Minimizing the Impact of Euthanasia on Veterinary Teams

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Veterinarians and veterinary nurses take an oath that includes promoting animal welfare and preventing animal suffering,1,2 but the oath can become a burden when those helping patients and clients do not take care of themselves. Euthanizing a patient is one of many stressful veterinary events that contribute to compassion fatigue,3-7 a condition experienced by those in helping professions5,8 that depletes internal resources.6 Therefore, veterinary professionals need ways to cope with such stress.

Veterinary team members often have mixed emotions about euthanasia, which is literally translated as good death. Some have difficulty seeing any good, whereas others feel privileged to offer euthanasia to clients and help them make an end-of-life decision for their pet. The conflicts team members experience depend on personal beliefs and values, as well as the circumstances; for example, team members may not struggle internally when a patient has a low quality of life but may be deeply conflicted when euthanasia is chosen for reasons such as the owner’s quality of life, financial situation, or other nonmedical issues.3,4,7,9 

Many other emotions can arise in these situations. Veterinary team members often feel grief when they have formed a close relationship with a client and patient and can be conflicted with other feelings10 (eg, relief the patient is no longer suffering, sadness his or her life has ended, gratitude to have helped provide a peaceful death). Other team members may feel angry or frustrated that a treatable animal was euthanized, helpless because they could not do more for the patient, but grateful for knowing the patient’s fate.

These feelings can manifest in compassion fatigue and affect team members emotionally, spiritually, socially, physically, and intellectually.6 Practices should always have a plan that addresses every effect.  

Delicate Discussions

In human medicine, patient rounds provide a forum for healthcare team members to discuss cases from emotional and psychosocial perspectives. One study found physicians who attended Schwartz Rounds experienced a statistically significant decrease in stress and an increased ability to cope with the emotional aspects of their work.11 (See Resources.)

In veterinary medicine, debriefings can allow team members who play different roles during a euthanasia to share their feelings, perspectives, and experiences. This can help each team member feel less isolated, see the situation from a different perspective,12 regulate his or her internal feelings,13 and realize others experience similar emotions. 

For example, following the euthanasia of a young cat that presented with an aortic thromboembolism, a veterinary team member may feel proud about educating the client on the medical needs and treatment options available, glad the patient was no longer suffering, frustrated more could not be done to save the cat, and sad the clients were too upset to stay for the euthanasia.

These delicate debriefings are likely to be more successful when facilitated by a mental health professional who has expertise in veterinary-related issues.11

Finding a Facilitator

  • The AVMA offers wellness and peer assistance online16 that allows members to assess their wellness and connect in online forums.
  • Many state VMAs offer resources.  
  • Veterinary practices could consider training a team member in emotional CPR (eCPR), an educational program that teaches people how to assist others through an emotional crisis,17 either individually or in groups.
  • Facilitators are available at many universities. For example, University of Tennessee College of Social Work offers a veterinary social work certificate that is designed to train mental health professionals to provide services at the intersection of veterinary medicine and social work practice. In the future, the certificate will be available for those working in the veterinary setting. For more information, call (865) 755-8839.

Individual Counseling

The impact of euthanasia on a team member may need more attention than a group debrief. Multiple euthanasias, situational factors, and outside personal stress are some reasons a team member may seek additional individual support. When looking for a local counselor, it is important to find someone who specializes in grief support and/or compassion fatigue and who has an understanding of veterinary medicine’s unique aspects.

Emotional Detachment

Some team members may emotionally detach themselves from patients as a protection against compassion fatigue, which can have benefits and drawbacks. Temporary emotional detachment can be helpful if it allows a team member to complete a euthanasia, so long as he or she later acknowledges his or her emotions, but complete detachment can lead to loss of compassion.7,13  

‘In the End We Are Simply Angels’

Benchmarks 2015 contributor, Mary Gardner, DVM, co-owner of Lap of Love Veterinary Hospice, shares how end-of-life care has transformed her life and practice:

“The biggest impact this line of work has had on me is the amount of appreciation and, in many cases, relief I see from families. They need our help as a profession. They are scared, they have concerns, and they want to honor their pet in ways that are meaningful to them. We embrace that, and the feedback has been overwhelming. I thought I would suffer some type of compassion fatigue euthanizing so many pets every week, but I can see the suffering in the pets and their families and I am able to help all of them. My compassion is actually overflowing after I leave every appointment. Most of our clients are taken aback by the experience and how “good” we make it. Initially, they may assume the “angel of death” is coming to visit, yet in the end we are simply angels. And that’s what they all tell us. It’s very humbling.”

Source: Benchmarks 2015: A Study of Well-Managed Practices. Columbus, OH: WTA Veterinary Consultants & Advanstar Publishing; 2015:110-111.

