Written by: Shannon Fujimoto Nakaya, DVM
Euthanasia is one of the most difficult parts of my work as a veterinarian. Having the ability to end life is a weighted responsibility, especially for one who embarked on a career to heal animals. Moreover, bearing witness to the sadness and grieving that accompanies the loss of a beloved pet as you facilitate it's passing is not for the faint of heart.
That being said, as much as I dislike ending life, not all patients age and die gracefully on their own. There are some diseases which cause unyielding respiratory distress, intractable vomiting, non-healing wounds, unrelenting seizures, irreversible paralysis, or inconsolable anxiety. There are certain conditions which cause such severe suffering that death becomes a relief. As much as I dislike euthanasia, sometimes it does seem like a patient's quality of life is simply just not good enough. Sometimes when people choose choose hospice and a natural passing, patients don't die gracefully. They get stuck somewhere between here and there, unable to move, eat or drink; occasionally they vocalize and yowl, paddle, hallucinate, and just make for a traumatic ending to an otherwise good life. In these situations, even the most steadfast opponents to euthanasia usually agree to "cocktails" that relieve pain, anxiety, and distress.
As is done for terminally ill humans who suffer unyielding symptoms, we can narcotize animal patients and ease their suffering through morphine drips or their equivalents. But when this goes on for days and weeks, we start to realize that while we may be alleviating suffering, we have not recovered any quality of life and are simply waiting for the patient to die. As difficult as it might be for some of us to let go and “pull the plug” on a beloved companion, is this drug-induced coma what our companion would want? And is this what we would want for ourselves if the situations were reversed? In some cases, the answer is “yes” and gratefully, there are ways of maintaining patient comfort, even if it does involve a chemically-induced coma. In other cases, euthanasia is a release from suffering and a more graceful way of passing.
Sometimes physical barriers complicate caregiving. Lifting a 120 pound dog that can't walk is very different from lifting a 12 pound dog. At the same time, allowing any dog to repeatedly lie in its excrement because it can't independently move away is cruel and unusual punishment.
Sometimes there are financial limitations, both due to the cost of care and/or the number of other dependents being cared for. TIME is also a finite resource. Depending on the patient's condition, caregiving can sometimes become a full-time job or even more. As much as one might want to quit his or her day job to care for an ailing or aging animal companion, it is not always feasible.
For better and for worse, euthanasia is an option for animals. For many, this is one of the most difficult and heart-wrenching decisions to make on behalf of an animal companion. To me that's the hallmark of someone who really cares about that animal and who has really given deep thought to the matter of ending life. To me, having that kind of advocate is a gift and those are the animals who are blessed. As difficult as my job can be, I am convinced that I get to connect with the best humans on the planet – those who truly care about the animals who have crossed their paths.
When called upon to assist in euthanizing an animal, my goal is to make the transition between life and death as graceful as possible. That means being free of pain and anxiety through the dying process. That means getting every last cell in the body to take that final bow in concert. Truth be known, it is both a science and an art to facilitating a graceful exit. The formula that works perfectly for one patient may not work for the next patient. Some are “ready to go” and some maintain a diehard tenacity to life even when it is clearly a toil for them to do so.
These days, my euthanasias usually start with an individually tailored “cocktail” -- a combination of drugs that it is administered subcutaneously or just under the skin with a very tiny needle. The goal of the “cocktail” is to chemically induce a profound narcolepsy and analgesia – in simple language, make the patient pain free and really really sleepy. Remember when you were a child and really didn't want to fall asleep because there was a party going on and you didn't want to miss anything like Santa delivering presents? But eventually you just got sooo sleepy that you couldn't stay awake any longer, even when the party was still happening. That's essentially what I'm trying to effect. The patient feels no pain, only peace at being in familiar surroundings with familiar humans. As the “cocktail” begins to take effect over the next 15 minutes or so, the patient gets sleepier and sleepier till they can't stay awake any longer.
The art of a graceful exits is in the tailoring of the cocktail. It is a combination of knowing how different substances work on the body, what processes are affecting the body, how the patient is dealing with all that is happening, and the patient's underlying personality, temperament, and tenacity to life.
You know how some children just fall asleep when they're tired while others will fight sleep and get hyperactive and some will have a temper tantrum and kick and scream in frustration? Same thing with animals. Some just go with the flow and some dislike feeling like they're not in control; some respond to their "cocktail" as permission to let go and proceed to dying naturally, and others need to have their cocktails “topped off."
When the cocktail has done it's work, the animal should be in a very deep and comfortable sleep and very, very minimally – if at all – conscious of the actual euthanasia. Euthanasia is achieved by a barbiturate overdose given by intravenous injection. This means that a needle is inserted to a vein and a drug is given that effectively stops breathing and heartbeats. The drugs and the method of giving them intravenously makes this part go relatively quickly. Usually, the patient stops breathing before the injection in completely given. Usually, the patient's heart stops beating while the injection is still being administered, or within a few minutes thereafter.
Sometimes there will be urine and feces released just as or just after the animal dies. This is not a statement from the animal about dying; it is biology. The sphincters which the animal was holding shut in life are no longer being held thus and the bodily substances are leaving. Sometimes there can be muscle twitches here and there for some minutes after there is no definable heartbeat. This is the part about every last cell in the body taking their final bows; in some plays, the performers take their final bows in groups rather than all at once. All of these stages can and do occur in natural passings as well as assisted ones.