Making the decision to euthanize

• Euthanasia is considered acceptable when a disease has become unmanageable, and suffering is present or imminent. A decision to euthanize may be necessary after severe trauma. One of the most common questions owners ask is “when is it time”? It can be extremely challenging to decide when this point is reached and there is often a grey area anchored by white and black at either end .
• As veterinary professionals it is our duty to support owners during this difficult time. 
• Aspects to consider include:
  • Is the dog still eating/drinking enough to sustain energy? 
  • Does the dog respond to attention from its owners? 
  • Is the dog able to participate in the things it likes to do? 
  • Is there uncontrollable pain? 
  • Has caring for the dog become too difficult for the owners? Fecal/urinary incontinence, mobility issues and cognitive dysfunction syndrome can take an emotional and physical toll on owners.  
  • Can the owner afford to continue care? 
• It is imperative that the owners do not feel rushed into making the decision to euthanize, although it may be necessary to educate about pain and suffering if the owners are not aware of it. Providing a Quality-of-Life assessment tool and working through this together can help owners to make decisions and understand why they must make a difficult decision. 
• There are other situations when euthanasia of a dog may be requested such behavioral issues, especially aggression. Often these owners have tried treatment (eg behavioral modification and medication) but are often judged for their decision. Mental health and physical health are both important when making euthanasia decisions. When a dog has unpredictable behavior, the safety of everyone it has contact with must be considered.  
• Owners may request euthanasia when the dog is no longer wanted or their circumstances have changed (housing, financial, etc). In these situations, the veterinarian must decide whether they will perform the euthanasia based on their own moral or ethical compass. They may be able to offer alternatives such as rescue groups or rehoming centers. To help with these challenging cases the British Veterinary Association has developed a Decision Tree: bva_guide_to_euthanasia_2016.pdf. 
• Legally, if it is performed humanely, an owner may request euthanasia of a dog for any reason. Ethically, we aim to offer euthanasia when no other options are possible. 
• In a recent study in the United Kingdom, the top three disorders with greatest odds for death by euthanasia were poor quality of life, undesirable behavior and spinal cord disorders (Pegram et al, 2021). 
• For shelter animals, risk of infection and insufficient holding space are additional reasons. 

Consent for euthanasia

Requirements of the consent form

The euthanasia procedure

New challenges in Euthanasia

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Pegram C, Gray C, Packer R M A, Richards Y, Church D B (2021) Proportion and risk factors for death by euthanasia in dogs in the UK. Sci Rep 11(1), 9145 PubMed Full Article.
• Bishop G, Cooney K, Cox S et al (2016) 2016 AAHA/IAAHPC end-of-life care guidelines. JAAHA 52 (6), 341-356 PubMed.

Other sources of information

• Cooney K A et al (2012) Veterinary Euthanasia techniques: A Practical Guide. Ames IA; Wiley Blackwell, pp 73-109.

Online open access articles 

• Euthanasia protocols (updated 2021) (cliniciansbrief.com) : 
  • Euthanasia Protocols 
• Alternative routes for anesthesia (cliniciansbrief.com) : 
  • Alternate Routes for Euthanasia 
• Quality of Life tools: 
  • lap-of-love-quality-of-life-scale.pdf (lapoflove.com) 
  • Quality of Life Scale for Pets online calculator (journeyspet.com) 
  • Quality-of-Life.pdf (utk.edu) 
  • HowDoIKnowWhen.pdf (osu.edu) 
• RCVS Code of conduct for veterinary surgeons regarding euthanasia:
  • www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/euthanasia-of-animals/ 
• BSAVA position statement on euthanasia: 
  • Euthanasia  
• BSAVA collection of end-of-life articles: 
  • BSAVA publishes new end of life collection with a pastoral focus - News 
• American Veterinary Medical Association 2020 Euthanasia Guidelines (avma.org) : 
  • AVMA guidelines for the euthanasia of animals  
• State Laws Governing Euthanasia in the United States:
  • www.avma.org/Advocacy/StateAndLocal/Pages/euthanasia-laws.aspx 
• Drug shortages: 
  • Pentobarbital back orders and potential alternatives (avma.org) 
  • Anticipated shortage of euthanasia products for animals - Recalls and safety alerts (healthycanadians.gc.ca)