Dysthanasia

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A Newer Meaning to a Relatively New Word

I’m guessing that if you’ve been practicing veterinary medicine long enough, you’ve had the misfortune of witnessing a euthanasia gone wrong. You may be the unfortunate one who facilitated it. Such a euthanasia rattles us, hijacks our thoughts, and forces us to relive it over and over. As caregivers, our euthanasia mission is to provide a gentle death, which is exactly what our clients want. How haunted will they be, and what will be the lasting memory of their pet’s life, if they witnessed pain or great distress?

As the Companion Animal Euthanasia Training Academy (CAETA) director of education, I have received emails and letters from clients about their harrowing experiences. They use words like “atrocity,” “egregious,” “horrifying,” and “devastated” to describe what their beloved pet endured, and how they felt. One woman described herself as a hollow shell, lost and alone. The clients tell me how much they are hurting, and how devasted they feel. Veterinary personnel also reach out, asking me if what they saw (e.g., a strange reaction to a drug, or a slow death) was normal, or acceptable, according to malpractice standards. Often, drugs and protocols we have used confidently for years suddenly become ticking time bombs, making veterinary professionals unsure about how to safely proceed with their next euthanasia appointment. To legitimize these situations, we need a proper definition—a word that will call us into action to support our clients, and help us be ready to manage such cases. If euthanasia equals “a good death,” what is its opposite? What should we call a bad death?

When we pull from the Greek language, as we did for euthanasia (Eu meaning good, and Thanatos meaning death), we come up with dysthanasia (dys meaning bad). A newer word found in only a few sources, “dysthanasia” is described as “the practice of prolonging the life of terminally ill animals, and allowing suffering without palliative care, or necessary euthanasia”—in other words, an end-of-life experience without palliative care, animal hospice, or proper caregiver guidance that could lead to neglect at such a delicate time.

I suggest we call this scenario something also aligned with a lack of proper veterinary care before death. Since euthanasia pertains to the act of taking life, dysthanasia is also a suitable word to distinguish taking life in less than ideal ways. According to CAETA, dysthanasia is the opposite of euthanasia, and many are beginning to use the term in practice.

While the two words have numerous comparisons and differences, the following illustrate the concept:

Euthanasia:
• The animal feels minimal to no anxiety, pain, or fear.
• Proper technique is delivered.
• The procedure is in line with professional and societal welfare expectations.
• Observers (i.e., loved ones) feel safe and supported.

Dysthanasia:
• The animal feels unacceptable pain, anxiety, and/or fear.
• Improper technique is used.
• Observers (i.e., loved ones) experience distress and anguish.
• Support among the patient, client, and veterinary team breaks down.

I recognize that defining dysthanasia leads us to a slippery slope, but euthanasia also is difficult to label clearly. What exactly is “unacceptable” pain, anxiety, or fear? Many, including those providing similar services in the same cultures and demographic regions, may define “unacceptable” differently. But, naming a bad death experience enhances a veterinary team’s ability to target and address the negative situation. When a dysthanasia occurs, and is labeled as such, a clear resolution plan can be set in motion. We cannot undo the procedure itself, but we can change how we manage the bad situation.

Here’s a case example:

The veterinary team has decided what equals a quality euthanasia appointment. They have put protocols in place to deliver a pleasant euthanasia for the pet, and a gentle experience for the client and their team. During the appointment, however, things go awry, the technique of choice doesn’t work, and the euthanasia becomes an unpleasant, drawn-out ordeal for all involved. The client is visibly upset, and the team is shaken. But, management is clear. According to the established protocols, the appointment is labeled a dysthanasia, and the next step is to adequately address what happened, first with a team debriefing to discuss what went wrong and troubleshoot solutions to prevent future occurrences, and then, of equal importance, reaching out to the client (i.e., the animal’s family) with sympathy and a discussion about what happened.

Talking about a dysthanasia will never be easy, but connecting with clients afterward, to answer questions and belay fears of the unknown, is always necessary. People have a tendency—in my opinion, perhaps—to misinterpret a good euthanasia, let alone a bad one. Gently and compassionately reviewing the facts helps put things in perspective and calm fears.

Families should be called no later than 24 hours post-dysthanasia. Lead with a gentle message of sympathy and support, to assess their feelings. Your team does not need to begin with a declaration of frustration, but should simply ask how the client is doing. The client may perceive that everything went smoothly, and be grateful for your caring words. If they were obviously angry after the appointment, your role is to be a sounding board. Let them talk about their concerns, and ask questions. Lead the conversation with, for example: “Yesterday did not go as we all expected. While some things are beyond our control, I want to thank you for your patience with the process, and for allowing me, and my team, to move forward in the best way possible. Do you have any questions that I can try to answer?”

Clients have the right to be angry after a dysthanasia, whether or not your patient’s death experience was largely out of your control. Allow them to grieve in their own way. Hopefully, by reaching out to them, you show recognition of their feelings, which may allow them to heal, and help them understand you did your best.

Professionally, we must forgive ourselves, learn from the experience, and use the dysthanasia as a legacy for improvement. Some hospitals, especially those with a large euthanasia appointment volume, hold rounds focused on euthanasia, or at least include successes and challenges each time they meet. Dysthanasia begs talking about, not only to address the technical issues, but also to provide space for team members to share their experiences. Team members commonly internalize both primary traumatic and secondary traumatic stress during dysthanasia, a double whammy, and a catalyst toward compassion fatigue. Confident delivery of euthanasia procedures has been increasing for years, thus reducing dysthanasias, and as each team develops a stronger euthanasia A-game, the more likely they will prevent those gut-wrenching “What just happened” incidents. We all can devote our time and resources to learning how we can do it right the first time, but no matter how much we prepare, dysthanasias will sometimes happen.

My advice? Define the experience as a dysthanasia, address it with the team, and protect the client’s mental health. You’ll always be grateful you did.

I’ll close with the most reliable way I know to protect the euthanasia experience—embracing the three C’s:
• Provide compassion. Things may go wrong, but you can always fall back on your desire to love and serve.
• Portray confidence. Setting this tone increases trust in your abilities to handle the situation.
• Maintain control. Do what you can to keep the process moving forward, or make the delicate call, and postpone the process until issues can be resolved.

Practicing with compassion, confidence, and control will protect you during any dysthanasia experience.

This content was written by Dr. Kathleen Cooney and first published with DVM 360 in 2020.

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Kathleen Cooney

DVM, CHPV, CCFP Founder, Director of Education for the Companion Animal Euthanasia Training Academy
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