Choosing Euthanasia: What happens next?

 The process of euthanasia

Once you have made the decision to euthanize your cat and called your veterinarian, the office staff will schedule a euthanasia appointment. Generally these appointments are open-ended, so that you can spend as much time as you need before or after the euthanasia to feel closure, and to feel composed enough to leave the hospital. It is best to bring someone with you, if possible, to drive you home, if needed. It is also best not to bring small children, if at all possible, or have them step out of the room while the euthanasia takes place, so that you are able to focus on your last moments with your cat.

Feral Cat Silhouuette by Blake Shaw

You have the option to be present with your pet during the euthanasia or to leave the room – either leaving your cat in the capable hands of your veterinary staff and exiting the building before the euthanasia takes place, or to come back into the room after the euthanasia solution has been administered to view your pet. There is no “right” way to do this, and most veterinary hospitals are very flexible about what can be done. The only thing that they may ask is that you allow a staff member to gently restrain your animal for the doctor, which might prevent you from having your cat in your arms or on your lap for the euthanasia, itself.

If your cat is distressed by the veterinary office, you may be offered a sedative either prior to travel to the hospital, or at the time of your appointment to relax your pet before the euthanasia takes place. Depending on the sedative, your cat may merely be calmer, or may actually fall asleep before the euthanasia.

During the euthanasia procedure, an overdose of an anesthetic medication is injected into one of your cat’s veins. Most cats do not react to the needle poke, though some may protest a little at having their leg held. This medication causes your cat to fall asleep first, and then the respirations and heart will stop. Many cats will heave a sigh, as though of relief, as they fall asleep and feelings of pain and discomfort subside. Sometimes, they may look around or look up as though they are having a moment of clarity, or are looking for your face, before they become unconscious. Usually, the cat’s heart has stopped before the veterinarian is finished giving the dose of the euthanasia medication. Most people are quite surprised at how peacefully and how quickly their pet is “gone”.

Some of the mechanical things that happen to the body as life passes can be uncomfortable to watch or disconcerting, especially if you are not expecting it. Unfortunately, cats do not close their eyes after euthanasia. Some cats will lick their lips – if this happens, their tongue may continue to stick out after euthanasia. Sometimes, a cat will urinate or defecate as their muscles relax. Rarely, several minutes after the cat is “gone”, electrical impulses in the body can trigger the diaphragm to move after the heart has stopped. It might look as though the cat is gasping for breath, but this is only a reflex.

After Care

At such a sad time, who wants to be faced with decisions? However, there is one last thing to decide – will you take your pet home to bury in the garden? You may need to check local ordinances in your area before doing this. Certain times of the year, this may be impractical – December in Michigan is a difficult time of year to try to bury anything! Most veterinary offices have other options available as well. There are a few places that provide a Pet Cemetery, where your pet can have a grave site that you can visit. There are also two cremation options - general or group cremation means that your cat will be taken to a special pet crematory facility and cremated along with several other pets. Their ashes will be combined with other ashes and buried on site. You cannot go visit them, however.  Private cremation means that only one pet is cremated at a time, and you can have the ashes returned to you – to bury, scatter in the garden, place in an urn or have turned into memorial jewelry or artwork. There are quite a few artists and businesses that will incorporate your pet’s ashes into a painting, drawing, glass bead or pendant.

Paw Prints are a lovely way to memorialize your cat

If you do not want your pet’s ashes returned, you have other options to memorialize your pet. Many people request that a small amount of fur be clipped and saved for them, others opt to have a clay pawprint made. Some people prefer to remember their cats through photos, and some people find it too painful to keep any memento of their cat and find themselves donating cat beds and toys to shelters and rescues. Some people go out right away to find a new cat to shelter and care for, while others may need to wait before welcoming in a new furry friend. Some may find that the thought of any other cat in their house is too painful. Again, there is no “right” way to deal with the loss of your cat. It hurts. You have to find the way that is best for your own self to heal that hurt. 

