quality of life. Some characteristics are, by themselves, indicators for prompt euthanasia. For example, a pet who can no longer arise without assistance, or an animal that has lost bladder or bowel control, and who urinates or defecates on herself. 

Quality Of Life Assessment

Walking

8

No longer can walk
Walks to eat, drink, or toilet only
1 Stiff, cannot run

Arising

8 Cannot get up without help
3 Arises slowly, is stiff

Eating & Drinking

8 Is not eating &/or drinking
5 Losing weight &/or dehydrated

Playfulness

Does not play anymore
1 Limited playfulness, reduced play interest

Toileting

Urinates or defecates on self
8 Painful urination or defecation on a chronic basis
Cannot hold urine or feces indoors / has accidents

Affection

Shows aggression when approached (fangs, growling)
No longer shows affection even when petted or rubbed
1 Only shows affection when laying down

Artificial Life Prolongation (ALP)

8 Is on 3+ ALP measures
5 Is on 2 ALP measures
3  Is on 1 ALP measure
____
<== Total Points

Recommendation Table
Total Points Action
1-3 Re-assess every 90 days
4-7 Re-assess every 30 days
8+ Euthanasia recommended

Many characteristics are not, by themselves, an indication for euthanasia. For example, stiffness and reduced interest in play have small numerical values. Adding the smaller values together may generate a score which is high enough to indicate the time has come to euthanize, or the score may only indicate that the pet should be re-evaluated periodically.

The Pain Assessment allows the human companion to estimate the amount of pain which a pet is experiencing. Unfortunately animals do not speak in human languages, so they cannot tell us in our language what amount of pain they are experiencing. As a result, the human companion must look for behavioral signs which are then interpreted as indicators of pain.

Pain Assessment

8 Cries or moans when moving or re-positioning
4 Avoids all but necessary activity such as eating or toileting
2 Cannot climb stairs or inclines
1 Stiffness
____ <== Total Points

Consider the example of a 14 year old German Shepherd, named Corrie. Her Quality of Life Assessment numbers were: Stiff (1), Arises slowly (3), Limited playfulness (1), for a score of 5. A score of five is not an indication for euthanasia; rather, it simply calls for re-evaluation every 30 days. 

One day Corrie began to cry when she arose from lying down. This continued for two days, so this new behavior was not a transient symptom. Using the Pain Assessment method, Corrie's score was found to be an 8. Though her score on the Quality Of Life Assessment was still a 5, the Pain Assessment score indicated that Corrie had reached the stage where euthanasia was the humane action to take.

The third method is subjective and does not generate scores which can be checked on a recommendation table. Using the Insight method the human companion answers three questions in the way the pet would respond. Doing so illuminates the pet's wishes. When we put ourselves into our animal companion's mind, we may find that they want to be released, even though we - their human companions - are not ready to let go. The desires of the pet should be honored as a final act of love and respect for them.

Insight Method

  1.  Do I want to be alive any longer?

  2.  Do I still enjoy life?

  3.  Am I ready to go?

When it is time for a beloved pet to be euthanized, typically it should be done within a day. If the animal is suffering, it should be done right away. If a veterinarian will make a house call, euthanizing your companion animal at home allows your pet to transition in a familiar environment. This reduces stress for you and your pet. 

There will never be enough time to say goodbye to a faithful best friend; however, there are activities for saying goodbye that can be meaningful (see sidebar).

Saying Good-bye

* Gather humans and animals who love the pet, for a chance to say good-bye. The humans may want to light candles and put them in a sand tray while they share a few special words or memories. Soon, the room will be illuminated by many glowing candles.

* Share a special time alone with the pet. Make a special meal, go to a favorite park, and spend time cuddling and petting. You might want to bring a camera for pictures.

There are many ways to memorialize a beloved pet, such as making a contribution to a local animal rescue organization, or building a web page with pictures of your pet.

Whether euthanasia is administered in the home or at the animal clinic, it is important that the veterinarian follow the Humane Euthanasia Protocol, which is outlined below. 

When a pet is euthanized by a veterinarian, a solution of barbiturates is injected. These chemicals stop the heart and lungs from working, and typically, an animal dies within 30-60 seconds after injection. It happens very quickly. 

