It was a tough day for a new veterinarian. I stepped out of the exam room and walked to my desk visibly upset. The senior partner of the three-doctor practice asked me what was wrong. Three times that morning a client had asked me if they should end their pet's life, and I felt ill-prepared to counsel people in these cases. If the person who lived with my patient was unclear, how could I know better? What if I was wrong? Can we predict miracles? I did not want to "play God," and I was afraid of making a decision that would turn out to be incorrect. After all, the choice to euthanize a beloved pet is permanent. No amount of regret can undo the action once it is done.
The gentle doctor rubbed his salt and pepper beard and acknowledged my concerns. He asked if I would like some suggestions.
What followed was some of the best advice anyone has ever given me:
- Acknowledge the affection and feelings associated with a pet's life. The word "euthanasia" means "to bring about a good death." The choice to treat or euthanize is a major one. No one, veterinarian or guardian, wants to be wrong. It's simply a very big choice. While none of us ever wants our favorite fuzzy friend to leave, we do desire that they pass gently and without pain, suffering, fear or degradation. This means that questions about when and how are natural and necessary between people who share affection for animals.
- Clients and doctors are partners. Clients and veterinarians share information and they share decision making, but there is a sacred aspect of the human-animal bond that is best described in the concept of stewardship. Ultimately, the steward of this patient is the guardian. No veterinarian can make the final choice for an animal guardian. The final choice must come from them, but it's natural and beneficial for a veterinarian to assist in that process as an extension of the professional and personal relationship that manifests from our shared affection for living things.
- Acknowledge the guardian's love and track record in making good choices. Many of us worry about making mistakes, and in medicine mistakes can be fatal and lead to irreversible damage. The fear of error can actually make us more likely to make mistakes, so we are better off in this discussion if we banish fear, and realize that this process is simply about loving our friends and making choices based upon what is best for them. Looking and discussing work better than worrying. Most of us make right choices when we are given safe space, correct information and support, which allows us time to come to a conclusion on our own.
- Ask, "Does he have more good days than bad ones? More good moments than bad?" Honestly assessing this question gently leads most people to a safer place for discussion. It is amazing to me how fast many people answer this question and how easily it leads them to sensible choices. Sometimes we are not really looking, and we may need to honestly and objectively assess this fact before we can decide. In most cases it is fine to simply decide to take a week and really look at this fact. People need to be aware though that conditions can change, and so it is important to look for more than just a moment. For instance, some arthritis pain cases get really bad after cold, wet weather. Waiting until the weather clears may result in a totally different decision, so do be sure to give enough time to really know.
- Knowing it's time. Many people experience a moment where they look at their pet and suddenly a moment of calm silence ensues when they know it is time. If a person knows it is time and I have no other medical information to share then I feel good about their choice.
- If it is not time, is there something that needs to occur? A family member may wish to visit and say their goodbyes, or we may want to share a few more ball catches at the beach, or watch some more sunsets together. If we can name those things and enjoy each moment, then it becomes easier to say farewell.
- Do you know your options? It is necessary to know all the options before deciding. Euthanasia can be done in the examining room of the veterinary hospital, or it can be done at home. People can be present or not depending on their needs. There are other options beside euthanasia, as natural death following hospice is a rich choice for many people. Hospice is a growing area of interest, especially as our technical abilities improve. I've lectured for years about how we can address the needs of clients and patients with "hopeless or terminal" diseases. Some of these patients can live long, happy lives despite their serious conventionally diagnosed condition. In their lives, we learn so many lessons that enrich our abilities to be happy.
All living things are born, grow old and pass away. Death is a part of living and if we concentrate on living then we have better, happier lives. If we face death with the same sense of love and understanding that we live our lives, then we can navigate this process and learn many things along the way. As death comes, we are faced with the importance of relationship and not with things. Sometimes just calmly being together is the greatest gift of all. Don't wait to learn that lesson.