The Companion Animal Euthanasia Training Academy (CAETA) invites you to consider the following fictional euthanasia case and reflect on how to proceed. After reviewing the case, read the questions and consider your answers before continuing on to CAETA’s suggestions. This case is designed to test your knowledge of companion animal euthanasia and be a conversation starter among the veterinary team. Case outcomes are enhanced when following CAETA’s 14 Essential Components of Good Euthanasia.

Euthanasia Case; Bella the painful cat

Bella, a 14-year-old, FS, 3.8kg, Himalayan cat with diabetes, is at home with her family in preparation for a home pet euthanasia. Bella has been receiving insulin injections for the past 2 years and is not a fan of needles or handling, and is now declining in health. The family consists of an elderly woman (the primary owner) and her adult son, both of whom are hoping for a peaceful euthanasia for Bella. The veterinarian arrives at the home and sits down with the family in the living room to review things. Bella is on the elderly woman’s lap, appearing very comfortable. When it comes time to give Bella her pre-euthanasia anesthetic injection, she is kept on the lap on a towel. The plan is to get Bella sleeping before the pentobarbital euthanasia solution is given. The veterinarian attempts an intramuscular (IM) injection of 3 different drugs in one syringe, including tiletamine with a low pH. Bella cries out in pain and runs to hide under the couch. The owner and son are visibly upset and trying to console Bella. After a few minutes, it becomes clear that another injection will be necessary. The couch is tipped up so the veterinarian can reach Bella, a towel is placed on her to keep her in place, and another injection is given to help her anesthetize. The upset owners ask if Bella’s response is normal and if they should have expected this.

Discussion Questions

1. Bella is not a fan of needles or handling. What can you do to make sure she receives her pre-euthanasia injection more smoothly?
2. Home euthanasia offers many variations to the hospital, including a larger space to work in compared to an enclosed exam room. What might be done to better control the environment?
3. The family asks if Bella’s response is normal and if they should have expected this outcome. How do you respond?

CAETA Euthanasia Case Suggestions

1. There is a strong likelihood Bella will react to an injection even if she is used to them. It is advisable to reach for a two-step drug protocol rather than beginning with a drug like tiletamine that has a low pH and can sting. Consider starting with a combined injection of acepromazine and butorphanol. After a few minutes when Bella is more relaxed, another injection with tiletamine can be given to place her in deep unconsciousness, assuming this is necessary. If you plan to give pentobarbital euthanasia solution into the vein, unconsciousness is not required. Nice, relaxed sedation may be ample. It is also smart to ask the client if Bella is in pain anywhere in particular so you avoid injecting that area. If Bella is very fearful of handling and/or painful, perhaps she should have received an oral sedative like gabapentin before the appointment. Fast-acting oral drugs may also be given at the start of the appointment to avoid injections altogether.
2. Begin by discussing what’s important to the owner and Bella when the appointment is set. Ask questions about the environment, where Bella is most comfortable, and how she responds to new people and handling. There may be a smaller room in the home that provides better control over the situation, especially if Bella may want to hide. Choose a space where she feels safe and where you have more control. If need be, Bella may be gently and securely wrapped in a small blanket or towel. A solo veterinarian may want to invite a veterinary technician to travel to the home to assist as well.
3. The client asks if this strong negative reaction is normal. First, take a deep breath and relax your body to avoid internalizing the trauma in the room. The client will hopefully feed off your calm energy. It’s then necessary to acknowledge Bella’s reaction. “She is unhappy with me and that’s understandable. I would be unhappy too if I were tired of receiving injections.”  Next I would directly address their question, with honesty. “No, I didn’t anticipate Bella being so displeased with the injection. I’m sorry that she had this reaction, and I’ll do my best to keep her calm and comfortable as she begins to welcome her sleep.” Clients may feel significant guilt when their pet experiences distress, and veterinary teams should acknowledge their part and seek to make it right.

This case highlights the following Essential Components: O=Outline caregiver and pet preference, S=Safe space to gather, A=Avoid pain and anxiety, U=Use pre-euthanasia sedation/anesthesia, H=Helpful and compassionate personnel. These examples are just a few of the ways euthanasia can be enhanced. Consider what else might be done to ease the client’s emotional burden and support the patient’s needs for a gentle death. The Companion Animal Euthanasia Training Academy is here to elevate your euthanasia expertise.