Everyone loves their pets and wants them to last forever. But as we sadly all know, pets pass on eventually. Many of them do so at their local vet practice via an injection. We call this euthanasia, from the Greek for ‘good death’. Euthanasia is one of the most important forms of treatment veterinary surgeons have access to and allows us to give animals a quick and comfortable death, where without many would suffer needlessly. 

There are different ways to perform euthanasia in animals. And as humans become closer and closer to our pets, what owners expect from euthanasia is changing. This has led to some argument whether certain techniques are the ‘correct’ way to perform euthanasia. Today we will be looking at one vet’s claims that “most vets are not doing euthanasia properly”, and whether there is any merit to this. 

Table of contents

We are aware that some readers will find the descriptions of euthanasia procedures distressing; but others will want to know about the details. We have tried to keep this article to the compassionate overview, but please be aware there are comparisons of different approaches to humane euthanasia below.

How Are Most Euthanasias Performed?

Many of you will have had to experience a pet’s euthanasia in the past, or at least know how it works. But for those who do not, let us outline the most common methods for euthanasia in small animals (dogs and cats primarily).

In an ideal situation, euthanasia should not come as a surprise. For elderly animals or those with underlying health issues, it is good for owners and vets to discuss how euthanasia works well in advance, what the best technique might be for the individual animal, and if there are any specific requests the owner has. Though this conversation can be difficult, especially if the pet is not that unwell yet, it is always better to have some prior understanding first. We appreciate in some cases, such as emergency euthanasias, this does not occur. But we encourage vets and owners to talk about euthanasia where they can.

Once the vet and owners agree that a euthanasia should take place, a consent form should be signed. This is a legal document that gives the vet permission to put the animal to sleep. It is important that the owner reads this carefully and discusses any concerns. Some consent forms will also detail what happens to the animal after death, such as burial or cremation. 

The majority of euthanasias in the UK are performed with a drug called pentobarbital/pentobarbitone. This is a barbiturate drug that causes anaesthesia at lower doses; or stops respiration and leads to death at higher doses. In veterinary medicine, it is exclusively used for euthanasia – similar drugs are used as anaesthetics or anti-seizure medication. Pentobarbital is administered via an injection, preferably intravenous though it can also be injected into body cavities or organs to cause death as well. 

In days past, vets always used pentobarbital ‘off the needle’. This means they injected the drug directly into a vein straight from a needle and syringe. More recently, many vets prefer to place an intravenous catheter into an animal’s vein first, and then inject the pentobarbital through the catheter. There are pros and cons to both approaches, as we will discuss later.

In many cases, the above procedure is performed with the animal entirely conscious. In some cases, a vet may wish to administer a sedative first, often orally or via injection. Again, there are pros and cons to this. In either case, pentobarbital tends to work rapidly, rapidly causing unconsciousness, and then respiratory arrest and death within minutes. 

Why Does One Company Claim That “Most Vets Are Not Doing Euthanasia Properly”?

In an article written on the website Quietus Vet, a company offering a 3-step at-home euthanasia, the writer discusses their personal experience with having a general anaesthetic, and their experience as a practicing vet of around four decades. They outline their problems with the most common method of euthanasia (detailed above). And then describe their technique and why they believe theirs is superior. Let us discuss their points in turn. 

Point 1: Injecting ‘Off the Needle’

First, the writer explains that injecting pentobarbital off the needle, without a catheter, can be problematic. Due to technique, the animal wriggling or just bad luck, when performing this technique there is a chance the needle can exit the vein. This can result in a vet injecting pentobarbital peri-vascular, or outside the vein. This, they claim, causes ‘immense pain’. 

It is known that barbiturates cause tissue damage, often because the solutions are highly alkaline. This can cause local pain, so the claim is generally true. However, it should be noted that ‘immense pain’ may not be an accurate term to use, as we could find no study looking into how painful a perivascular injection was. One study in mice found that injections of pentobarbital intraperitoneal (into the abdominal cavity) “did not result in increased… pain” and “although sodium pentobarbital is capable of inducing inflammation… intraperitoneal administration… does not result in overt signs of pain when compared with injection of saline”.

A human drug index also indicated that side effects, including pain, may be reduced in patients that are already very unwell; which many animals undergoing euthanasia are. These two points may indicate that pentobarbital may not be any more uncomfortable than other perivascular injections, or at least may not be ‘immensely’ painful.  

Further studies are clearly needed, however, this author would agree that, when possible, intravenous catheters should be placed prior to administration, to avoid any possible pain of any magnitude. In some cases, such as if animals have very poor blood pressure or euthanasia cannot be delayed due to welfare reasons, the use of an off the needle injection may be acceptable. 

Point 2: Using a Catheter

While the author of the article writes that catheters are preferable to off the needle injections, which we again agree with, they also point out some problems with catheter placement. They claim that catheters can be difficult to apply, animals will ‘feel’ them and thus may struggle. The author notes that due to this struggle, many vets will apply a catheter away from the owner. 

Firstly, while fitting a catheter can be difficult, especially in very nervous or aggressive animals, or those that are very unwell, this is not always the case. Placing a catheter is a skill, and one can become more practiced at it the more they apply. While everyone will struggle to apply a catheter at times, many vets do not struggle to apply one in general and would not describe them as ‘tricky to introduce’. 

