Client Services
When It’s Time: Safely Discussing the Option of Euthanasia with Clients typography

By Kathleen Cooney, DVM, CHPV, CPEV, DACAW

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n order to perform euthanasia for pet patients in failing health, veterinarians first need to talk about the option. Diagnosing an animal with cancer and laying out medical options for clients is a transformative experience. It’s a delicate moment requiring strong communication skills and emotional intelligence. When delivering bad news like this, the mood is somber and respectful and naturally sets the tone for even deeper topics like euthanasia.

Based on the patient’s signalment and the client’s psychosocial factors (time to provide care, financial resources, previous experiences with cancer, etc.), veterinarians make quick determinations on the best course of action. These include elements related to their own experiences and morals. And sometimes it happens so quickly that clients don’t even perceive the complex decisions their vet is making right in front of them. The decision to offer euthanasia may be on the tip of the tongue, but then the challenge lies with how to bring it up safely and effectively.
Here are some examples of language you may want to try:
  • “We’d like to talk with you about something that may be hard to hear.”
  • “Based on everything you’ve shared with us, and knowing the seriousness of the condition, it’s important we understand that time is limited.”
  • “Have you experienced cancer with other pets? What can you share with us about that experience?”
  • “How do you envision the last days of their life? What does quality of life look like to you?”
  • “If their comfort becomes hard to manage, how do you feel about releasing them from their body before things get too difficult, through euthanasia?”
  • “They trust you to make whatever decision you feel is best, and this includes euthanasia.”
Creating Safe Space to “Go There”
When facing a serious conversation with a client, it’s important to establish rapport. This involves making a personal connection and building trust with everyone in the room. Rapport is built with good eye contact, sincerity and a genuine interest in what the client has to say.

In fact, if you want people to hear your recommendations, you should let them share what’s on their minds first. What are their concerns? What are they hoping for now, knowing it’s cancer? People experiencing grief have a huge need to be understood but have little capacity to understand. The more they can get off their chest and diffuse tension, the better they will listen when you bring up the subject of euthanasia. When the space feels supportive and comfortable, veterinarians can gently lean into the euthanasia conversation.

Carefully Choose Your Language
Veterinarians will need to leverage their best communication skills when delivering bad news—especially when asking a client’s permission to proceed with a very serious topic. Asking permission and delivering a warning shot are some of the most useful tools in the communication toolbox for euthanasia discussions.1

This last one is my go-to statement when I want to bring up pet euthanasia. It’s not a question asking how they feel about it, but rather an honest sentiment that seems to reduce guilt over such a monumental decision. While some may consider it anthropomorphizing, I truly believe that when love is at the heart of a euthanasia decision, and significant suffering is expected, animals trust their owners to do what’s necessary.

Aids to Guide the Decision Process

Quantifying a pet’s day-to-day experiences can help clients see what the veterinarian sees or suspects. There are numerous quality-of-life scales for veterinarians to reach for,2 and while most are not validated, they can still effectively aid in opening up dialogue around a patient’s quality of life.3 If the situation is serious enough, the findings will help illustrate that euthanasia may be the best decision.

Disease trajectories can also help clients understand the normal course of conditions like cancer. They get a better feel of what’s ahead, and it makes bringing up the idea of euthanasia sooner rather than later more logical, especially when cancer cure or palliative care treatments aren’t possible. While the exact timing of a natural death from cancer is hard to predict, veterinarians follow patterns to guide clients on knowing when euthanasia is acceptable.

graph illustrating Disease trajectory to aid in euthanasia decision-making

If they ask me what I would do if it were my pet, I answer honestly from their perspective, not mine: “Based on everything we know in this situation, I would feel OK with the decision. Very sad, but OK knowing it’s the best way to prevent further decline and struggle.”

Clearly Defining What Euthanasia Is
When I was a new grad practicing in Michigan, a young man brought in a cat with severe ketoacidosis. Appearing almost deceased on the table, the cat’s condition made it obvious to me to offer euthanasia and end her suffering. When I said something akin to, “Choosing euthanasia may be the kindest thing to do for her. How do you feel about this?” The man responded with “Yes. That’s what I want to do. Wait, what does euthanasia mean?” When I explained it would be to end her life as gently as possible, his demeanor changed and he firmly declared “no,” and to give the cat every chance to recover.

The experience was so surprising to me. I was under the impression everyone knew what euthanasia meant, but here was a person who was unfamiliar with the word, and had he not asked for clarification, I may have proceeded.

In modern times with such ethnic and language diversity, gathering informed consent before carrying out euthanasia is vital. Beyond just conversation, my consent forms define euthanasia as “humanely terminating life.” I highly recommend this standard for all veterinary services performing euthanasia.

Honesty and Compassion Should Take the Lead
It’s important to remember that while you may have euthanasia conversations regularly, today is your client’s first time. I think we can all empathize over what the option of euthanasia and death means…no more joyful memories together; no more snuggles or adventures. The book of this pet’s life is drawing to a close and we veterinarians are writing the final chapter. What clients want from us is affirmation that euthanasia is the right thing to do, and to know that we recognize the significance of the pending loss.4

If they ask me what I would do if it were my pet, I answer honestly from their perspective, not mine: “Based on everything we know in this situation, I would feel OK with the decision. Very sad, but OK knowing it’s the best way to prevent further decline and struggle.”

Lastly, if you believe your patient has entered into the dying process, even if a few months away from a natural death, let the client know. Sometimes just stating the obvious has the greatest impact.5

No one likes to have this conversation—client or veterinarian. But if there is a sweet spot to euthanasia, it’s hearing about the beauty of the human-animal bond and knowing any physical and emotional struggle is coming to an end.

References
  1. Shaw, J. R., & Lagoni, L. (2007). End-of-Life Communication in Veterinary Medicine: Delivering Bad News and Euthanasia Decision Making. The Veterinary Clinics of North America. Small Animal Practice, 37(1), 95–108.
  2. Lap of Love Quality-of-Life Scale. https://www.lapoflove.com/how-will-i-know-it-is-time/lap-of-love-quality-of-life-scale.pdf
  3. Fulmer, A. E., Laven, L. J., & Hill, K. E. (2022). Quality of Life Measurement in Dogs and Cats: A Scoping Review of Generic Tools. Animals: an open access journal from MDPI, 12(3), 400.
  4. Matte, A. R., Khosa, D. K., Coe, J. B., Meehan, M., & Niel, L. (2020). Exploring pet owners’ experiences and self-reported satisfaction and grief following companion animal euthanasia. Veterinary Record, 187(12), e122–e122.
  5. Cooney, K. (2023, April). When Quality of Life Scales Aren’t Enough; Counseling clients who can’t let go. CAETA. https://caetainternational.com/when-quality-of-life-scales-arent-enough/
Dr. Kathleen Cooney headshot
Dr. Kathleen Cooney is Senior Director of Medical Education for the Companion Animal Euthanasia Training Academy (CAETA), an educational branch of Lap of Love Veterinary Hospice. Dr. Cooney is well known for her work as an author and speaker on topics related to end-of-life care for companion animals. She loves all things old and gray.
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