You Have Asked ...

How often do you deal with requests for euthanasia for nonmedical reasons? Have you established a policy about what you will and will not do?

This column provides a means of exchanging ideas. To pose a new question or to share your opinion on the next topic, visit www.cliniciansbrief.com and click on the Clinician's Brief icon. Each issue, we will publish a representative sample of reader responses as well as an expert's view.
Next question: What would you recommend as first steps for a practice interested in beginning to offer the sale of products to its clients? We have never actively marketed any products, although we do carry veterinary diets.

Our Readers Say ...

Making the Choice
Our clients' reasons for requesting nonmedical euthanasia include:
• Behavioral problems
• "Old age" with poor quality of life
• Change in owner's situation (moving, "allergies," health, etc.)
• Owner cannot or will not pay for veterinary care
These reasons constitute less than 10% of our overall requests.

Our policy is that we will honor the owner's request under the following circumstances: 1) if reasonable effort has been made to avoid the need for euthanasia, 2) if euthanasia is truly in the best interest of the animal, and 3) only after reasonable payment options have been offered to and declined by the owner. Alternatives include behavioral
consultation, humane society adoption, or private adoption.
Barry Brown, VMD
Canfield Vet Dog and Cat Hospital, Pittsford, New York

Rarely Even Asked
Rarely do we receive such a request. Unless we have a valid medical reason, such as dangerous aggression, we won't do it. Instead, we try to find a home for the client's animal or to place it with a shelter.
Norman Manning, DVM, MS
Wake Forest Animal Hospital, Wake Forest, North Carolina

The Answer is "No"
We never euthanize an animal, except for medical reasons. I just can't imagine that any veterinarians perform euthanasia for nonmedical reasons. Unless there is a strong possibility of biting or other potential for serious injury to others, we avoid it.

In general, our staff turns away clients who ask us to put down their animals for reasons of convenience or financial constraint. As an alternative, we have them sign a release form that allows us to rescue and place the animals in new homes. If clients make this decision, we ask them to keep this service confidential, as we want to discourage people from dropping off animals that they no longer want or can't take care of.
Susan Tasillo, DVM
Edgefield Veterinary Hospital, Hampstead, New Hampshire

In the Interest of Safety
None of us likes dealing with euthanasia for any reason. I find myself having more problems with it every day, even after 34 years of practice. I believe that euthanasia for convenience when other options are available can't be condoned. The aspect that must not be lost, however, is that in some instances aggressive dogs can be a danger to their owners or others. Behavior modification may work in some of these cases, but there are hard-core aggressive dogs that pose a risk to the owner and any other person who comes in contact with them. Aggressive dogs kill many people in this country every year. We should not fault those who may feel that the risk of having a child or an adult killed or seriously injured outweighs the guilt of euthanizing a potentially dangerous animal.
Ralph E. Barrett, DVM, Diplomate ACVIM
Fort Collins, Colorado

A Question of Conscience
The decision of whether to perform nonmedical euthanasia is left up to the individual doctor at our hospital. The main reason that we would agree to this extreme measure is aggression, as we really can't recommend adoption. These requests make up only about 5% of our euthanasias. Most owners request euthanasia for older pets that have a poor quality of life.

There have only been a few pets that our hospital has declined to put down. If a healthy, nonaggressive pet is adoptable, we make recommendations that the owner contact the appropriate rescue service or animal shelter.
Julia Larson, DVM
All Our Pets Veterinary Hospital, Sacramento, California

Education and Personal Ethics
Performing euthanasia as a "convenience" is one of those issues with which veterinary professionals continue to struggle, especially when asked to end the life of a healthy animal. There are instances in the literature where veterinarians refused to euthanize a healthy animal, and then the owner killed the animal in an aggressive or violent manner. However, ending the suffering of a beloved pet is seen as a "gift of love" by many pet owners and veterinarians.

Educating clients about the pet's condition, whether behavioral or medical, is extremely important. Many decisions, such as euthanasia, are made from clients' feelings of frustration, helplessness, lack of control, or confusion. Knowing there are choices and reviewing the options and resources can help clients understand that their situation is not unique and that more than one solution exists. Education leads to knowledge, and knowledge leads to better decisions.

Euthanasia is one of the topics discussed in the course I teach to senior veterinary students on the human-animal bond. My experience with the students has been that both sides of the issue are supported and strongly defended, although both sides usually allow flexibility for "special" circumstances. For both veterinarians and clients, to avoid doing something that upsets them or that they feel is wrong is the best way to approach this issue. Such dedication to one's moral beliefs frequently leads to creative problem resolution.

