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EUTHANASIA: Determining Quality of Life, Making the Decision, and What to Expect

With the improved vet care we have today, it seems few animals pass on their own with dignity and without suffering. Most pet parents find they are the ones who must make the decision to end the suffering of their pet.

To be the one who must look at his or her pet and determine if the quality of that pet's life has diminished beyond repair, is a heavy burden. To sign the papers giving the vet permission to administer an overdose that will stop the breathing and heartbeat of one you love so much, can seem an unbearable task. To be present in that moment and see the brilliance of life fade away, knowing that you had to make the decision that make it so, can bring an overabundance of guilt.

It is a decision I have had to make many times as a pet parent, vet tech, and animal rescuer. As part of my job at a humane society operated clinic that offered free euthanasia for sick or elderly pets, I became a certified euthanasia technician by the American Humane Association.

Most of the time, it is a veterinarian who performs the euthanasia process in a veterinary setting. In some settings, the certified technician may perform the duty. This was the case for me when I was employed by a humane society-operated clinic. After my certification, it was my responsibility to perform the euthanasia of elderly, ill, or aggressive animals, under the indirect supervision of the veterinarian. Normally, during the euthanasia process, the pet parents were present.

Those of us who have worked in the pet care and rescue industry, see euthanasia differently than those who are rarely faced with the concept. We have seen the suffering that is worse than death.

As difficult as the decision is, we have the power to give to our pets, what we cannot give to our human family the mercy of a painless death. We can end the suffering of our pets instead of forcing them to live in pain, in fear, in misery. It takes a strong, loving, and self-less pet parent to make a decision that they know will hurt them to make. These pet parents put the needs of their pet ahead of their own.

Perhaps the most asked question is “How do I know when the time is right?”

While no time “feels right”, there are some guidelines to help you make the best decision. The conditions below assume all treatable conditions have been discovered and discussed with your veterinarian. If not, consult with your veterinarian to be sure there is nothing else that can be done.

Conditions that show that the quality of life may be greatly diminished:

• No Appetite

• Refusal to drink

• Excessive Pain not relieved by prescription medication (or being unable to afford the medication)

• Poor mucus membrane color

• Avoiding activities the pet once enjoyed

• Difficulty breathing, collapse upon exercise

• Displays of fear during normal conditions

• Pet isolates him or herself from the family

• Pet is unusually clingy to family members or afraid to be alone

• Pet has been diagnosed with a fatal disease or a disease that the pet parent cannot afford to treat.

Sometimes the signs of a poor quality of life can seem subtle. Many pets do not show their pain and suffering as freely as humans do. This is an evolutionary instinct. Therefore, what you see may only be the tip of the iceberg. Signs of pain, nausea, and other symptoms must be interpreted with this fact in mind.

Not being able to afford treatment for one's pet is hard, but it is a reality that happens more than we care to admit. It's by far the most guilt-induced condition on the list.

Pet parents living in poverty will often go without in order to have their pets treated. However, there are times when all possible options have been exhausted, and the pet parent is left with a very sad and difficult decision.

An example is a cat diagnosed with diabetes. A cat with diabetes has four options.

One, you can treat her. To do so will require a few days to a week in the hospital in order to find the appropriate dose of insulin needed to regulate her. There will be multiple blood draws, multiple glucose tests to run, and a change in diet. Once the cat finally makes it home, there will be new prescription food to purchase, insulin and insulin syringes to buy. Someone will have to give the injections twice daily. A routine will have to be followed. More vet visits will be needed in order to continue to regulate the medication properly.

Your second option is do nothing. The cat will continue to lose weight rapidly in spite of eating. Ketones will build up in the system that will make her feel extremely sick. The organs will start to fail. Intense nausea will be a constant. The appetite will cease and the cat will become more and more dehydrated. Death will be slow and miserable.

Option three. Finding a rescue with experience in caring for animals with diabetes who would be willing to take your pet. Contact your local animal shelter for possible rescues, Google for "special needs animal rescues", or look on social media.

