The decision to euthanize a cat can be extremely difficult for the caregiver and the veterinary team.
Difficult Circumstances in Euthanasia:
The undecided cat owner is one of the biggest challenges we face during end of life discussions. They may feel guilt about considering euthanasia for their cat too soon, yet they don't want their cat to suffer unnecessarily by prolonging the decision. This is the ideal time to go over quality of life discussions, quality of life scales, and what makes their cat unique, as well as ask if they are seeing that uniqueness anymore. Having a compassionate discussion and coming together with a decision that removes regret will help.
+ How can we deal with convenience euthanasia where the veterinarian feels the cat can be rescued and rehomed?
It is not in the best interest of the patient and the veterinary profession to perpetuate an image of itself as willing to kill a companion animal ‘on demand.’ The veterinarian should respond to these situations by reminding the client that their cat is a valuable member of the family, deserving respect, love, and medical care. It is important to remember that the veterinarian must remain the patient advocate when a healthy, well-behaved cat is presented for ‘on-demand’ (convenience) euthanasia. If all reasonable alternatives have been presented and discussed with the client, the veterinarian is encouraged to follow their own moral and ethical code in determining the course of action. Developing a relationship with a no-kill animal shelter may help to offer support and foster solutions in these circumstances.
Ethical decision making is subjective and personal which can cause stress for the veterinary team. A veterinary working group has created a tool called the Veterinary Ethics Tool (VET) to assist in ethical decision making. More information can be found under Further Reading.
+ What can you do when the loss the family is going through is a cat that belonged to a deceased family member?
When the cat’s primary family member is deceased, the loss of the cat may take an extra toll on the family. It is a living link to that lost family member and holds a valuable emotional place with the family. Honoring the bond that the cat had with the deceased person is vital but also the bond that holds with the remaining family. They may request more mementos than usual or even more time to say goodbye. Acknowledging this is the first step, and giving them the ability to memorialize the cat how they wish is imperative.
+ Should other animals in the home be present for the euthanasia or see the deceased cat one last time?
A study by the American Society for the Prevention of Cruelty to Animals did show that many cats exhibited decreased appetite, prolonged periods of sleep, and increased vocalization after the death of a companion. Allowing housemates to see and smell the body may be beneficial in helping them with closure. It is also important to understand that each animal is different in how they view a housemate that has passed. Some cats may hiss at the deceased pet, act indifferent, or they may sulk for days. It is important the caregivers understand that the surviving animals may not exhibit the same level of grief that they are exhibiting, and that is okay.
Oftentimes, there will be a family member that would like to be present but cannot. Using technology can help tremendously. Using Facetime, Skype, or other video platforms can make the family member feel included. Also, offering to hold the cat's body at your practice, or making special arrangements with the crematory so they can view the body upon their return, can also help with their grief.
It has been said that people will undergo more grief if they never get to say "I love you" before a loss. This sudden loss is unexpected, and the family will not have had time to process or begin to prepare emotionally. This is the case in emergency euthanasia or death. Encouraging the owner to focus on memorializing their cat can help them through this additional grief. Go over all the ways they showed their cat that they loved them before they passed, how well they cared for them, and reminisce about all the stories they shared with you. Encourage the story sharing by asking open ending questions. Allowing them to view the body at your practice or at the crematory can be helpful with closure for some families.
+ What do I tell a caregiver if they decide to euthanize the cat for a behavioral issue that I believe can be treated or overcome?
Behavioral issues can be a huge struggle for a family to manage. It is vital to try and understand what they are going through in the home. That will first give you a good path on how best to approach the case. If their emotional budget is tapped out and their bond is broken, there are probably no treatment options that you can offer to repair that, and euthanasia may still be elected. What you also may find is that the family thinks you are judging them and never return. The best approach is to empathize with the issue and the struggles they face at home, relay that you support their decision to euthanize if they still want to, and then discuss the treatment options. For example: “I know how difficult this behavior is to manage and live within your home. I support your decision to euthanize today. I do just want to offer one suggestion so that no one has any regrets for not considering all options. Many cats have had successful results with XYZ treatment, and I just wanted to let you know about it before we make a final decision.” By letting the family know that you will support their decision to euthanize, their guard may be lowered, and they may be more open to hearing about the other option. Showing support for their decision also removes the feeling of guilt they may have if you do not.
+ How do I explain to caregivers who don't believe in euthanasia (and/or want their cat to die at home) how that decision will impact their cat's quality of life?
We are fortunate as veterinarians to be able to provide a peaceful death for our patients so they do not have to suffer to the very end. Many caregivers feel that letting a pet die at home will be a more peaceful end to their life than having them euthanized. It is very important that we assist these clients to understand that helping these cats through a good death is just as important as what they did to ensure a wonderful life. Explain that a natural death is not always a peaceful process and there exists a possibility that their cat can experience tremendous suffering and a diminished quality of life without euthanasia.
If an owner is still committed to have their cat pass on their own, the veterinarian can help the owner find an end-of-life practitioner that can help arrange for a veterinarian-assisted natural death. Education about comfort care can be provided, as well as prescription medications focusing on the pet's comfort.
