The Companion Animal Euthanasia Training Academy (CAETA) invites you to consider the following 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; Denzel the anxious dog
Denzel, a 7-year old, M, 30kg, Australian shepherd with bladder cancer, presents for euthanasia to your hospital. He is alert and anxious as he explores the hospital waiting room and it is obvious he would rather be somewhere else. The client, Denzel’s owner, is also anxious. She just learned about the cancer diagnosis a couple of days ago and her young family is devastated. The veterinary assistant brings the pair into the main euthanasia room to wait for the veterinary technician, who will bring Denzel to the treatment area for placement of an IV catheter. When the technician enters, Denzel barks excitedly at her so he is given a few minutes to relax before being led to the treatment area a few doors away. The assistant sits with the client and hears more about Denzel’s decline.  The client begins to cry as the assistant asks questions related to Denzel’s cremation. Ten minutes later, Denzel returns to his owner with his IV catheter placed. The veterinarian enters the room to find a distraught client and anxious dog.

Discussion Questions

1. Denzel is anxious when he enters the hospital. What can you do to help calm him?
2. The client begins to cry when the veterinary assistant starts talking about cremation. What can the assistant do to support the client?
3. The veterinarian enters the room to find a distraught client and anxious dog. How should they proceed?

CAETA Euthanasia Case Suggestions

1. If Denzel’s anxiety is known ahead of time, he may be prescribed pre-visit oral pharmaceuticals (sedatives) in line with a Fear Free approach. This will make his entering the hospital and IV catheter placement less stressful, not only for him but for his owner. Calm animals lead to calmer experiences in general, and during the final moments of life, calm is what we want. If oral sedatives before the appointment are not possible, Denzel should be led directly into the euthanasia room and given oral or injectable sedatives right away to ease his anxiety. He should also be kept with his owner for the duration of the appointment, especially if she is a calming presence for him. Elements in the euthanasia room such as soft lighting, noise absorbers, and pheromones can also help.
2. Regardless of the reason for euthanasia and the relationship the client already has with the hospital, the veterinary assistant will want to begin the interaction using a soft tone of voice and slow, kind words.  “We are so honored to be caring for you and Denzel today. You are in good hands with us.” The key is to establish rapport which in turn builds trust. The more information the assistant can gather related to the significance of the decision to euthanize, the better. Offering 5+ minutes to simply talk together goes a long way to help the client feel heard and understood. She may have started crying during the cremation discussion because her emotions needed to be released, and that was when it happened. She may have started crying during that moment because it made the loss of Denzel more real. This is a good time to offer face tissues and water. When possible, veterinary staff will want to relay cremation options before the appointment (giving access to information online or verbally reviewed), or even delay cremation discussions until after the appointment. This is becoming more common thanks to aftercare services who make arrangements directly with the client.  
3. The veterinarian enters the room and must now work to create a calmer space. First thing will be to take a deep breath and relax their body. The veterinarian will think and speak more clearly when relaxed, as well as make a better connection with client and patient. They should take a few minutes to build rapport and answer the client’s questions, and learn if the client has been present for a euthanasia before. Whether yes or no, the veterinarian will gently inform on what’s going to occur, keeping Denzel’s comfort front and center. If Denzel is still anxious, the veterinarian may offer to give an IV sedative/anesthetic to relax him.  When it comes time to euthanize, the veterinarian can offer a few moments of privacy, then proceed to administer the euthanasia solution.  After pronouncing the patient deceased, the client may be given more privacy or time to talk and share stories about Denzel’s life, and legacy. It can be advantageous for the veterinary assistant to be there during the procedure for added emotional support and to help assist the client out to the car. Veterinary social workers are well suited to this role too.

This case highlights the following Essential Components: E=Establish Rapport, 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. CAETA is here to boost your euthanasia expertise.