Working with euthanasia-reluctant clientsHow to handle the unpleasant but necessary conversation. September 6, 2017 By Don Vaughan When an animal begins to fail due to age or disease and its quality of life diminishes, the inevitable and unpleasant discussion about euthanasia may become necessary. Ideally, the owner understands what’s going on and is in agreement that it’s time to humanely end their pet’s suffering. Sometimes, however, a doctor may find herself working with a client who refuses to acknowledge the realities of their pet’s condition and circumstances. How a practitioner handles this situation can mean the difference between a one-time client and a life-long relationship, experts say. “Most veterinarians are caring and nurturing, and it breaks their hearts to have to euthanize a patient,” said Judy Helm Wright, a professional pet grief coach and owner of Animal Human Connection in Missoula, Mont. “It’s by far the hardest thing they do because it’s in their heart to want to save all animals, and they can’t.” Empathize with the attachment During discussions about the possible need for euthanasia, it’s important that veterinarians understand and acknowledge the emotional value pets bring to people’s lives, said Whitney Johnson, LPC, a grief counselor and therapist in private practice in Raleigh, N.C. For many, animals instill a sense of purpose, love, and belonging. “Animals can improve mood for some people,” Johnson said. “In others, they improve motivation and routine because they provide structure and a schedule.” When a pet begins to decline and the end appears near, these and other emotions can get ramped up, Johnson added. “Owners often struggle with guilt,” she said. “People struggle because the veterinarian may be telling them it’s time, but they believe their pet isn’t ready to go yet.” Indeed, clients may cling to the desperate hope that their pet’s health will suddenly improve, or that a miracle cure will be found. “They may be concerned that their pet had trusted them for love, and to end their pet’s life at their own hand would be a betrayal of that trust,” Johnson said. Empower the owner During discussions about a failing patient, veterinarians should actively seek input from family members and give them specific choices, said Wright. “The veterinarian might say, ‘Option one is we can operate, but it’s going to cost X amount of money,’” she said. “‘Two, we can let nature take its course, which might take three to six weeks, but during that time, Rosie is going to be in pain. And the third option is euthanasia, which is a painless way for Rosie to go on her next great adventure.’” Tap into your humanity Veterinarians should engage in active listening when discussing euthanasia with clients, said Johnson. This means acknowledging what the client is saying, as well as their emotions. “The practitioner should be able to empathize with the trust piece and the difficulty in making such a weighty decision,” she said. “If that can be treated with respect, as opposed to just medical jargon, it will be better received. Most important is validating the client’s love of the animal and their connection with it.” Johnson also warns against using negative phrasing during such conversations. Avoid harsh words as well as labels that could make the client feel guilty about the decisions they have to make. Suggest hospice as an option If the patient is failing but still weeks away from actively dying, hospice care may be an appropriate measure. “Hospice brings a level of acceptance and understanding, as well as a base of knowledge about the grieving process,” said Wright. Some practices offer hospice services, while others refer them out to specialty practices such as Colorado-based Home to Heaven, an end-of-life mobile service started in 2006 by Kathleen Cooney, DVM, MS, CHPV. Home to Heaven incorporates a five-step plan that includes collecting the patient’s medical history, designing and implementing a care plan that meets the needs of the patient and the client, and providing pet loss support throughout. Hospice can help clients come to terms with the their pets’ pending death, and make the choice to euthanize a little easier. But despite its benefits, Cooney reports a negative attitude toward end-of-life care among many of her colleagues. “We have many, many veterinarians practicing today who are not openly embracing it, likely because they are entrenched in the old paradigm of ‘give these pills and call me when you’re ready to euthanize.’ I see it every day,” she said. “Many vets also resist the concept of natural death without euthanasia, which is an option preferred by many owners.” Keep negativity in check End-of-life services can be a practice builder through consultations, disease education, pharmacy sales, and more, Cooney said. Clients pay for end-of-life services because they want the best for their beloved pets, but ultimately, it’s a practitioner’s kindness and compassion that ensures a long-term relationship. “End-of-life services engender good will among clients because their veterinarian was there for them when they needed him,” Cooney said. “When veterinarians provide good supportive care, clients will come back to them. They are bonded. I have clients who have been coming to me for 10 years only for end of life; they see their regular vet for all other needs.” Simplify the situation Eventually, the time will come when death is imminent and euthanasia may be the most humane choice. During this trying time, there is much that a practice can do to make the situation easier for the reluctant client, Johnson said. Foremost is empathy, understanding, and sensitivity on the part of the office staff. In other words, taking off their medical hats and simply acting as concerned friends offering sound guidance. Schedule the euthanasia for late in the day, when the office is less busy. If that’s not possible, escorting the grieving client through a back exit can bring needed privacy. Some practices provide euthanasia off-site, such as at the client’s home or at a location that meant a lot to the dying pet. Many also offer commemorative keepsakes, such as special urns for pets that are cremated, or the pet’s paw print in plaster. This can go a long way toward helping a client come to terms with the death of a pet, according to Wright. “The more involved the pet parent can be during the process, the healthier it can be for everyone,” she said. l Judy Helm Wright, a professional pet grief coach and owner of Animal Human Connection in Missoula, Mont., offers a brochure that answers owners’ questions about pet loss. Free office copies are available at animalhumanconnection.com. WHEN PET BEHAVIOR DRIVES THE OWNER’S DECISION Not all animals brought to veterinary practices for euthanasia are sick or dying—many have behavior issues that have made life at home unbearable for their owners. Such cases place practitioners in a difficult position, but there are options, experts say. “Behavior problems are a very common reason for relinquishment or euthanasia,” said Amy Pike, DVM, DACVB, head behaviorist with Veterinary Referral Center of Northern Virginia in Manassas. “The main issue for dogs is aggression, and the main issues for cats are aggression and urinating or defecating outside the litterbox.” If the patient has no medical issues, the veterinarian may want to refer it to a board-certified veterinary behaviorist, if the client is amenable. But this must be the client’s choice, Pike said. “At the end of the day, it’s the owner who has to live with the pet, not the veterinarian,” she said. “The vet should be supportive and offer options, but it’s the owner who has to make the best decision for his family and the pet.” A dog that has exhibited aggressive tendencies and has not responded to behavior modification probably should be euthanized because aggression is a public safety issue, Pike said. However, if the animal is otherwise healthy and the behavior is more of an inconvenience (urinating outside the litterbox), the veterinarian may want to take the animal and turn it over to a rescue organization or shelter that can find an appropriate home for it. When discussing relinquishment or euthanasia with the owner of a behavior-challenged pet, practitioners should avoid labels that could suggest the owner is to blame, said Pike. “Instead, use diagnostic terminology, such as ‘this animal is exhibiting fear-based aggression.’ This will help the owner feel better about what’s going on,” she said.