Thursday, July 30, 2015 - Mark Humph
"They wouldn't treat an animal like this." It's the common cry of supporters of voluntary euthanasia, appalled that while we are willing to put animals out of their misery without their consent, we won't do the same for humans at their own request. This was also the exact phrase uttered by the 96-year-old father of the former Guardian editor Alan Rusbridger as he lay dying a slow, painful death.
Putting down animals is something that commands near-universal support. Even PETA (People for the Ethical Treatment of Animals), which has questioned the morality of using guide dogs, agrees that "euthanasia, performed properly, is often the most compassionate option" to "prevent the suffering of unwanted animals in the most responsible and humane way possible". And, says Dawn Murray, of the Living With Pet Bereavement support website, every consideration is now taken for the animal and its distraught owner.
"In the Sixties or Seventies, you might have been expected to pass your dog to the vet, take your leave and go," she says. "But now vets are looking at helping to provide clay paw prints or hair clippings as mementoes. There is consideration for the impact on the owner in ways that would have been unheard of."
Indeed, observes Murray, "probably the last one that anybody considers is the vet". Which is somewhat strange given how often vets are called upon to end the lives of our pets.
Studies in Australia and the US have suggested that throughout their careers vets may have to perform euthanasia four to five times a day. For vets working in animal rescue, the number is much higher. In 2011, the RSPCA euthanised 44 per cent of the animals it took in. Following some negative reaction to the statistics, it no longer publishes them but the maths suggests that the proportion is even higher now: in 2014 the charity "rescued and collected 128,209 animals" but only "found new homes for 53,263".
This creates what sociologist Arnold Arluke calls the "caring-killing paradox". In order to fulfil the goal of helping animals to live healthy, happy lives, vets have to kill those for whom this is no longer possible. How do vets cope with this grim aspect of their work?
Look at the headline figures on vets and mental health and you might think: not very well. Problems like depression are more common in the profession than in the population as a whole. A 2012 study found that a third of veterinary students had experienced depression, compared to around an eighth in the general population. Vets are also three to four times more likely to take their own lives – significantly more than doctors.
And sometimes even the toughest vets can be affected, says Dr Rosie Allister, who researches mental health and wellbeing in veterinary students at the University of Edinburgh. She says that even those vets who spend their careers dealing with animals born to be slaughtered for human consumption can suffer from depression – especially if they are confronted with epidemics such as, for example, the 2001 foot-and-mouth outbreak. "I have spoken to vets who have been burned out by having to euthanise large numbers of healthy animals in a short space of time during disease epidemics," says Allister. "They may have to euthanise animals as soon as they are born, or put down pregnant ewes and make sure that the foetuses are dead too. Nobody becomes a vet for that."
Nor is it always just the fate of the animal that upsets the vet. From her own practice, Allister knows that observing the plight of the owner can sometimes be distressing too. "Veterinary medicine is almost as much about people as animals, and owners will often be quite explicit that the animal is what they are living for. Then you have to put it down to end its suffering. A lot of vets have been in that position, often when the owner is elderly or vulnerable in some way.
"Some of the euthanasias that have stayed with me years on are those that were absolutely justified, but where the owner's love for their animal and their grief were evident, and in some cases where I felt concern for how the owner would cope after the animal's death."
But Robin Hargreaves, senior vice-president of the British Veterinary Association, says that, although there is a "colossal mental health problem in the profession", to think "it must be caused by killing all those animals" is too "simplistic". For Hargreaves, the most stressful aspect of the work is "having a course of action that you could take, but not being in a position to take it". Sometimes that situation could even be being able to end an animal's suffering but the owner refusing to take that step.
For Hargreaves, euthanising animals "is one of the aspects of my job that I genuinely enjoy. It relieves more suffering than virtually anything else I ever do. I do more good by euthanising some animals than by trying to treat them." One reason why he is positive about euthanasia is because he has reached a point in his career when he's seen animals die of everything, and hasn't yet seen one way to go that is "anything like as nice for an animal as being put to sleep". He wants pet owners to see that when they take on a puppy or a kitten, they are also taking on a kind of social contract, so that, "when the time comes, you'll also be able to put it to sleep".
