Recently I was in conversation with some colleagues, discussing a veterinarian’s right to choose whether they proceed with a client’s euthanasia request for their pet. It got me wondering how common it is for veterinarians to follow through with a euthanasia request, and how many will turn it down in the hopes of a different outcome for their patient. With euthanasia so final, it’s understandable that veterinarians will give pause before proceeding. But how common is it for them to say, “Not today. Let’s try something else?”

According to a 2011 study asking private-practice veterinarians their opinions on refusing euthanasia, refusing euthanasia occurred most commonly when the patient appeared too healthy (aka, not suffering to the point that euthanasia was necessary) or looked like a suitable candidate for rehoming. Reasons to proceed with euthanasia, even if the veterinarian was unsure, included the concern for the animal if euthanasia wasn’t carried out (would suffer somehow) or simply wasn’t a good candidate to live somewhere else. Euthanasia was carried out most of the time, and refusals were low overall. (1)

Veterinarians follow both a professional and personal code of ethics when considering the euthanasia of a patient, and these decisions are inherently challenging. Conflict arises when a client asks for euthanasia before the veterinarian feels it’s time. Speaking from experience, this is a tricky situation because the client is the owner of the animal and can make such a choice, whether or not I agree with it. Veterinarians must decide if they want to be the one to carry out the request. Conflict and uncertainty tend to follow cultural differences, previous experiences, available resources, and ultimately one’s beliefs over what is right and wrong. It’s no wonder euthanasia decisions are challenging. It’s hard being the “gatekeepers of death.” (2)

Based on my calculations in the US, the number of companion animals (i.e. fish to dogs to horses) facing euthanasia decisions in private practice (outside of shelters) is likely around 50,000 per day. (3) This means that veterinarians and their staff are regularly facing the question “to euthanize or not to euthanize” and trying to navigate between what they feel is best for their patient and their client, not to mention their own mental/moral health. This is especially true for emergency hospitals and end-of-life specialty services that provide euthanasia multiple times a day, where making life and death decisions feels as normal as breathing.

Veterinarians have an obligation to professionally determine if euthanasia is warranted, and if not, wait until it is time. Often the decision to euthanize or wait comes down to whose suffering is worse…the client or the patient. There is an understanding that if the client is denied their desire to euthanize their pet, they may go somewhere else and have it done. Some veterinarians may feel it is therefore best to proceed rather than put the animal through that, or that relinquishment to a shelter would be worse. These issues are part of the job.

It’s also complicated when one veterinarian on the team would euthanize and another would refuse. Standardizing the veterinary service’s “euthanasia culture” is one of the best ways to prevent internal disputes. To do this, start by asking new hires how they feel about euthanasia, what their previous experiences have been, and perhaps have them explore a case example with management. It’s wise to address beliefs and expectations around euthanasia early on.

Aligning the Veterinary Team on Euthanasia Decisions

1. Use a manual to define what types of cases are suitable for euthanasia (what is acceptable vs what is labeled as unacceptable or for convenience).
2. Ensure the staff know how to talk about euthanasia with clients, in a manner that is safe and nonjudgmental.
3. Impart a policy that says staff can, or should, speak with management before denying euthanasia, especially for new hires or those with uncertainties/concerns.
4. Provide resources and other options for continued care or relinquishment to clients denied euthanasia services for their pet.
5. Hold “euthanasia rounds” regularly to talk about euthanasia cases and increase understanding/tolerance to various outcomes.

One of the best ways to set a veterinarian up for decision-making success, especially with a new patient, is to schedule the appointment not as a euthanasia, but rather as a quality-of-life (QOL) consultation. In this way, clients are not promised something as permanent as euthanasia just because they asked for it. The veterinarian gets to assess the situation and determine what is best for their patient, without the added pressure of “I have to euthanize this animal, or I have failed.” An end-of-life consultation can have the added caveat that the client wants to euthanize, but it is not a guarantee. In other words, it’s put in the schedule as a “QOL consultation/euthanasia” instead of just a “QOL consultation” with no expectation of euthanasia.

What I hope to see in all euthanasia decision-making is critical thought given to what is in the best interests of the animal, with considerable reflection on what the client can handle if the animal continues living. Turning down clients who want to euthanize their pet can lead to outrage and negative feedback, especially for those who perform euthanasia as a regular part of their daily offerings. With attention to ethical considerations, the burden of caring for a sick or dying pet, and the best interests of the pet itself, hopefully veterinarians and clients can find the win-win-win and avoid the guilt that often surfaces during tough times like this. 

(Author note: This topic is more complex than one short blog can cover. Please continue exploring euthanasia decision-making and ethical considerations in both private veterinary practice and animal shelter settings).

1. Yeates, J. W. & Main, D. C. J. (2011) Veterinary opinions on refusing euthanasia: justifications and philosophical frameworks. Veterinary record. [Online] 168 (10), 263–263.
2. Knesl, O., Hart, B.L., Fine, A.H., Cooper, L., Patterson-Kane, E., Houlihan, K.E. and Anthony, R., 2017. Veterinarians and humane endings: when is it the right time to euthanize a companion animal? Frontiers in veterinary science, 4, p.45.
3. https://www.avma.org/resources-tools/reports-statistics/us-pet-ownership-statistics