One veterinary technique injects the solution directly into one of the animal's veins, with the animal fully conscious. This method does not prepare the animal with sedatives or pain killers. As a result, a substantial number of animals struggle during the procedure, thus requiring one or more veterinary technicians to forcefully restrain the animal so that the lethal injection can be administered. Often, during the struggle, it takes several attempts to place the needle into a vein. The effect of being forcefully restrained and repeatedly stuck by a needle frightens and stresses the animal during its final moments of life. 

HUMANE EUTHANASIA PROTOCOL

  1. To eliminate distress or pain, the animal is tranquilized, given analgesic, or sedated (Typical medications used are acepromazine, butorphanol, Buprenex, or morphine). 

  2.  An intravenous catheter (ICV) is secured in place in the petís forelimb and then flushed with heparinized saline. This is usually done in the treatment room by the technician.

  3. The pet is brought back to the exam room, to spend a few minutes alone with those humans and other pets in attendance. This is the quiet time when you say good-bye.

  4. The veterinarian enters the room and administers a sedative first (usually diazepam or Propoflo) immediately followed by the euthanasia solution.

There is a 100% certainty that an animal, at the time of euthanasia, will not panic or be stressed when the Humane Euthanasia Protocol is used. Accordingly, the human companion of a pet must insist that the Humane Euthanasia Protocol be followed. The fee for services will be higher because sedatives, analgesics, and an I/V catheter will be used. 

Step 1 relaxes the animal and eliminates any pain he may be feeling. After sedation the pet will be semi conscious. His eyes will likely be open, and he will want to lie down.

During Step 2 the pet is taken to the treatment room, while the human companion and other animal friends remain in the exam room. In the treatment room, technicians put in an I/V catheter, tape it into place, and then flush it with a solution to make sure it is open and functioning. After that, they bring the pet back to the exam room to be re-united with its companions.

During Step 3 the pet shares its last moments with those friends who are present. This is the time when you say good-bye. After a few minutes the veterinarian enters, and completes Step 4. 

One of the authors (Nelson) has, on two separate occasions, with two separate veterinarians, requested that the Humane Euthanasia Protocol be followed, and in both cases the veterinarians tried to use the direct technique (restraint & force with no sedatives or pain medication). Both times the veterinarian had to be reminded that only the Humane Euthanasia Protocol was going to be used. Some veterinarians prefer the direct method because it is cheaper and faster. 

How To Insure The Humane Euthanasia Protocol (HEP) Will Be Followed

  1. Give a photocopy of the HEP to the receptionist, and ask that it be put into the companion animal's chart.

  2. Request charges for the drugs and equipment used in the HEP, and pay for them in advance. Sign the necessary forms.

  3.  Ask the doctor if (s)he saw the HEP, and if (s)he will agrees to follow the HEP. Secure a promise to do so in advance. Leave if (s)he will not agree to follow the Humane Euthanasia Protocol.

The decision to euthanize a companion animal is painful, because pets bring such joy into our lives. There is, however, comfort in the fact that guidelines can be used to determine, with certainty, when the time for euthanasia has come. Further comfort can be had through the knowledge that the pet's departure was carried out in the most humane way possible. It is normal to question one's judgment regarding whether the animal could have lived longer. Using the three assessment methods can reduce decision making anxiety, and give clear indication when it is time to send a beloved pet ahead, to wait for us on the other side. 

___________________________________________

Sharon Zito owns Rosecrans Pet Hospital in San Diego, CA. She is an emergency medicine specialist, and often volunteers her time with veterinary relief organizations. Sharon lives with her husband Rick, nine dogs, seven cats, and three horses on a ranch in eastern San Diego County.

Eric Nelson has been an adjunct professor at National University since 1998. He has trained dogs semi-professionally for 10 years. Eric is also employed full time as a police officer. He lives in Northern California with Kenja (Dutch Shepherd) and Roger (Visla/Lab mix). 


If you have any questions or issues to discuss, you may contact the authors HERE 

© 2006 Eric L. Nelson, MS, MA @ Sharon Zito, DVM 

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