It’s the season of graduation for thousands of newly-minted veterinarians. This blog is for you graduates as you prepare to care for dying patients. It can feel scary to navigate end-of-life conversations and facilitate a gentle death. Let’s take what you’ve learned in school and reflect on what clients and pet patients need during such a delicate and sensitive time.

Early in my veterinary career, it became clear that my role with clients was going to be equal parts counselor and medical director. Clients often invite us deep into their story to support them while they care for their pets, especially as the pet approaches the end of its life. They need to.  What it takes to both love and provide for a pet can feel monumental. Over the years, I have found client support to be my favorite part of the work. As I honed my communication skills, as you will too, my appreciation for the depth of comfort veterinarians can provide is profound.  Every appointment is an opportunity to strengthen trust, to practice with authenticity and integrity, and elevate a client’s perception of our profession. Veterinarians are held in high regard by the pet-loving community not only for our ability to heal and protect, but for our capacity to love and guide all who seek our help.  

Good communication will be at the heart of your work. To support the dying, we rely on empathy and understanding. Gone are the days of paternal communication, where a client is only told what to do and how to do it. We practice in a time when a sincere exchange of thoughts and opinions on both sides establishes better delivery of care. As practitioners, we will focus on learning the full story, gain an appreciation of inherent challenges to our recommendations, and modify any and all treatments to align with what’s truly possible. Patient care is a marriage of good communication, counseling, and medical acumen.

When it comes to difficult, emotional conversations around the end of a patient’s life, you will be called to assist clients in perhaps their darkest hour. This is a huge responsibility that can be filled with uncertainty. During these interactions, it’s important to slow down, take some deep breaths, and let your natural abilities rise to the surface. Follow the old rule of treating others the way you want to be treated. Think about what you would need if you were the client and the dying pet was yours. We want to do all we can to support the bereaved, but it is beyond our capability to fix their pain and sadness. Dr. Alan Wolfelt, a noted bereavement expert, recommends this simple approach: “Mouth closed, ears open, and presence available.”(1) It is one of the best means of consoling clients.

A veterinarian’s job is to use whatever means necessary to relieve suffering, and this includes the delicate task of euthanasia. While often looked at as a failure when cure or palliation is unobtainable, I see it differently. What a kind gesture we can make to ensure no further struggle remains. Dr. Frank McMillan, veterinarian and philosopher, remarked, “When it comes to the sick and injured, euthanasia is not an act to end a life. This is not its purpose, and not the outcome we are striving to achieve. Euthanasia is an act to end discomfort. Death is the unfortunate, unavoidable, and unintentional effect of achieving this goal.”(2) I find this sentiment very profound and have shared it numerous times with my clients to reassure them. It is an agonizing task for a client to choose to end the life of a beloved friend. Our responsibility is to lessen this burden by delivering the most gentle and peaceful death possible.

An artful delivery of pet euthanasia does best with the right ingredients. The appointment goes much smoother when you’ve readied your emotional and physical self. Here are the fundamental steps I use to ease my clients’ hearts while strengthening my euthanasia work:

1. Relax your mind and body through deep, slow breathing. Let all tension go.
2. Focus on the power of the human-animal bond.
3. Build rapport with the client and your pet patient.
4. Take time to listen to their stories. Embrace your communication skills.
5. Deliver a technically strong euthanasia.

There will come a time when your client feels the time is right for euthanasia but you do not.  Sometimes you will advocate for it and your client resists. Have patience. Seek to find common ground and educate them on all possible outcomes. Regardless of said outcome, focus your energy on the dutiful steps you took to support them, not the outcome itself. This is paramount if we are to live in a state of “compassion satisfaction” rather than “compassion fatigue.”(3)  Remember that ending the life of an animal is heavy with complexities. Go easy on yourself. Know your limits and stick to them. Stay true to who you are.

You may find end-of-life work speaks to you. Up until the mid-2010s, it was almost unheard of that a newly minted veterinarian would devote their career to animal hospice or euthanasia-centric work. How fortunate we are to have such resources available to us that allow for this kind of specialty. If you find partnering with clients and patients during a time of transition appeals to you, explore it. One of the most endearing things about veterinary medicine is all of the opportunities awaiting you. Upon graduating veterinary school, I envisioned myself in traditional general practice; instead, I found a calling to support grieving and bereaved clients while providing the smoothest death I could for my patients.

Every one of our patients will have an end-of-life journey, therefore all of us will need to be stewards of death at some point. It is an honor to help a family say goodbye to a beloved companion. It is the last chapter in hopefully a long and meaningful life. Remember that all your clients, patients, and colleagues expect of you is to be kind, employ your knowledge, and guide with compassion. Whenever in doubt during pet euthanasia appointments, ask yourself, “What’s the most loving thing I can do right now?”

References

1. Wolfelt, A. When Your Pet Dies; A guide to mourning, remembering, and healing.  2004. Companion Press, Fort Collins, CO. 

2. McMillan, F.  Rethinking Euthanasia: death as an unintentional outcome. JAVMA Nov 2001, Vol. 219, No. 9, Pages 1204-1206

3. https://caetainternational.com/utilizing-euthanasia-to-reduce-compassion-fatigue/.  Accessed February 14, 2024