I have been closely monitoring modern euthanasia decision-making and client discussions for the past few years. It is becoming more and more evident that veterinarians are struggling with how to talk with pet owners (veterinary clients) about euthanasia and feeling invited to discuss alternatives, especially when pet owners appear determined to euthanize their pet. Veterinarians may feel pressured to proceed even when they know continued life is possible. On the flip side, clients who wish to provide ongoing veterinary care for their pet may be pressured by their veterinarian to euthanize. Perhaps a euthanasia discussion tool would benefit both parties as well as the patient.
The Legal Right of Pet Owners to Seek Euthanasia
Veterinarians face moral strain as a regular part of the job, and euthanasia work is no exception. The permanency of euthanasia makes the decisions around it very important, and veterinarians are trained to be sure that if it is performed, it is at the right time for the right reasons. Companion animals are classified as property in the United States, meaning pet owners have the legal right to seek euthanasia for their animal. According to a 2018 study, 22% of veterinarians reported experiencing economic euthanasia at least once a week, while 45% of respondents agreed that veterinarians use euthanasia as an aid or method to resolve difficult cases when this may not be in the best interest of the patient. The second most common reason for reluctance to decline a client’s euthanasia request was the difficulty in doing so once the client had reached this decision. A fundamental ethical problem is whether veterinarians should give primary consideration to the animal or to the client. Many veterinarians provide care they disagree with, and this includes euthanasia. This said, it is still the responsibility of the veterinarian to discuss alternatives to euthanasia, but this can be tricky to navigate with emotional clients.
Pet Owners Who Aren’t Ready for Euthanasia
Veterinarians use their training and experience to guide clients towards outcomes they believe are best for the pet. They broach the subject of euthanasia when they feel it is a viable option, especially when suffering is expected. There will be instances, however, when euthanasia is not the best outcome, but the veterinarian is convinced it is. In these situations, the client may feel trapped and without choice. It is fairly common for veterinarians to review quality-of-life (QOL) scales with clients to open dialogue about what the animal is experiencing due to disease or age-related changes. Veterinarians and clients decide if suffering is present and if euthanasia is warranted. There is no requirement by the veterinarian to offer alternatives to euthanasia, therefore while QOL scales present a reasonable picture of the pet’s physical and mental health, the conversation may end when euthanasia is mentioned.
The Importance of the Veterinarian-Client-Patient-Relationship (VCPR)
The full scope of the veterinarian-client-patient-relationship (VCPR) states that clients are to be informed of the benefits and risks of treatment options. It is possible that veterinarians may avoid discussing such things even though the client may want it. The following is taken from the AVMA’s VCPR Information page informing clients about their role in the VCPR (with specifics related to euthanasia considerations):
What is a veterinarian-client-patient-relationship (VCPR)?
A VCPR is the professional relationship between client, animal, and veterinarian. It exists when the veterinarian knows the animal well enough, typically through a recent physical examination or regular visits, to make informed decisions about the animal’s health. This relationship is the foundation of safe, effective veterinary care. It must be in place before the veterinarian can diagnose a condition, prescribe medication, or treat an animal.
The client’s role involves:
· Choosing a veterinarian to care for their animal.
· Asking questions to make sure they understand any diagnosis, treatment, and care plan.
· Agreeing to follow the veterinarian’s instructions and to take responsibility for the animal’s care.
The veterinarian’s role involves:
· Seeing the animal recently enough to understand their health needs.
· Making clinical judgments based on direct knowledge of the animal’s condition.
· Accepting responsibility for providing the animal with medical care.
· Keeping a complete, up-to-date record of the animal’s medical care.
· Advising clients about the benefits and risks of different treatment options.
Reasons for a Euthanasia Agreement Tool
If there is to be greater consensus between veterinarians and clients about the need for euthanasia before it is carried out, a discussion tool would prove valuable. In human medicine, the Medical Aid in Dying (MAID) questionnaire is extremely detailed, and physicians take significant care to ensure that assisted death is warranted. Veterinary medicine remains unique in that euthanasia can be readily chosen; however, it does not negate the need to properly review all care options. A thorough review of US veterinary state practice acts revealed few requirements to discuss reasons for or against euthanasia. Clients deserve to hear what their veterinarians really think.
A euthanasia agreement tool has the potential to:
1. Improve veterinarian and client discussions
2. Ensure greater alignment on outcomes
3. Protect patient welfare
4. Promote decisional harmony while reducing regret
5. Prevent client-driven litigation (upset that alternatives to euthanasia were not given)
The hope is that veterinarians feel they may safely broach the subject of alternatives as much as advocate for euthanasia when they believe it is the best option. Veterinary support staff can also benefit knowing the veterinarian discussed options with the client. Concerns over what some deem convenience euthanasia reasons are a real issue and there can be disagreements between staff members.
Example of a Euthanasia Agreement Tool
While research is still looking into the most effective way to utilize a euthanasia agreement tool, the following is proposed:
Opening statement to the client – I understand you are requesting euthanasia for your pet. It is my responsibility to ensure we discuss all end-of-life options, including alternatives to euthanasia so you are fully informed as you make a decision. Let’s take a few minutes to ensure you have all the information before we proceed.
Discussion with the client about the pet’s condition
- Based on what you have shared with me, and what I have learned from your pet’s condition, these are the care options as I see them.
- (example) We can offer pain medications to see if there’s improvement.
- (example) We can attempt to surgically correct the problem in the hopes of a return to normal functioning.
- (example) We can elect euthanasia.
- Would you like to conduct a quality-of-life review together?
- Do you wish to proceed with euthanasia for your pet?
- Are you making this decision of your own free will, and are all legal owners in agreement?
- Is there something you wish to discuss further before we proceed?
- Would more time or more discussion change how you feel?
Closing statement with the client – We agree that euthanasia is necessary today. You are in good hands with us, and we will prepare to move forward.
In Summary
The goal is to open the floor for discussion, then conclude with a series of yes/no questions while providing space for continued dialogue. CAETA’s euthanasia agreement tool will be developed over the next year, but veterinary teams may begin practicing with it or use their own. As the human-animal bond evolves, veterinarians may have an increased obligation to present more information on euthanasia alternatives before agreeing to the procedure. While it is standard practice for veterinarians and clients to form a VCPR, there is no guarantee that all options will be discussed with the client, which would increase the odds of an informed euthanasia decision. It may therefore be advantageous for all involved to complete a euthanasia agreement that covers a more thorough review of potential outcomes, which reduces uncertainties and decisional regret.
References
Berg, C. and Vickers, H. (2024) Complaints to the veterinary disciplinary board related to the euthanasia of animals. Frontiers in Veterinary Science, 11, p.1480106.
Kipperman, B. et al. (2018) Ethical dilemmas encountered by small animal veterinarians: characterization, responses, consequences and beliefs regarding euthanasia. Veterinary record. [Online] 182 (19), 548–548
Moses, L., Malowney, M.J., and Boyd, J.W. (2018). Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. Journal of Veterinary Internal Medicine 32:2115–2122.
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