About half of euthanasia appointments are made within 24 hours of needing the service. This may not allow for your practice to prepare or have the most ideal appointment times. Be as flexible as possible and do not judge the caregiver for "waiting until the last minute" – it is the hardest decision for a caregiver to make, and one that often comes last minute. It is important to have an established protocol for last-minute appointments. Having your procedures, including the euthanasia experience, well-planned can make these urgent appointments easier.
It is perfectly fine to cry during euthanasia and show families that you have empathy for their loss. Expressing condolences is not only appropriate but encouraged. But make them heartfelt and more than just "I’m so sorry for your loss." Instead, something more sincere like, “How lucky (Mingo) was to be loved so much. I am sure her loss will be hard – I am here if you need anything.”
Calling the families to check in on them is a wonderful sign of compassion, and you may be able to help them with their grief. Do not avoid this call for fear of opening wounds. Most likely, you will get a voicemail and can say, "This is Mary from Pet Vet Animal Hospital just calling to say I am thinking about you today. Please know that we are here for you if you need anything."
Protecting the Caregiver’s Mental Health:
Being non-judgmental is important during the end of life process. The impact of losing a pet on individuals or families must not be underestimated. Be supportive, compassionate, and proactive if the caregiver needs assistance with their grief. A caregiver may even begin to experience anticipatory grief once the difficult decision is made. It is important to recognize this is a normal process that comes with emotional changes associated with death, and to proactively support the families through this process. Having information for pet loss resources and actively providing them to all families is recommended. Many may be too embarrassed to ask for resources themselves but can benefit greatly from them.
Being compassionate, as well as confident, when explaining the process should ease the mind of the family. Make sure the answers are delivered by the best person. For example, if a family has detailed questions about sedation, then you may suggest a phone call with the veterinarian. If they want specific details about where the cat’s ashes will be scattered, then the front office team member should be able answer that question. What you need to avoid is misinformation or confusion. It is best for all members of the practice team to be knowledgeable about the entire process.
Children can learn valuable lessons about compassion, commitment, and responsibility when they are involved in the decision to euthanize their cat. Being honest with the children about how sick the cat is will also be much easier on both the parents and the children after the cat has been euthanized. Having the child present is a decision that is best determined by the parents. It is extremely important that the child is prepared ahead of time on what to expect if they are present. Children should at least have the opportunity to say goodbye before the cat is euthanized. Avoiding the use of phrases such as "putting their cat to sleep" can help minimize anxiety and stress about bedtime, especially in younger children. Showing sadness and grief in front of the children also teaches them that it is okay to cry. Encourage the sharing of positive, happy memories about their cat.
+ How can I avoid the caregiver associating the veterinarian and practice with their cat’s death and not wanting to come back?
The best thing you can do is to provide a smooth, calming, and compassionate experience that honors the life of the cat, and ensure that the cat is not able to feel any pain. Understand that everyone deals with loss in their own unique way. If you follow the tips in this Toolkit regarding the euthanasia process, environment, and final arrangements, you can apply best practices to your own processes. Do not forget that outreach to the family can help them feel support from the practice by demonstrating compassion and respecting the human-animal bond.
Many families will get a new pet before the first one has passed or soon after. There should never be any guilt placed upon that owner from anyone on the team. Getting a new pet is not about replacing the other pet but about filling the deep hole that the first one dug and providing another pet with a good home to live in.
Protecting the Veterinary Professional’s Mental Health:
As veterinarians, we want to cure, treat, save, and protect pets from suffering. Euthanasia is not normally on the list of things we ‘want’ to do, but it is a necessary service we do provide. Performing euthanasia can be taxing on the soul and cause emotional distress. This usually comes from the euthanasia that we feel are not warranted or where there is a chance for a cure or treatment for the cat. It is important to remember that not everyone has the same monetary, physical, emotional, or practical capacities to manage a sick or older cat. What we would do as a veterinary professional is not always what the general public would do. When faced with euthanasia that you struggle with, try to avoid judgment as it only adds an emotional tax that is not needed. Instead of focusing on why we have to euthanize, focus on how we can do it well. This Toolkit will provide you with some tips on best practices to perform the euthanasia. If you are able to relieve a cat’s anxiety or suffering during the euthanasia, that may relieve you of some of the mental exhaustion that could accompany it.
Venous access is the most common way euthanasia solution is delivered, but all the other routes noted in this Toolkit are very easy to achieve, and some are preferred by many veterinarians for cats. The team should be educated and prepared for the use of all routes of euthanasia administration.
Many cats with high levels of pain or those in respiratory distress will require more sedation to achieve a calm plane. If you are unable to achieve a sufficient plane of anesthesia, then you must only use the IV technique.
If you find yourself in a situation without enough euthanasia solution available, you should refer the cat to a practice that does. Learn and understand your local laws about borrowing euthanasia solution from a local veterinary practice as it varies from state to state. More information can be found in the AVMA Guidelines for the Euthanasia of Animals.
© American Association of Feline Practitioners, 2021