Other Coping Mechanisms

Here are other suggestions for coping with the emotional toll of euthanasia. (See Resources.)

  • Taking a short break before seeing the next patient6
  • Practicing meditation, self-reflection, or relaxation
  • Taking care of oneself with enough exercise and sleep6,12,14 
  • Laughing—there can be a place for humor, even in emotionally charged situations3,15
  • Creating memorials (eg, a board in a common area for notes from clients that acknowledge the loss of their pet and the veterinary team’s good work)   

Conclusion

Euthanasia is an emotionally wrought experience for the veterinary team and clients, but its effects can be minimized when the practice has a plan to take care of the many ways team members and clients are impacted.

1Recognize the toll euthanasia appointments take on personal well-being and provide resources (eg, time to meditate, memorials) for processing emotions.

2Prepare a plan that addresses all the feelings (eg, grief, anger, frustration, sadness, helplessness) that can manifest in team member compassion fatigue.

3Hold debriefings, preferably with a mental health professional, to allow team members who play different roles in euthanasia to share feelings and perspectives.

References and author information Show
References
Resources

 

  1. Veterinarian’s oath. American Veterinary Medical Association. https://www.avma.org/KB/Policies/Pages/veterinarians-oath.aspx. Accessed 2016. 
  2. Veterinary technician oath. National Association of Veterinary Technicians in America. Accessed 2016.
  3. Morris P. Blue Juice: Euthanasia in Veterinary Medicine. Philadelphia, PA: Temple University Press; 2012.
  4. Yeates JW, Main DC. Veterinary opinions on refusing euthanasia: justifications and philosophical frameworks. Vet Rec. 2011;168(10):263.
  5. Rank MG, Zaparanick TL, Gentry JE. Nonhuman-animal care compassion fatigue: training as treatment. Best Pract Ment Health. 2009;5(2):40-61.
  6. Mitchener KL, Ogilvie GK. Understanding compassion fatigue: keys for the caring veterinary healthcare team. J Am Anim Hosp Assoc. 2002;38(4):307-310.
  7. Sanders CR. Killing with kindness: veterinary euthanasia and the social construction of personhood. Sociol Forum. 1995;10(2):195-214.
  8. Huggard PK, Huggard EJ. When the caring gets tough: compassion fatigue and veterinary care. VetScript. 2008:14-16. http://www.compassionfatigue.org/pages/HuggardVetScript.pdf. Published May 2008. Accessed October 2016. 
  9. Rollin BE. Euthanasia, moral stress, and chronic illness in veterinary medicine. Vet Clin North Am Small Anim Pract. 2011;41(3):651-659.
  10. James JW, Friedman R. The Grief Recovery Handbook: The Action Program for Moving Beyond Death, Divorce, and Other Losses Including Health, Career, and Faith. New York, NY: HarperCollins Publishers; 2009.
  11. Lown BA, Manning CF. The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Acad Med. 2010;85(6):1073-1081.
  12. Cohen SP. Compassion fatigue and the veterinary health team. Vet Clin North Am Small Anim Pract. 2007;37(1):123-134.
  13. Bonanno GA, Papa A, Lalande K, Westphal M, Coifman K. The importance of being flexible: the ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychol Sci. 2004;15(7):482-487.
  14. Pfifferling J-H, Gilley K. Overcoming compassion fatigue. Fam Pract Manag. 2000;7(4):39-44. 
  15. Francis L, Monahan K, Berger C. A laughing matter? The uses of humor in medical interactions. Motiv Emot. 1999;23(2):155-174.
  16. Wellness and peer assistance. American Veterinary Medical Association. https://www.avma.org/professionaldevelopment/personal/peerandwellness/pages/default.aspx. Updated 2016. Accessed 2016.
  17. Emotional CPR. National Empowerment Center. http://www.emotional-cpr.org. Updated 2015. Accessed 2016.
Author

Sarina Manifold

LCSW University of Tennessee College of Veterinary Medicine

Sarina Manifold, LCSW, is assistant professor of practice with veterinary social work at University of Tennessee Veterinary Medical Center (UTVMC). As a licensed clinical social worker and certified grief recovery specialist, she provides crisis intervention, guidance for end-of-life and treatment decision-making, resources, and grief counseling to clients, faculty, and team members in small and large animal practice at UTVMC, as well as to community members and local veterinarians. Sarina earned her master’s degree in social work from University of Tennessee, Knoxville. Sarina’s areas of interest and clinical work include compassion fatigue support, communication skills training for animal-related professions, and grief and bereavement support for individuals and families who have experienced the death of their companion animal. 

FUN FACT: Sarina enjoys reading, running, and playing with her 1-year-old daughter and her 3- and 13-year-old fur children.

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