Euthanasia: Gentle Death, Painful Decision
Copyright Sarah Hartwell
Adapted with permission from Cat Resource Archive and edited by Dog Breed Info Center®.
This was the original euthanasia article that was later expanded into the article "Time to Let Go.”
The decision to end a life is hard and can feel like a betrayal of trust. One may feel she has murdered her terminally ill dog. Another, in a similar situation, felt guilty at not making the decision sooner.
It is easy to become emotionally caught up in keeping a pet alive when common sense tells you there is no hope of it regaining its health. Sometimes it seems that your own life can't go on when you have to make the decision to euthanize a long-term K-9 companion. It is hard enough to end the life of an old and frail dog; perhaps if you give it another day, or another week, the dog might die naturally in its sleep even if you know that it will linger uncomfortably until it succumbs to dehydration, starvation or to the gradual poisoning of its blood by liver or kidney failure. If the dog appears outwardly healthy but has an untreatable medical condition, the decision is made yet harder.
A good vet will help you to weigh the pros and cons of further treatment versus euthanasia, but ultimately it is your decision. It is never easy, but it helps if you are prepared. The following are common guidelines:
- A dog is in incurable pain that cannot be alleviated by drugs.
- A dog has severe injuries from which it will never recover or which severely compromise its quality of life.
- A puppy is born with serious defects which cannot be surgically corrected and cannot be endured by the dog; it may not survive weaning or it may not reach maturity (e.g. progressively worsening hydrocephalus).
- A dog has unresolvable behavior problems which mean you cannot keep it and which mean that it is not re-homeable; the problem behaviors have not responded to behavior modification therapy or to drugs—for example, aggression towards humans that results in people being physically injured (note: some behaviors are due to neurological conditions/brain damage and are incurable), soiling behavior.
- A dog has an age-related condition that cannot be alleviated and causes misery, e.g. advanced senility, incontinence.
- A dog is terminally ill and will deteriorate. Euthanasia may not be an immediate concern, but will be later on. Euthanasia may be chosen immediately to prevent suffering later on.
The first five points are fairly clear-cut cases for euthanasia—no caring owner lets a pet suffer. The final point causes the most soul-searching and this article addresses some of the problems of deciding when to have a terminally ill dog euthanized and whether treatment to prolong life for a short while will benefit the dog. Sometimes, a terminally ill or injured dog is given life-prolonging treatment because the owners cannot yet come to terms with its condition. It is hard to come to terms with mortality in general.
Cost of treatment may be the deciding factor at a very early stage. Unless the dog is insured, the owner has savings or unsecured loan facilities, or the vet offers a pay-by-installments plan, any available treatment may simply be too expensive.
Find Out About the Illness or Condition
- How much do I know about my dog's illness or condition?
- Is it in pain, distress or mild discomfort? How feasible is it to alleviate this pain and give the dog a reasonable quality of life for a period of time?
- Are there any new treatments available for it?
- Are there any surgical advances for this condition?
- Would a second opinion be beneficial to the dog?
- Can I afford the treatment?
- Can I administer treatment at home, e.g. daily tablets, daily injections, prescription diet, manually expressing dog's bladder and/or bowel?
- Will the dog physically resist treatment?
How fast will my dog deteriorate without treatment? How fast will it deteriorate with treatment? How fast does the illness progress and what are the signs of its progression?
Some vets view disease as a challenge and death as an insult to their competence, regardless of the animal's condition. Others believe that prolonging an animal's life through treatment is inhumane. Most fall between these extremes and recommend that life be prolonged only for as long as the dog has a reasonable quality of life. While a second opinion may be helpful to you, don't prolong a dog's existence in the hope that the 14th, or 15th, or 20th vet consulted knows of a treatment. Don't prolong its life purely in the hope that a treatment will be available before the illness or condition reaches its inevitable conclusion.
When is a second opinion useful? Vets in small-animal practices may have more up-to-date information than those who mainly treat farm livestock. In these cases the vet himself will most likely refer you to another vet. A good vet is aware of his own limitations. There is a tendency to look up information on the Internet (that's possibly why you are reading this). There is some excellent information available about up-to-the-minute treatments. There are also articles and individuals who will give you false hopes and some of those groundbreaking treatments may not mention the failure rate or whether they are still experimental.
