Recently I was asked to aid in the passing of a sweet old dog owned by members of the deaf community. This family scheduled the appointment through my online web portal, and even though we communicated via email and a translated phone call beforehand, I found myself ill-prepared to fully support them during the death of this dog, to my standards anyway.  The euthanasia experience was beautiful but I couldn’t help feeling afterwards that I should’ve done more to prepare, in particular to find ways for this family to share joyful life stories and how I could better relay what was happening during death itself.  I found myself wishing I could sign  words like welcome, comfort, privacy, sleep, death, heart, normal, beautiful, and thank you. And while we could not fully express what we wanted to say, love did carry us through.

About a week after the appointment, I hosted a Companion Animal Euthanasia Training Academy (CAETA) EuBoosters session through Facebook (these are offered monthly).  The topic of helping the deaf community through euthanasia turned out to be a popular one.  Many veterinary professionals have discussed how to communicate more effectively with the hearing-impaired in general, but it turns out not much has been written or discussed about the euthanasia appointment.  We took this opportunity to share ideas and gain skills for future euthanasia work.  

Here are some ideas to ponder in preparation for your own euthanasia patients and their deaf loved ones. The topic is so big, CAETA is making this a 2-part series. Part one will focus on pre-planning and communication strategies.  Part two will highlight the importance of choosing the right drugs when hearing-impaired clients are present, and how to describe death itself.

Pre-conversations and Determining What’s Important 
Before the appointment, veterinary teams will want to ask about previous euthanasia experiences. This indicates some level of familiarity with appointment logistics, or lack thereof to work off.  Of course each euthanasia experience is still unique and veterinary teams will want to inform on what to expect. Next would be to ask about the client’s appointment goals, such as where they want to gather (home/hospital, inside/outside), what special touches they want (pet bedding, toys, favorite foods, ceremony or rituals), aftercare arrangements, and who they want to be there (extended family/friends, other pets).  Next it will be your turn to ask questions in preparation for the procedure itself.  During my last appointment, I’d wished I’d already learned if the pet was painful anywhere and more about her temperament because this proved challenging to capture through dry erase board communication.  Was she receptive to new people and new environments? After gathering information, the veterinary staff can inform on arrival details, room setup, and details about the procedure itself to reduce the guesswork when the appointment begins. Payment can also be handled ahead of time. And in closing the pre-conversation, it’s a chance to open the floor to learn about the pet and the relationship to the family.  Give space to share stories, especially if it’s a new patient.  “We’d love to learn more about Daisy and your relationship together. Please feel free to share some of your favorite stories with us.”

Here is an example of a pre-visit Deaf Client Pre-Euthanasia Questionnaire

Staff Preparedness
It varies among veterinary services how many personnel will be involved with a given euthanasia.  CAETA advocates for use of a Euthanasia Attendant that can be specially trained to support those with special needs. Regardless of which staff member is engaging with deaf clients, they can have all the supplies ready in the room for use.  This reduces the need to excuse themselves to go get things. Medical supplies including necessary drugs, plus tissues, water, and potty pads/towels can all be in place.  Comfort rooms also include soft elements like images of nature, pillows, and blankets.  The staff can also have all communication aids ready. And my personal favorite is when the staff can take a moment to mentally prepare to receive the family for this most sacred event.  They quiet themselves. Relaxed people tend to move more slowly, which is perfect for any euthanasia but especially with the hearing-impaired.

Greeting and Establishing Rapport
Good body language includes soft smiles and good eye contact as a part of the greeting. This conveys non-verbal empathy which is exactly what the deaf need.  You can take deep sighs to demonstrate relaxation and move slowly in a non-clinical or rushed manner. Attention should be given to the client’s movements and their non-verbal cues too.  A nice gentle gesture of hello and welcome will help to establish rapport and build trust together. Offering compliments is another way to establish rapport.  Everyone loves praise.  You can compliment the beauty of the pet, praise how well they’ve been taken care of, and give thanks for allowing you to support them today.

Communication
Some of you may already know a few American Sign Language (ASL) words, others fluent or none at all.  There are digital ASL translator apps to ease communication. I’m starting to learn more about these and like what they offer. Non-digital means include dry erase boards (what I used) and pen/paper.  What I found useful was to pause for just a moment before writing and really think about what had to be said.  Editing is everything.  CAETA has always advocated to say only what really needs to be said to grieving clients, and this has never been more true than with the hearing-impaired.  If your team does have someone ASL trained, perfect.  Get them in the room and keep them there. In the meantime, here is a useful site to teach basic words.

The 14 Essential Components of Companion Animal Euthanasia all hold true.  Each one can still be included, with many of them pre-discussed before the appointment begins. In Part Two of our series on support for deaf owners during pet euthanasia, we will learn how to describe the medical act of euthanasia, plus determine which drugs lead to a smoother patient death, thus reducing the need to inform on active signs of dying. In closing of Part One, I want to thank this family for providing an opportunity to reflect on what’s best with the hearing-impaired.  In the past, other families have come to me with translators or with a moderate ability to verbally communicate. This time, the entire appointment was quiet, and it was so special.