Option four, if you have no possible way to afford the treatment of the pet, is to be strong enough to admit it, and compassionate enough to give the pet who has loved you and whom you have loved, a gentle, quick release from illness.

Ignoring the decision is really not ignoring it. It is saying “I chose to let my pet suffer so I don't have to make this decision”. To do that is unfair to the pet and unfair to the veterinary team that may be taking care of your animal. While pet parents try to pretend nothing is happening a technician is holding your pet as he slowly dies. The reality of euthanasia, is, it is a peaceful process. The methods today are far improved and the training better.

The term “euthanasia” comes from the Greek word εὐθανασία; meaning "good death".

Euthanasia is a difficult and mysterious subject for many. Euthanasia conjures up some of the worst thoughts and fears when it is, in fact, very peaceful when done in the proper way.

Taking away the mystery and understanding what it is and how it is done, can make the decision and experience a bit easier.

The process of euthanasia is a quick, humane death, caused by an overdose of the barbiturate sodium pentobarbital, or a sodium pentobarbital/phenytoin sodium combination. The drug is most often administered in the cephalic vein on the pet's foreleg.

First, the drug makes the pet unconscious. At this point, he or she is completely unaware. Next, the drug causes the respiratory process to cease, stopping the breathing. Finally, it will arrest the cardiac system, stopping the heart completely. It normally takes 50-120 seconds from injection to total arrest and death.

Cardiac function, temperament, the comfort of the vet giving IV injections, and the presence of the pet parent during the euthanasia. determine certain aspects of the euthanasia process. Poor cardiac function and low blood pressure often make the process very difficult. Unlike humans, the veins of most pets can only be felt, not seen. If the cardiac function is compromised, it may not create enough pressure to make the vein palpable. This can make it difficult to find and secure a vein for injection. Often, in these cases, the pet will be taken to the treatment room and an iv catheter will be installed, securing the necessary vein. The pet will be returned to the room and the veterinarian will administer the overdose.

Some clinics require every pet that is to be euthanized with the pet parent present, to have an intravenous catheter installed. In these cases, it is usually because the veterinarian is more comfortable having the iv already secured by his or her technicians. The concern is that the family will experience anxiety if the veterinarian must reinsert the needle after a failed attempt. A catheter will usually increase the cost of the procedure.

An alternative method to an iv catheter for cats, ill kittens, sick puppies (under 8 weeks old), and pocket pets, is the intraperitoneal method. This is a method in which the pentobarbitol (not pentobarbitol/phenytoin combination drug) is given in the abdominal cavity. This is a very peaceful method and appropriate for pet parent-attended euthanasia. The time from injection to cardiac death is 7-10 minutes, but it is also very gentle as the pet quietly falls asleep in her pet parents' arms. Many pet parents have found this method comforting as it gave them time to say goodbye. It is not recommended for puppies or dogs over 8 weeks old.

The two-injection method is preferred by many veterinarians and is used often in animal

shelters. An injectable sedative is first given intramuscularly. The pet is usually sedated in 3-5 minutes. Once the pet is fully sedated and unaware, the overdose of pentobarbital can be given. When the pet parents are present, the injection will be given intravenously.

Isoflurane and sevoflurane, both gas inhalants used during surgery to maintain sedation can also be used to bring sedation for pocket pets and other small animals. Clinics often have small chambers for this purpose. The gas anesthesia may be pumped into the chamber, or a cotton ball saturated with the liquid isoflurane may be added to the chamber. Within seconds, the pet is unconscious, and an intraperitoneal or intracardiac injection can be given. It's a much more peaceful alternative than was used at one time. My vet was unaware of this method, so I showed her how it worked when it was time to put my hamster to sleep. She's been using it ever since.

Admittedly, the decision to euthanize is the most difficult of all. The key is considering what is not in your best interest, but in the pet's best interest. I would much rather agonize to make the decision, than make my pet suffer another minute.

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