C. Joy Dias, PhD, LMFT
Gainesville, Florida

WHAT THE EXPERT SAYS . . .

As a specialist in behavioral medicine I cannot condone, recommend, or participate in euthanasia of convenience. After all, at some point someone has recommended that every single one of my patients be killed. This has been the past mantra of behavioral medicine. In fact, the first year that the number dipped under 100% was 1998 when only 90% to 95% of my behavior patients were recommended for death. We tend to recommend killing things that we either do not understand, think we cannot fix, or feel that the clients cannot handle medically, emotionally, and financially. If we remove the option of euthanasia of convenience-such a sterile, clean sounding term, which is why I use the word "kill"-and do the best we can, the outcomes can be very different. For example, well over 90% of my patients improve so dramatically with treatment that few people would believe that they could have been so problematic. This is not to say that some dogs are not too dangerous to safely keep-but these cases are very, very rare-and my ability to determine which animals fall into this group is flawed. Experience has shown that the commitment of the client to work with and protect the dog is actually the best prognosis.

Views and Assumptions
Now that I am on the faculty of a human psychiatry department, I see this issue with even more clarity. Nonmedical euthanasia has more to do with people and their views than it does with pets. Euthanasia is simply not an option in human medicine, so when faced with a problematic case, health professionals automatically begin to evaluate all other options. When this works well, people think creatively and engage in discussions of values and realistic options. Too often people feel that pets are "disposable" if they do not meet some idealized worldview. And...we contribute to this. Many people who bring me their pets tell me that their vet thinks that it would just be "easier" to euthanize the dog. Just because something is hard doesn't mean you shouldn't attempt it.

"Disposability" of Life
Having practiced both emergency and general medicine, I am familiar with the extent to which our culture still entertains the concept of "disposable" pets. I personally have never agreed to participate in nonmedical euthanasia because I could not live with myself. Most people who request nonmedical euthanasia have fears, financial concerns, and constraints that they are not sharing. By talking to them, I often learned that they wanted to euthanize the pet to avoid abandoning it in an animal shelter or risking having it "abused" by someone else. These people do not realize that there might be other options. These options may still involve relinquishing the pet, but most of the time they do not. The solutions sometimes involve talking to other people-family members, doctors, social workers-or making arrangements for pet care. When there was truly no way to make the situation work, I ethically felt that I could only refuse to euthanize the pet if I could find it another suitable home. This is how many vets come by their "office" cats and dogs, so I know am not alone.

Self-Respect and Ethics
The issue of nonmedical euthanasia was the second most common topic (after the issues of local politics and concerns about the pay and treatment of women in veterinary medicine) for which veterinary students approached me in my 14 years of veterinary academia. My advice was always that they had to get up and look one person in the face every single day: themselves. If they felt sick about something, they shouldn't do it. This is the same logic I have always taught clients regarding dog training or choosing a veterinarian: If it feels wrong in the pit of your stomach, walk away.

Unfortunately, once you have done this you are ethically obligated to take the next step, and the alternatives to nonmedical euthanasia are time-consuming. Veterinarians generally feel that they receive no return on their ethical investment. However, they miss the point. By acting in an exemplary manner you send a message and you set an example. As with all nonmaterial circumstances, you may not be able to evaluate your impact until a generation or so later. The force that will eradicate nonmedical euthanasia involves a change of attitude.

Timing is Paramount
The most important visits veterinarians have with their clients are those before the clients obtain or choose a pet and the first visit with the pet. Yet how much time do we allocate to first puppy and kitten visits-15 minutes? We need to begin to practice integrated anticipatory guidance with our clients before the pet is chosen and for every stage of life of the pet and the clients, because we all change as we age. That education works is not in doubt. Witness the changes wrought by early spay/neuter programs. (See numerous articles in the past few years in the Journal of Applied Animal Welfare Science.)

At the crux of why I feel so strongly about this issue are two concerns: (1) How we treat those less fortunate than us and those dependent on us, for whom we are guardians, is the ultimate reflection of the type of people we are. Heartfelt concern and taking responsibility for these living things will make us better people. (2) Having a pet can be the defining experience that makes a child into a humane adult. We should consider how we alter this metaphor when we condone euthanasia of convenience.