Thursday, January 5, 2017

Euthanasia. Why do we make it so convenient?

Let's boil it down to the simple one sentence conclusion: Life isn't easy, it isn't fair, and it shouldn't be convenient.

Don't we all agree on that?

I am at the point in my veterinary career where easy is not my primary job compulsion. To make it easy in some way seems to be diminishing the importance of that life. The reflection of what their time meant. The transient nature of a disposable, replaceable piece of property. There is beauty in all things, saying goodbye, watching life move to another place, and the peace of being in the last chapter included. We have tools to help with pain, and suffering but removing them because they are unpleasant seems a bit like cheating their value to the beauty of life's magnificent moments.

No doubt my most uncomfortable and difficult moments reside in assessment of "quality of life". I scrutinize every euthanasia appointment and debate whether this is appropriate and necessary. It is not what some clients want to hear. They expect I am there to comply without question or discussion. (So much for the healing hands BS you thought your life represented in that stupid white coat of compromise?)

There is this growing segment of our profession for in-home euthanasia veterinarians. I understand why so many have chosen this as their way to avoid the stress and pain of general practice. The old joke that vets receive the nicest cards, comments and adoration from our clients is when we euthanize their pets. How sad is that? They like us the most when we are the hands of death?

People euthanize their pets for a huge number of reasons. Granted the overwhelming number of people who seek in home euthanasia veterinarians are looking for a quiet peaceful way to bid their beloved pet a final farewell. We have painted this picture of these hospice angels who are a phone call away to help end suffering as harbingers of the best of our professional compassion. We also paint analogies between ourselves, the all compassionate vets, and our human counterparts who watch and prolong suffering because they are powerless to call it as it is and end human life humanely. We cannot, nor should not, make such parallels. Although the love is consistent in all of these relationship scenarios, pets are, and remain, at the mercy of society's classification that they are property. Any human being can walk into any veterinary practice or shelter and relinquish their pet. If this is a cat they will most likely be euthanized immediately. If this is a dog there is a chance, a small chance, they will not be killed and perhaps given a second chance with another family. We live in a consumer driven, quick, convenient, disposable world.

We are a profession of dichotomies. We do not practice what we preach and we do not support what we condone. We advise routinely that clients spend thousands of dollars on care and provide economic euthanasia when they cannot afford us. We have to decide who we are and stand as a profession behind the care we recommend from start to finish. It is time to start asking the hard questions, debating the grey area, and supporting each other simply because we all share a love for pets as a part of the family.

How does a vet handle this? We all handle it differently. Most are left to feel that if the owner won't provide care and support they should not feel guilty or obligated to do so themselves. In my opinion it is the biggest fracture in a vets ability to live at peace with themselves and one of the biggest reasons our suicide rate is so astronomical.

How can we compare ourselves to the medical profession if we can seek, and feel most appreciated by euthanasia?

These are open questions for me.

I know day to day general practice is demanding. It is stressful, anxiety-ridden, and fraught with having to always make sure your ass is covered and your client is happy. Euthanasia is free from all of this. Why is that? Well, sadly because as much as we advocate, commercialize and promote the notion of being "the other family doctor" we are not. We have no protocols, criteria, or restrictions on which cases are euthanized and by what criteria. This is a far cry from what our human counterparts have to adhere to. In a few states around the USA people can seek assistance to end their own lives. The stipulations and guidelines for this to be permitted require at least three doctors be in agreement and that the patient is coherent to understand their own disease and prognosis. A waiting period for permission to get access to the life ending medications is also required. In short it is never a quick, easy, or independent process.

Why so do we then promote one phone call to permit it on the veterinary side? Because pets are property. And we all know that the peaceful passage with a veterinarians assistance is better than the backyard and a bullet. Hard to make an argument when reality and a millennia are your precedence.

I don't spend much time in the delivery room, insemination collection or distribution arena anymore. It is not where I find a sense of purpose. The world of breeders has shifted to the pages of Craig's List, backyards, and tax aversion employment. The established breeders are increasingly doing more on their own, in their own breeder selected veterinary clinics. All of those that I know of are high volume, low price assembly lines. My time and focus has shifted to the middle and endings of the life spectrum.

While I would not be so bold to say that I am not a hypocrite I understand the desire to have my dear beloved pets laid to rest peacefully and quietly at my home. For every dying soul in my family they have met their light in my arms on the floor of our home with just myself and my husband bawling our eyes out, blurred in my ability to find a vein and delivery our goodbye. I too don't want them to be carted off  in our car to sit waiting for the vet to see us in our darkest and final hours. I embrace the empathy in this.

Where I have a very hard time providing a blessing is in the lack of professional courtesy between the lifelong general practitioner and the euthanasia practitioner. As the field of available on call euthanasia vets grows there has still yet to be one phone call, one request for medical records, or one questioning of whether there might be some palliative therapy, some provision of hospice, and some assistance to not make death easy and abrupt.

Why is it our mission to make life easy? Free from feeling? Why are we shortchanging our patients lives with a feeling of pride that we provide convenient options for end of life decisions?

As I add another notch of another year of practice to my veterinary belt I am changing my viewpoints on life, death, and my role in the continuum of these in the veterinary spectrum.

Life isn't easy, it isn't fair, and it shouldn't be convenient.

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  1. Thank you for the post and the hard look on euthanasia.

    I've found that a lot of people wait to take their pets to the vet until the animal is unable to stand, soiling itself, refusing to eat, etc. I find myself wishing that they had come in sooner so I could have done something, at least palliatively, so the animal didn't have to suffer to its final day. So we tend to euthanize the same day we see the failing animal because it is suffering so much. How can we encourage people to come in earlier when we might be able to ease the pain and maintain quality of life longer? Is it a cost thing? Or do they think we will euthanize right away and aren't aware of the other options, so they delay to have a few more days with their pet?

    Of course, there is also the case of convenient euthanasia for behavioural problems. I'm afraid of what will happen to the cat or dog if I refuse to euthanize. What options do I have?

    1. Hello,
      Many thanks for reading, and for leaving a comment!
      I have struggled with these questions my entire practicing life. I have written about them often. What I have done is decided that I will offer options I believe are in the best interest of my patient. I will put them first. I will only do what I feel comfortable with and I will not sell my soul in tiny pieces to provide an easy ending to an inconvenient life. I have lost clients, made some tough decisions and even been reminded by the state board on more than one occasion that "euthanasia IS a treatment option" to which I politely remind them that I respectfully disagree. I have made allegiances with local rescues to take custody when I believe a patient is treatable. I do it with a full acceptance of financial and emotional responsibility. It is not easy but I have built a practice of healthy amd happy staff and devoted clients who step up to help every time I ask. I had grave doubts it would or could work but the only other option was to leave general practice. So I made it work. I continue to make it work. I offer options I make myself accessible and we treat life and death as a team. Or they can pick up and drive 0.2 miles away for a drive through euthanasia clinic down the road.
      I hope that you feel a bit more empowered that there are always options. Always.

  2. Thank you for sharing. I was experience the pet hospice care to my beloved Tagger when his vet told us that even he will undergo operation, he will still suffer the pain. We can't see him suffering and living in pain. Even if it's hurt to admit that we will end here, I know this time this is the best way to do, to give him a peaceful sleep. Till we see other again Tagger!