Vice President of Media Strategy, NAVC
Euthanasia of pets. It’s one of the most difficult decisions a pet owner has to make, and there are often many complicating factors.
When a patient is suffering without any hope of reversing the animal’s condition, most veterinarians will recommend or support the decision for euthanasia. But there are times when a veterinarian refuses to end the animal’s life, such as when they’re asked to perform “convenience euthanasia.” This is the practice of euthanizing an animal because the pet has become too much trouble for the owner or they don’t have the financial resources for the treatment needed. Veterinarians are also faced with a distressing situation when a pet owner won’t consider euthanasia even when their beloved pet is suffering and the pet’s illness or condition is completely hopeless. These are end-of-life situations that veterinarians struggle with in their practices.
A 2018 study, Ethical Conflict and Moral Distress in Veterinary Practice: A Survey of North American Veterinarians, which was published in the Journal of Veterinary Internal Medicine, took a look at euthanasia and explored its impact on career sustainability and well‐being among North American veterinarians. The study received 889 responses from veterinarians in North America. Dr. Lisa Moses, a veterinarian at the Massachusetts Society for the Prevention of Cruelty to Animals-Angell Animal Medical Center and a bioethicist at Harvard Medical School, is the study’s lead author.
A majority of respondents reported feeling conflict over what care is appropriate to provide. Over 70% of respondents felt that the obstacles they faced that prevented them from providing appropriate care caused them or their staff moderate to severe distress. Seventy‐nine percent of participants report being asked to provide care that they consider futile. More than 70% of participants reported no training in conflict resolution or self‐care.
Nearly 27% of vets across different practice types “sometimes or often” received what they considered inappropriate requests for ending animal lives. Most vets had received such requests at least once; only about 7% had never received them. Almost 45% said it caused them or their staff a moderate amount of distress and 18.7% reported it caused them or their staff severe distress.
Just over 75% said they never or only rarely carried out “inappropriate” euthanasia.
In response to the study’s question, “How often have you been asked to do something in the course of your clinical practice that feels like the wrong thing to do?” 45.3% said “sometimes” and 5.6% said “often.” Although approximately 25% of respondents said they never complied with these requests, 45% of respondents said they complied “rarely,” 23.6% said they “sometimes” did so, 7% said they “often” did so and less than 1% said they “always” did so. Sixty‐two percent of respondents stated that “sometimes” or “often” they felt they could not “do the right thing.” Many respondents in text comments cited financial constraints as the most common obstacle to doing what they felt was right, but some also cited external pressure from an employer or management policies.
The study authors note, “The findings implicate moral distress in generating feelings of burnout and compassion fatigue, raising concern that moral distress may contribute to the development of mental health problems among veterinarians. We join other researchers in veterinary profession in urging that the roots of stress and poor well‐being in the veterinary community be fully explored and addressed by professional societies.”
Moral distress is thought to be one reason why veterinarians suffer professional burnout and compassion fatigue. Sixty‐nine percent of respondents said they felt they had moderate to severe amounts of distress as a result of not being able to provide care they thought was appropriate. When asked “How often have you felt distressed or anxious about your work?” 35% of respondents reported “sometimes” and 43% answered “often.” When asked how often they had been asked to do things that are outside of their skill set for financial or other reasons, more than 50% of respondents said that they “sometimes” or “often” were so asked.
Twenty‐six percent of respondents said their empathy for their patients had waned over time and 31% said that their empathy for pet owners had waned over time, and 60% of respondents said they feel like they have prioritized the needs of animal owners over their patients.
When asked about coping mechanisms when they felt they could not do the right thing, 11% said they had sought unspecified professional help. And when asked about how they coped when “a client refuses to do what you think is in the best interest of your patient,” 9% of respondents indicated that they sought professional help. In both of these situations, over 75% of participants indicated that they discussed the situation with a partner, friend, or colleague, whereas approximately 20% responded that they “did nothing.”
On the other side of the coin are the clients who refuse to consider euthanasia and request “futile” treatments for their animals. The respondents were nearly split evenly on the question, “Have you ever refused to provide a treatment that you feel is futile?” With 50.7% answering “yes” and 49.2% responding “no.” Nearly 55% of veterinarians reported that they “sometimes” feel conflicted or upset because a pet owner refuses to do that they thought was in the best interest of the patient. More than half (57.1%) said they “sometimes” recommend euthanasia to pet owners who have not brought up the topic and 85% said they have recommended euthanasia to pet owners who have stated they will not consider it.
“Veterinarians would benefit from training and support in managing the distress they inevitably will feel in their everyday work,” the study authors conclude. “Our findings indicate that, to date, such training and support have not yet happened. We hope our findings as well as future research will lead to supportive, positive changes that will make the practice of veterinary medicine sustainable, less damaging and, in the end, better for veterinarians, their patients, and staff.”