Find out about your dog's illness or condition. Ask the vet to explain it to you in terms that YOU can understand. Ask sensible questions. He may recommend reading informational leaflets produced by animal welfare societies. Write down any questions and have them ready for your next visit to the vet. If you have obtained information from other sources—journals or the Internet—ask your vet to discuss it with you. Treatments which are offered in one country or locality may not be available or feasible due to lack of expertise, or perhaps affordability, in other localities.
Your vet may know of specialists offering experimental treatments. They may be situated some distance away which means a lot of traveling or leaving your dog with them for a while. The word “experiment” does not mean vivisection and your dog will not be made to suffer unnecessarily. Whether the treatment is successful or not, your dog has not suffered unnecessarily and lessons learnt from treating it will be useful in helping other dogs in the future.
If you have any misgivings about allowing your dog to receive experimental treatment/surgery then discuss these. If the veterinary hospital offering the treatment is some distance away, you may decide that travel and separation will distress your dog. As the owner, you know your dog better than anyone else and a good vet will respect your decision if you decide against further treatment. Choose what you believe will cause your dog least distress.
When faced with the difficult choice of whether or not to attempt life-prolonging treatment with no guarantee of success, I sometimes have to say, "She's had a good life, I don't want to prolong it just because I can't bear the thought of losing her."
Life Expectancy and Life Quality
- What sort of life expectancy does my dog have with/without treatment?
- Will treatment prolong life or merely prolong suffering?
- Will the treatment or side-effects cause distress for either of us?
- Do my other dogs risk being infected or can they be inoculated?
Having learned that a pet is incurably ill or showing signs of advanced age, an owner usually asks “how long has he got?” Some illnesses progress very slowly even if untreatable. Other conditions are more aggressive and progress rapidly after symptoms first appear. Dogs are good at hiding early signs of illness and, even if the owner is vigilant, some reach an advanced stage of their illness before exhibiting symptoms. Dogs also differ in the way they react to diseases and to treatments so your vet probably won't be able to give you a hard and fast forecast about life expectancy. He can give you guidelines and he can tell you about the signs of deterioration. Knowing whether the dog has a few weeks or a few years of relative health will affect your decision.
Most vets will give estimates of life expectancy varying from days to months depending on the normal rate of progression of the illness, the stage of illness the dog is at, the dog's age and general condition. They will normally advise as to what sort of quality of life the dog can expect and for how long. Knowing whether a dog can expect a few weeks or a few years of relative health or discomfort greatly affects the decision.
Some diseases are infectious though the dog may stay relatively healthy for a while. Dogs with certain diseases can remain healthy for some time. Your other dog may be vaccinated, but what about your neighbors' dogs? Are you able to keep your dog indoors or segregated from other dogs all the time?
Assessing the side-effects of treatment (ranging from a prescription diet for first-stage kidney disease to daily injections for diabetes or even weekly dialysis sessions under general anesthetic) is also a major factor as is the possibility that a dog can survive comfortably for a short period without a potentially distressing course treatment.
When an 11-year-old pet showed the first signs of heart failure (collapse and loss of consciousness) the owner opted to try the available treatment. Some animals had lived for 18+ months using daily medication. However, after four days the pet began to deteriorate, refused to eat and showed signs of distress at enforced inactivity. She was depressed, suffering and the vet confirmed that she was not responding to treatment. For a previously active, happy pet there was no alternative but euthanasia, however much it hurt the owner to make that decision.
What matters to the animal is quality of life not length of life. A dog doesn't make plans for next year's vacation. Dogs live for the moment—and for their next meal. Some treatments offer a good quality of life for many years. Sometimes, however, a ”short life and a gay one” is better than a long, miserable existence.