Hargreaves has an almost spiritual approach to this part of his work: "We take a problem in the form of injury or disease that the animal cannot overcome and convert it into grief that the owner can, with time, conquer."
It seems most vets take a similar view. However, some, such as Dr Bruce Fogle, a practising vet with 45 years' experience, admit: "As the years go by, it gets more difficult." Experience, he explains, makes vets more confident in their diagnoses – which just leaves more time to consider the plight of both animal and owner. "One of my contemporaries can no longer put animals down," he says. "He can help owners with the decision, but he gets one of his colleagues to administer the injection."
For Fogle, who edited the textbook Interrelations Between People and Pets and wrote the chapter on euthanasia and grieving, the hardest part is telling a distraught owner that their pet had to be put down. On the other hand, "the next owner to walk in from the waiting room will have worked out what has happened and sympathise. And then, in a little while, you will get a note or a basket of muffins from the dead animal's owner, thanking you for what you did."
When it came to his own pets, the process was actually easier. Fogle, father of the broadcaster Ben, has put four of his own dogs down, and about six pets belonging to close family. "It's much easier with your own," he says. "It reduces you to tears, and you feel the loss for months afterwards, but you know your dog, and that its life is no longer worth living. When you don't know the animal, when you are not so familiar with its personality or its circumstances, making the decision becomes more difficult."
Particularly, says Fogle, when not putting a suffering animal down: "The most tormenting set of circumstances is when the owner won't allow it. One of my most stressful cases was a few years ago when we had an elderly lurcher that couldn't walk, and had lost its sight, hearing and continence, but its heart was still beating and the owner refused to let it be put down. We were able to convince him to give the dog heavy doses of sedatives so that it was deeply sedated until the day it finally died. Before that, though, I was asked why I didn't just give it a dose of insulin which would have killed it eight hours later. The answer was: 'Because that's illegal.' But I have to say I would have done it if I'd thought I would have been able to get away with it."
And yet a minority of vets do struggle with the burden of euthanasia. Various studies over the years have suggested that vets can suffer symptoms such as unresolved grief, high blood pressure, depression, substance abuse, bad dreams, emotional numbing and recurrent, distressing memories.
Saying goodbye to a beloved pet has now become big business (Getty)The younger generation of vets, Fogle suggests, may suffer more than the old guard: "There is a greater problem now than there was 30 or 40 years ago, because it has become a genuinely caring profession. When I qualified in 1970 we were taught that animals like dogs and cats didn't have emotions and didn't experience pain. It took an awful long time, and, frankly, the entry of serious numbers of women into the profession in the 1980s, before it became a caring profession. But the way it used to be made it easier for our generation to put animals down."
Another intuitively plausible explanation as to why some vets suffer would focus on the different circumstances surrounding euthanasia. In very rare situations, vets euthanise because the owner no longer finds keeping the animal convenient, because the animal has been rescued but there is nowhere to home it, or because it has been used in experiments and is no longer needed. Still, Murray reveals, some vets can show considerable ingenuity in avoiding this where possible. "I know with 100 per cent certainty," she says, "how some vets have reacted when a greyhound owner has come in saying, 'He can't race, he's losing me money, put him down.' The vet has said, 'Yes, of course,' then taken it out by the back door and phoned the nearest rescue charity."
Besides, there is good reason to believe owners are less willing to have animals put down than in previous generations. When I was growing up, any pet with a serious illness would usually be sent "to live in the country" as parents often euphemistically explained it to their crying kids. Spending money on expensive treatments or tests was seen as a terrible indulgence. But, as Hargreaves says: "There's definitely been a social shift in people's attitude to animals and illness." And these changes are also reflected in what happens after death. One animal crematorium provider estimates that around a third of owners pay to have their pets individually cremated and to have their ashes returned, whereas before almost all were sent away to be cremated en masse, the ashes buried in one big functional pit.
Perhaps the most intriguing question raised by pet euthanasia for society as a whole is whether this affects vets' views on assisted suicide for humans. Hargreaves suspects that it does: "We see it as one of a suite of rational ways to resolve interminable problems."