You may find that your other cats mourn the loss of their companion, just as you do. Your other cats may wander the house, investigating places where the missing cat used to sleep, or may call out as though looking for her. Your other cats may be more aloof or more clingy than previously, and may be either more agitated and restless or more sedentary and sleepy. Your cats may show less interest in eating – in fact, the ASPCA notes that 11% of cats that appear to be mourning will stop eating completely for a short period. If your cat goes on hunger strike for more than a couple days, however, it would be best to schedule a checkup with your veterinarian.

The process of choosing euthanasia for your cat, when laid out in black and white is a lot less scary and emotional than when you actually find yourself within the process. Remember, though, that while you must be the one to make the final decision, you don’t have to do it alone. We veterinary staff members are happy to answer your questions, let you voice your concerns and fears, and discuss treatment options to allow you and your cat to enjoy a long, healthy relationship and to help you make sense of these troubling, but important and compassionate decisions. Sometimes, we must choose to suffer, ourselves, so that our cat’s suffering can end.

Resources:
Association for Pet Loss and Bereavement
ASPCA Pet Loss Resources
Michigan Pet Loss Resources
Michigan State University College of Veterinary Medicine Pet Loss Support 
UP Pet Loss Support Group
Pet Loss Grief Support
Beyond the Pawprint Pet Loss Support Group, Farmington Hills, MI

Choosing Euthanasia: A technician’s perspective

 How do you know when the time is right to say goodbye to your cat?

Due to the advances in veterinary medicine, the average lifespan of the cat has increased significantly over the years. Once upon a time, a typical backyard cat could be expected to live about 4-5 years. Now, pampered felines average about 14 years of good life, and a good number of our patients are seeing the other side of 20 years! Our own hospital cat, Ginger, was 22 years old when she developed an inoperable squamous cell carcinoma in her mouth, and we had to say goodbye.

How did we make that decision? How do you know when the time is right to say goodbye? Sometimes the choice is easy, or there is no real choice – if your cat has a traumatic accident or rapid organ failure that medicine cannot treat, it is kindest to end his or her suffering and pain. However, if your cat develops a treatable or manageable but incurable disease, knowing when to make the decision to euthanize can be hard.

I recently posted about my cat, Curie, who was being treated with chemotherapy. Just before Christmas, I had to make some decisions about her further care, and after considering her quality of life and weighing the options, I came to the decision to euthanize her. It was no easy decision, and I cried all day on the day I made the decision. I also cried on subsequent days, after we had euthanized her. However, I stand firm in my belief that it was the right decision for her. What follows are some of the factors that I considered when making my decision.

Deciding how to feel about Euthanasia

One thing to keep in mind is that, as a pet parent, you are your pet’s caretaker, their champion, and their advocate. Your veterinary doctor and staff, your friends and family, your breeder – they can all offer advice to you, but ultimately, the decision is yours. No one can make the decision to euthanize for you, and it is both a terrible and wonderful power to have.

Being able to make the decision to euthanize your cat is a huge responsibility because, even though you are not making decisions about a human being, you are still making decisions about life and death. Perhaps the decision is even harder than if it were a human being, because your cat can’t tell you what their wishes are. This is a very emotional and sensitive decision for most people. In my experience, as a caring human being who loves their cat, you will almost always second-guess your decision – no matter what decision you make - even if you know it is the right thing to do. Did I wait too long and let my cat suffer needlessly? Did I make the decision too soon? Would a little more time have made a difference? You wonder and worry simply because you care about your cat, and take your responsibility so seriously.

The power to decide can also be a relief, because when you know your dear friend is failing and there is nothing more that can be done, you can release them from suffering and spare them the misery of crippling pain, slow starvation or mental distress. I think most people know in their hearts when it is the right decision, even though it is not a decision they want to make. Once you have made the decision, you have to be firm with yourself that the decision was the right one - made with compassion and love.

