Euthanasia Decision-Making: Raising a Difficult Topic
Veterinarians are obligated to both the pet and the client to initiate and facilitate euthanasia discussions when they know that death is near. End-of-life discussions clarify the client’s wishes regarding the pet’s death, help minimize regrets about how the pet’s death was handled, enable the client to make decisions ahead of time, and allow the client to cope with the death of their pet.
The SPIKES model provides structure on how to conduct a euthanasia decision-making conversation with a client.
1. Create an appropriate Setting
- Ensure privacy, attend to client and patient comfort, minimize distractions, allow for time, sit down at the same level with the client and invite supportive individuals.
- Establish initial rapport, using empathy statements, open-ended questions and compliments.
“It seems like you have been on a roller coaster for the last few months. How are you doing?”
“How do you feel Max is doing? How are you coping with Max’s illness?”
“I am glad that we have the opportunity to talk about how Max is doing.”
“This has been a tough time for both you and Max.”
2. Understand the client’s Perspective
- Establish what the client knows about the pet’s illness.
- Understand the client’s perspective and values on end-of-life care.
- Ask about the client’s previous experiences with euthanasia, using open-ended inquiry.
“I am wondering whether you have had previous experiences with making a euthanasia decision. What factors came in to play in making that decision?”
“I am wondering whether you have been present at a euthanasia procedure in the past. Tell me about that situation.”
- Explore religious or spiritual beliefs that may impact a euthanasia decision, using open-ended inquiry.
“Some clients have religious or spiritual beliefs that guide the euthanasia decision. I am interested in how these beliefs might guide your decision-making process.”
3. Ask permission to provide information (Invitation)
- Obtain the client’s permission to discuss euthanasia.
“I am wondering whether it would be alright with you if we took a few minutes to discuss the option of euthanasia.”
“Although we may not be facing this decision soon, I would like to ensure that that we prepare ahead of time.”
“We can hope for the best in Max’s care and we also need to plan for the future so that we can ensure Max’s quality of life.”
“It can be helpful to work through some of the details ahead of time.”
4. Provide the explanation (Knowledge)
“This is one of the most difficult decisions a client faces in caring for their pet.”
“Making this decision on Max’s behalf is not easy. I wonder if it sometimes feels overwhelming?”
- Provide accurate and detailed information about the animal’s condition.
“Max is probably feeling like you do when you have a bad virus. It probably hurts to move and it looks like it is difficult for him to get comfortable. His body temperature is high and he is having difficulty breathing. (Pause)”
“Since I haven’t seen Max for three weeks, I have noticed some changes in him. He has lost more weight and muscle tone and seems less responsive. He seems to be experiencing some pain. While I can give him more medication for his pain, his body is declining due to the cancer. (Pause)”
- Give information in small easily understandable pieces, pause and check for understanding prior to proceeding.
- Provide instructions on how to monitor the pet’s condition.
“Mary, things to watch for in Max are a decrease in his appetite and interest in drinking water, reduced activity level, difficulty breathing, such as panting or increased effort, and a lack of interest or responsiveness to you and his daily activities.”
- Ask for the client’s permission to continue to disclose the details of the euthanasia procedure.
“I am wondering if it would be alright with you if I were to walk you through the euthanasia procedure we use at our clinic.”
“There are several details and decisions in relation to the euthanasia procedure. I am wondering if you would like to discuss them now.”
“Who would like to be present during the euthanasia?”
“Where would you like the euthanasia procedure to take place?”
“Who would you like to conduct the euthanasia procedure?”
“Would you like to consider an autopsy?”
“What are your plans to care for Max’s body?”
“Would you like a clay paw print or hair clipping?”
“Would you like a ceremony to honor Max?”
- Avoid use of technical jargon and define medical terms.
- Avoid the phrase “nothing more can be done”, and reframe using the phrases “supportive care” or “palliative care”.
“We will provide supportive care to Max to make his life as comfortable as possible.”
“We will continue to provide palliative care for Max’s symptoms and to treat his pain.”
- Throughout the conversation acknowledge, validate, and normalize the client’s emotional responses.
- Use silence, empathetic statements, and display compassionate and caring non-verbal behaviors.
“I want you to know that I fully support your decision and will do my best to honor your wishes for Max.”
“You have taken such good care of Max throughout his illness. I can tell how much you love him.”
“I bet it is hard to imagine life without Max. I can see how close you are to him.”
“It’s quite common for clients in your situation to have a hard time making these decisions. It feels like an enormous responsibility.
“Of course, talking about this makes you feel sad. It’s normal.”
6. Summarize, plan for follow-up, and offer support
- Summarize what has been discussed.
- Negotiate a plan for treatment or follow-up.
- Identify client support systems.
- Provide information on support services (i.e. grief counseling, pet loss support hotlines and groups).
- Provide brochures, handouts, booklets, etc. that discuss end of life issues.
Author: Jane R. Shaw, DVM, PhD, Assistant Professor, Argus Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University
Offers a variety of resources to assist you in guiding your clients through the process of euthanasia and assist them in their grief.
Shaw JR, Lagoni L. End-of-life communication: Delivering bad news and Euthanasia-decision making. Vet Clin Small Anim 37:1; 95-108, 2007.