He recounts one story where the contrast between the options for animals and humans was particularly stark: "One of my most painful experiences was with a dog that undoubtedly wanted euthanasia, in the living room of a house with all the family present. There was a family member in bed, who was clearly sleeping downstairs because he was so ill. All the typical platitudes like, 'They won't be suffering any more', 'He will be at rest', 'It's for the best' suddenly sound really rather hollow when one of the people listening is lying there having to put up with it regardless of how bad it is."
Hargreaves says that "in that hiatus after the animal has been put to sleep" many clients express the wish that a deceased relative could have been given an equally peaceful end – and sometimes, that relative was suffering from exactly the same condition. "I might have put an animal to sleep with congestive heart failure," says Hargreaves. "There are lots of people who have watched a loved one die with congestive heart failure and it's bloody awful. I have absolutely no doubt that being put to sleep two days before you drown in your own fluid would be a much better way out."
Nonetheless, Hargreaves recognises that with humans, "the decision-making process is going to be incredibly complicated and fraught with difficulty". Perhaps this is why, even though anecdotally vets seem to consider euthanasia an ethical and practical option for humans, there is little evidence that they support its legalisation any more than the general population.
Although received opinion has it that the goodness of animal euthanasia only makes the rightness of human assisted suicide plainer, there is at least one aspect of the veterinary experience which confirms the difficult dilemmas facing the human variety.
Hargreaves talks about how especially difficult it is to decide that "today is the day I'm going to kill my dog" when an illness is progressing incrementally. "What [owners] are waiting for is a catastrophe that will make it plain as day that they ought to do it. But tragically, if they wait long enough that catastrophe will probably occur and they'll always regret not doing it yesterday," says Hargreaves.
That worry about going "too soon" is even more acute for humans. Dogs and cats live in the moment and there is a sense in which death does not rob them of a future they can anticipate nor a past that they recollect which has shaped their identity. In that sense, whether they go today or tomorrow should matter less than for many humans, for whom tomorrow is present as a very real possibility. But the price we pay is having to be alive when we no longer have anything left to live for.
As always happens when we think carefully about other animals, we are reminded both of the many things that we have in common, but also the significant ways in which we differ.
The method by which an animal is euthanised varies according to species and size, from anaesthetic overdoses, to the shooting of horses, and even, in some places, the decapitation of fish.
The most common method of euthanasia administered by vets involves a drug called pentobarbitone sodium (PBS). Its effects are similar to those of an extreme overdose of general anaesthetic; within seconds it shuts down the heart and brain, making the animal unconscious before it realises that anything is happening.
This is generally delivered through an intravenous injection with a dosage of roughly one millilitre per five kilos of body weight. Smaller animals including birds may require oral administration or may even be euthanised with a gas such as carbon dioxide.
Horses are generally anaesthetised before the drug is injected to limit any distress during the longer stretch of time it takes to circulate in the blood. Alternatively, a horse may be euthanised with a single bullet to the centre of its forehead, but here accuracy becomes crucial and the British Horse Society advise that the free bullet may not be the ideal method for use with fractious or difficult horses. Any method of euthanising a horse should be given careful consideration beforehand due to the number of options available including the considerations needed for the carcass disposal.
Turtles and tortoises, slow by nature, take the most time to succumb to the effects of anaesthetic overdose. Controversially, some owners claim that the cold-blooded nature of these animals means putting them in a freezer is a credible, pain-free option. But the British Chelonia Group recommends a combination of the lethal injection and "pithing", a gory technique that destroys the animal's brain with a needle or other tool while it is unconscious, guaranteeing a quick and painless death.
Fish can be euthanised by dissolving anaesthetic, sometimes in the form of clove oil, in water. The Australian RSPCA also recommends decapitation, but British animal welfare groups do not permit it as a humane technique. Nowhere does anyone recommend the traditional method of flushing fish down the loo.
Vet Helpline is a confidential listening service for vets, vet nurses, students and any family or colleagues who are concerned about someone in the veterinary community. They are available 24 hours on: 0303 040 2551
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