In the literature
Gray C, Radford A. Using electronic health records to explore negotiations around euthanasia decision making for dogs and cats in the UK. Vet Rec. 2022;190(9):e1379. doi:10.1002/vetr.1379
The research …
Euthanasia is a common but emotionally stressful procedure in veterinary medicine. Although it is thus important to document conversations about euthanasia for thorough record keeping, these discussions and decision-making processes can be difficult to adequately record and evaluate.
This study reviewed electronic medical records from a veterinary surveillance database in the United Kingdom to determine the type of information (eg, whether the clinician or pet owner initiated the conversation, reason for euthanasia, negotiations for or against euthanasia) included in end-of-life discussions, specifically those in which euthanasia was delayed. Clinicians recorded components of conversations with owners that supported or opposed the decision to euthanize. Reasons for euthanasia included relief of suffering caused by systemic disease and subsequent decrease in quality of life, limited owner resources for continued care, and burden on the owner’s time, emotional state, and energy.
Disagreements between clinicians and owners were included in some records, indicating a misalignment in perceptions of patient suffering and potential treatment options. In cases in which euthanasia was considered the best course of action but was not performed immediately, recommendations were made for palliative care, and discussions regarding future plans for euthanasia were recorded.
Engaging in and recording conversations about euthanasia can be complex; a longer appointment may be needed to explore and document owner concerns and provide guidance. Detailed records can be beneficial, especially for subsequent clinicians who may refer to a patient’s records to understand the full decision-making process if euthanasia was not elected.
… The Takeaways
Key pearls to put into practice:
1. Discussions about euthanasia, including reasons for or against, are an important part of patient records. Detailed notes can inform the team of the complexities that led to the discussion and help focus future consultations.
2. Clear communication is needed with the owner, and ethical implications of the decision to euthanize should be considered. It can be helpful to understand current euthanasia best practices and what factors owners prioritize when making decisions.
3. Palliative care should be considered prior to euthanasia. Relief of clinical signs (eg, pain, anxiety) can increase comfort at the end of life. Owners not ready to move forward with euthanasia may instead elect palliative care to improve patient welfare.