Quantitative Measures of Deterioration
Ultimately, the dog's condition will deteriorate as the illness takes its toll. The emotive decision of whether to euthanize a dog becomes imminent. An owner who has opted for prolonged treatment may have built up such an emotional attachment to the dog that the decision is harder now than it was when the condition was first diagnosed. Blood and urine samples, tissue biopsies and X-rays or scans can be used to quantitatively measure the progression of the illness and can be used as an indication as to the dog's quality of life (since dogs are capable of hiding discomfort sometimes until they reach the point of collapse).
The measurements of urea and creatinine in the blood give an accurate measure of kidney function. The higher the levels, the worse the problem. A special diet can compensate for impaired kidneys for a while or even slow down deterioration. Once the urea levels reach a certain threshold, death is inevitable, uncomfortable and often protracted. At this point, most vets recommend euthanasia although many owners opt for euthanasia well before this point based on cost of treatment, life expectancy and life quality (this being very subjective).
- Will other commitments (job, family, holidays) prevent me from giving medication or from taking the dog to the vet regularly?
- Is there someone to continue the treatment when I go away on vacation or am I willing to give up vacations? What if I must travel because of my work?
- How often must my dog visit the vet—can we both cope with the traveling? Does the vet do house calls or must I take my dog for checkups at the hospital because checkups require specialist facilities/equipment?
- Can I afford long-term treatment for the dog? Does my pet insurance (if I have a policy) cover this sort of treatment?
- Will the dog allow me to give it tablets, injections, etc.? Will it become distressed when I try to medicate and how will the stress affect the dog's condition and my relationship with my dog?
Once, diabetes was a death sentence. Nowadays dogs can receive daily insulin injections and live an active life. Fifteen years ago, a dog was most likely put to sleep because it had epilepsy. Many epileptic dogs now have their condition controlled by tablets. Life-prolonging treatment may mean daily medication and nursing.
Not all owners can cope with giving daily treatment. With an extremely uncooperative dog, even giving tablets can be impossible. Some vets will give the daily treatment for you—if you can afford this. A determined dog may resist all attempts to nurse it until it is too weak to resist, by which time treatment may be ineffective. It may be healthy enough to enjoy a shorter life expectancy without medication, but check this with your vet.
You will also need to know what side-effects to expect and whether you can cope with them. You may decide that the side-effects outweigh the benefits of treatment. Sometimes, the economics of the situation will be a major factor.
Don't feel guilty just because you couldn't afford a particular treatment. You have no guarantee that the treatment would have worked in the case of your dog. The important thing, from your dog's point of view, is that you have provided it with a good home and good care during its lifetime and that you are not going to let it suffer or allow it to lose its quality of life.
- Is my dog going downhill?
- Am I witnessing deterioration or just a hiccup?
- Is further treatment possible, or humane, at this stage?
Eventually an old or terminally ill dog's condition deteriorates. Gradual deterioration may go unnoticed unless you keep notes, weigh your dog regularly or physically examine it regularly. Discuss the normal course of your dog's illness with your vet and ask what symptoms to look for. Certain symptoms may mean the dog has reached the final stages of its illness and has nothing but suffering ahead.
It is important to recognize when the dog is deteriorating and decide whether treatment is possible at this stage and if so, whether it is humane or would be purely to benefit the owner's desire to put off an unpleasant decision.
Facing the Inevitable
Finally, you can put the decision off no longer. Modern drugs are extremely fast-acting and the end is very peaceful. The final stages of a terminal illness, however, can mean a painful, prolonged end. If, during its life, your dog has been well cared for, you owe it this last duty—a gentle death, not a slow one. Further information on how to make the decision, how euthanasia is performed, death from natural or accidental causes and how to cope with bereavement are available in “Time to Let Go,” a dog-care article that evolved from this one.
In making the decision it is helpful for owners to understand how euthanasia is performed. Euthanasia in small animal practice is by anesthetic overdose, usually by injection into a vein or kidney, sometimes by gas if the animal is distressed by handling. The knowledge that euthanasia lives up to its literal translation of ”easy death” and is painless and fast while a ”natural death” may involve convulsions, hemorrhaging, starvation/dehydration and, in the terminal stages of many illnesses, pain, may be that crucial deciding factor.