A Euthanasia Protocol Including End of Life Conversations

Veterinarians are one of the very few healthcare professions that are licensed to euthanize, which is an incredible privilege and responsibility to manage. 

However, end of life conversations including euthanasia can be challenging. It is a topic that is never taught at University and the majority of graduates, over 75%, have never performed a euthanasia prior to starting work.

For pet owners facing advanced illness, quality of life is largely determined through conversations with their veterinary team. However, these conversations can be challenging and emotionally charged, making it difficult to manage and putting the patients remaining life at risk. Studies show that health professionals may avoid end-of-life or difficult conversations for a number of reasons including the fear of causing pain, the lack of knowledge in delivering bad news, or the anticipation of client disagreement. 

As the relationship between their pets and their families continues to strengthen, pet owners experience a more intense grieving process and higher expectations when it comes to saying goodbye to their companions. It is the veterinary team’s responsibility to give families the best memory possible of their pet’s end of life experience and prevent any thoughts of guilt that many clients are burdened with.

The Stages of the Euthanasia Procedure

There are essentially 8 stages to the euthanasia procedure.

STAGE 1. The End-of-Life Conversation

Acceptance of euthanasia

Don’t let the client be the first to suggest euthanasia. They can feel a great sense of guilt for bringing it up too early or giving up too soon. Even if they are not ready to consider this option, it gives them peace of mind for when they are ready to give it thought.

Sharing client communications on quality of life and what to expect with euthanasia will give them information they need to make the right decision for their pet.

Planning the euthanasia

Once the client has made the decision to euthanize, the veterinarian should decide whether the pet requires sedation and advise the client. This should not be a client decision.

Ask whether they would like to be present, if so, consider:

• Bringing in a treat for the pet
• Bringing in their favourite toy or blanket
  

Use positive statements such as “it is a peaceful process” or “your pet will be at peace”. Try not to use negative comments such as “she won’t be in pain anymore” or “it won’t hurt her”.

Consider euthanasia at home or in the car if the pet is not easily transported or too large.

STAGE 2. Scheduling the Euthanasia

1. Show empathy
2. Acknowledge the decision as the best thing for the pet
3. Don't be scared to show emotion - it shows that you care
4. Use words such as “I’m so sorry you’re having to go through this”
5. Explain options to the client - private cremation, communal cremation, home burial

It’s a very emotional time and decision making is difficult not to mention taking in everything you say - share online forms that help clients make the right decisions in the comfort of them home e.g. do they want to stay for the procedure, do they want to keep the pet’s collar, how do they want the pet disposed
Share handouts on what to expect with euthanasia, cremation and how to bury your pet at home (always get them to check local council requirements).

Explain the costs of these options and that payment is easier when upfront, prior to the appointment or over the phone in advance.

STAGE 3. The Euthanasia Appointment

Have the paperwork signed and completed.

Check over the euthanasia form with regard to the pet owner’s requests ie. will they stay, do they want to keep the pet’s collar, will the pet be cremated

If the client wishes to bury the pet at home, discuss the local regulations on doing so and be prepared to offer the client a cardboard box as a coffin or a burial bag.

Put the client into the room as soon as they arrive.

Post a professional sign or some type of flag system to make everyone aware that a family is saying good bye to their pet or that a euthanasia is taking place.

Room set up

• Consider a blanket on the table or on the ground
• Play soft background music 
• Lights a candle
• Have a basket with tissues, a mirror and a container for hair clippings

Re-explain the process and ask for questions

The injection is an overdose of anesthesia which will help the pet go to sleep and not wake up again. Prepare them for things such as the eyes will remain open, the bladder and bowels may relax and that there may be some muscle twitching and last breaths. 

Time alone with pet before procedure

Pet owners may want their last time with their pet to say goodbye. Ask if they would like you to leave the room during this time.

STAGE 4: The Procedure

Sedation can be administered and allows the pet owner to adjust to their pet going to sleep. Give the client 5-15 minutes to spend with their pet alone while the sedative takes effect.
Upon return, let the owner know that you will administer the final mediation and that the pet will pass within 30-60 seconds. Recommending the pet owner still talk to the pet and that they can hear them is a good way to keep their focus off you and on their pet.
Listen to the pet’s heart, remain silent and then confirm the death with a statement “She has passed”.
Watch for agonal breathing or twitching which can happen within 1-5 minutes of death. Comfort the client if they become distressed e.g. “this is just a spasm of the diaphragm. It is normal.” “the twitching is a sign of the body shutting down” 

Offer the client private time after the pet has passed and ask them to open the door slightly or give them a wireless doorbell to let your team know that you are ready to depart.

General client feedback

• They do not like their pet taken out of the room

• The clinic/hospital is a cold/sterile environment and not the nicest last resting place

• Appointments are always rushed

• The procedure happens too fast and they feel they have to leave quickly

• They left my pet’s body alone in the room

• Will my pet’s body be put into a garbage bag

STAGE 5. Memorial Items

Paw print

There is growing interest in the paw print. Using air dry clay e.g. Crayola Model Magic, is an easy and caring gesture to offer clients. 

As the grief washes over the client and they make eye contact with you, ask them if they would like a paw impression. Send them home with it and give them instructions on how to store it while it hardens.

Pet’s collar or leash

Offer a vet clinic bag or box with the collar and leash neatly wrapped in it.

Locket of fur

Craft stores offer cute boxes that you can place fur clippings into.

Photo for the clinic

Ask the client to email through a photo of their pet to add to your pet photo wall.

STAGE 6: Pet Loss Support

Grief is normal and very different for each individual. For some pet owners, the death of the pet is the most painful loss they will ever experience. Grief comes in many forms - sadness, anger, loneliness and guilt. It is important that you offer clients resources to cope with this grief. These can be digital brochures, local support groups or grief counselor details.

STAGE 7. Pet Body Care

When the client is ready to leave, respectfully remove the body in a blanket and in a way that no other client should see. Never use a body bag until the body is being placed into the cooler.

STAGE 8. Following Up

Sympathy cards, witten or digital, are a nice way to show support to the client. Owners greatly appreciate their vet team’s love for their pet. 

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