Telehealth and Euthanasia; How they fit together

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Telehealth is a hot topic these days. COVID has opened our eyes to what’s possible in the modern tech era. Vet med has been utilizing telehealth since the invention of the telegraph, but these days it includes text, phone call, video chat, emails, and every digital communication platform you can think of. While euthanasia requires a physical appointment to bring the veterinary team together with patient and client, there is a lot of telehealth to be harnessed before, during, and after death.

According to the American Veterinary Medical Association, telehealth is the overarching term that encompasses all uses of technology to remotely gather and deliver health information, advice, education, and care. It can be divided into categories based on who is involved in the communication and whether a veterinary-client-patient-relationship (VCPR) has been previously established. Euthanasias may be scheduled without a VCPR in every US state, however a veterinarian must have familiarity with the patient before proceeding, or to request a licensed veterinary technician to perform the procedure on their behalf.

What does this mean in the telehealth world? It is very common for pet owners to call veterinary hospitals or services and request euthanasia for their pet. Many times, the veterinary team has never met the pet and knows little to nothing of their history. During the phone call, the phone staff typically will hear the reasons for the request, triage the situation, and schedule the appointment based on the seriousness of the situation or veterinarian availability. Upon arrival, the veterinarian has the choice to move ahead with euthanasia or to recommend alternatives. If the pet has been seen before and the team is well-versed in the pet’s health status (the pre-existing VCPR), a scheduled euthanasia typically results in the pet’s death. Even those cases where the vet is meeting the pet for the first time, euthanasia is usually carried out (CAETA has no statistics on this; it’s anecdotal based on professional conversations).

Teleadvice can be offered before the euthanasia appointment. This provides time for the client to describe what’s happening and for the veterinary team to determine if euthanasia is the best course of action to relieve suffering. Teleadvice can be conducted by trained CRTs, veterinary technicians, or veterinarians, and involves quality of life discussions. They determine together if further medical support is advisable based on the circumstances. Advocating for euthanasia is ambiguous in this manner and becomes more clear when the VCPR is established during the appointment. Now the doctor is able to see the patient with their own eyes and conduct a physical exam, albeit minor at times, to ensure euthanasia is the right choice. It’s typical for the information gathered during the phone call, email, or online form to give much of the determining data. Teletriage is common in emergencies when quick decisions can reduce patient suffering.

Telemedicine is different from teleadvice because the pet in question is already a patient of the hospital or service. More is known about their history and hopefully the client is already familiar with euthanasia details. Preplanning and talking about euthanasia is common in advanced end-of-life care and a large part of telehealth overall. Veterinarians can ‘prescribe’ euthanasia more readily and efficiently, making the transition from life to death smoother.

Telehealth categories and how they pertain to euthanasia:
~Teleadvice – general advice on quality of life and decision-making.
~Teletriage – acute assessment of a patient in a critical state and recommendation to be seen by a veterinarian who will decide if euthanasia is warranted.
~Telemedicine – an understanding of the patient’s exact condition and recommendation for or against euthanasia based on this knowledge.
~Teleconsulting – discussion with a veterinary specialist who advises on whether euthanasia is the best course of action given the patient’s history.
~Telemonitoring and supervision – performed before euthanasia is carried out, often during hospice and palliative care. Response to care often dictates if euthanasia is necessary. This category can also include client emotional support during pet loss. (End-of-life care associates the client as part of the patient triad)

Telehealth is good for end-of-life care, with euthanasia being one large part of it. Hospice and palliative care is perfectly designed for telehealth and its subcategories, and often results in euthanasia when the time comes. Like most veterinary procedures, euthanasia can be discussed virtually, but not carried out virtually. For now, euthanasia itself remains an in-person experience.

*The AVMA Telehealth Guidelines

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Kathleen Cooney

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