As much as we may hate to admit it, for many of us, financial concerns may come into play. We may wish in our hearts to run every recommended diagnostic test, or try every possible treatment, no matter how new or experimental, but for most of us, a wall of dollar signs will eventually rise up. There is no reason to feel guilty that finances come into the equation. What good is it for you to have a kidney transplant performed for your cat if you cannot then afford to buy a high-quality, kidney-protective diet to feed her?

At some point, we may need to try to distance ourselves from our cat and pragmatically ask questions such as – What will continued treatment gain my cat? Am I continuing to treat her for her benefit or for mine? What is my cat’s current quality of life? Will continued treatment improve her quality of life? What is the likelihood of relapse? What kind of post-treatment care will be required at home? We may hate to ask these questions of ourselves, or of our cat’s veterinarian, but they can provide helpful decision-making information.  

Your veterinarian does not offer up euthanasia as an option lightly. The veterinary oath stresses that top priority is animal health and welfare, and their goal is to diagnose and treat your pet to the best of their ability. However, most veterinarians also know that there must be a balance between quality of life and quantity of life. What good does it do to have extra time with your cat when you can see that your cat suffers every day? In the veterinary office, we can only evaluate your pet based on a snapshot in time – the visit to the office. Ultimately, you know your cat better than we do, and are best equipped to make the final decision – based on the scientific, objective information that we veterinary staff can provide, and the contextual, subjective information that your cat displays at home, as well as your own emotions about your cat’s health and well-being, and any religious beliefs that you hold or financial factors that may affect your decisions about your cat’s care.

Assessing your cat’s Quality of Life

Many animal welfare organizations abide by rules called “The Five Freedoms”. These guidelines were developed in the UK for farm animals, but are applicable to any animal living under human care.

The Five Freedoms:

1. Freedom from hunger or thirst by ready access to fresh water and a diet to maintain full health and vigor
2. Freedom from discomfort by providing an appropriate environment including shelter and a comfortable resting area
3. Freedom from pain, injury or disease by prevention or rapid diagnosis and treatment
4. Freedom to express normal behavior by providing sufficient space, proper facilities and company of the animal's own kind
5. Freedom from fear and distress by ensuring conditions and treatment which avoid mental suffering

Evaluating your cat with these guidelines in mind can help make your decision less complex.

Ideally, if you are preparing for the eventual need for this decision, you should set aside some time each day or every few days and evaluate your cat’s quality of life. Does your cat still enjoy the Five Freedoms? Does he or she get a passing grade on the Quality Of Life scale (shown here: http://aplb.org/resources/quality_of_life.html)? Does your cat seem to feel “good” more than 50% of the time or have more “good” days than “bad” days? If so, you can relax and enjoy a few more special days with your furry friend. If not, then you should call your veterinary office. You may be able to ask your veterinarian for alternative methods of medication or treatments that would allow you to delay your decision to euthanize, and keep your cat comfortable longer.

The most important thing to realize about the decision to euthanize is that there is no one “right” decision in all cases. Each case has special considerations and is the “right” decision for the cat and the person or people involved.

If I Should Grow Frail

-         Author Unknown

If it should be that I grow frail and weak

And pain does keep me from my sleep,

Then you do what must be done

For this – the last battle – can’t be won.

You will be sad I understand

But don’t let grief then stay your hand.

For on this day, more than the rest

Your love and friendship must stand the test.

We have had so many happy years,

You wouldn’t want me to suffer so.

When the time comes, please let me go.

Take me to where my needs they’ll tend,

Only stay with me till the end.

And hold me firm and speak to me

Until my eyes no longer see.

I know in time you will agree

It is a kindness you do to me.

Although my tail its last has waved,

From pain and suffering I have been saved.

Don’t grieve that it must now be you

Who has to decide this thing to do.

We’ve been so close – we two – these years,

Don’t let your heart hold any tears.