On the point of ‘feeling the catheter’, presumably implying pain, this cannot be denied. As anyone who has had a catheter fitted before may know, the sharp stab of the needle can be uncomfortable. And so by extension, and this author’s anecdotal evidence, animals often do feel some discomfort when they get catheterised. Furthermore, poor technique or an uncooperative animal may increase the risk of pain. Physical stress will also be a key factor; and for nervous animals any invasive procedure can cause stress, including catheter placement. 

Saying that, a catheter needle is a similar bore to that of an injection needle

Therefore, pain should be of a similar magnitude. While we do not want to cause pain where it can be helped, the quick discomfort of a catheter placement may make the rest of the euthanasia painless, especially when compared to off the needle injection. Steps can also be taken to minimise a pain/stress response, such as using local anaesthetic, distraction techniques or sedatives. So, while we partly agree that catheter placement can be uncomfortable for many animals, this is not always the case; the level of discomfort should be considered relative to other techniques, and steps can be taken to minimise this. 

Finally, the author raises the point of taking an animal away from the owner to fit a catheter to prevent the owner seeing the animal in distress. In this author’s opinion, this is written in a way that implies this is a negative thing for a vet to do. In truth, there are pros and cons to performing any step of the euthanasia away from the owner. And this should be discussed with the owner well in advance. Some owners may wish to remain with their animal throughout the whole process. Some may not wish to see any of the process. And some may be happy to see certain parts and not others. 

Every owner is different, and an individual’s wishes must be considered. 

In this author’s opinion, some aspects of the euthanasia process can be stressful and unpleasant to experience for an owner who is not used to this. In some cases, the owner’s distress can increase an animal’s distress. By asking if the owner can step outside the room, both parties’ distress can be reduced; and the euthanasia procedure goes more smoothly. In very unfortunate situations, such as due to aggression, emergency euthanasia or in hospital, an owner may not even be permitted to be with their animal even if they want to. In summary, in some cases, separating the owner and the pet for part or all of the euthanasia process may be preferable or even necessary. But the owner’s preferences should also be taken into account where possible.

Point 3: The Final Injection 

The author finally discusses the final injection itself, correctly stating that “there is no evidence that this is painful if given properly into the vein,” reinforcing the idea that vets should utilise catheters where possible. However, they state that through their career they have often observed animals eliciting strange behaviours during; such as opening their eyes wide, tensing up, vocalising or ‘appearing to resist’. Again, the author does not explicitly state, but it can be presumed this is unwanted behaviour and a reason not to perform euthanasias in this way.

Despite this author’s considerably shorter experience as a vet, similar reactions have been observed from multiple animals during euthanasia. And these admittedly can be uncomfortable to watch, particularly for owners. However, this author is also cognisant that despite what many owners would wish for, and what TV and film may show, death is not always 100% calm and peaceful. Reactions do occur, including other unpleasantness such as rapid breathing or unconscious defaecation and urination. 

However, this author would argue, again from a more limited experience base than the author of the article, that the majority of animals do not have significant reactions and appear to pass peacefully

From what is understood, most of these reactions are likely to be unconscious on the part of the animal. They will not cause them distress. Distress on the part of the owner can be minimised by forewarning them of possible reactions. And it must not be forgotten that for many owners, euthanasia is an incredibly emotional time; focus is reduced, and subtle abnormalities vets are aware of, like eyes widening or tensing, are not noted by the owner. From experience, this author is happy to claim that the majority of euthanasias they have performed end peacefully. And the owners are satisfied with the proceedings. This author wants to emphasise how significant talking the owner through the procedure is on minimising stress during and after euthanasia. 

The 3 Stage Technique

Having explained why they believe the more common euthanasia technique above is not optimal, the author then outlines their preferred method for euthanasia. Remember that the author works for a company that sells euthanasia packages to owners. And that their method takes place at home. They claim their technique achieves a “calm and anxiety-free full-unconsciousness by the time we arrive at the final injection.”

Their website does not list specific protocols and drugs used, so we cannot comment in too much detail. Firstly, their vets administer an injection of a sedative and pain relief ‘under the skin’. We do not know which drugs are used, and if ‘under the skin’ means subcutaneous or intramuscular. The goal of this is to cause sleepiness. The vet then gives a second injection ‘under the skin’ to induce a full general anaesthetic. Finally, the vet will administer the final barbiturate injection to induce death. There is no mention of whether a catheter is used or not, though one could argue if a full anaesthetic has been induced, either would be appropriate.

Analysis of this Method

Let’s now discuss the pros and cons of this method, to see how it compares to more routine euthanasia. 

This author is a big proponent of minimising pain in all aspects of veterinary medicine. So it is encouraging to see Quietus Vet use pain relief as part of their sedative. As discussed above, euthanasia has the potential to be painful. And many animals undergoing euthanasia are in pain due to disease. This first injection can minimise this, making the procedure more humane. It should be noted however that any injection, however small, can be painful. So administering an additional injection will cause additional pain; similarly to the use of a catheter, however, this pain could be justified as preventing greater pain in future. 

Inducing anaesthesia is an interesting approach

On the one hand, done correctly, a full anaesthetic should minimise most stress or pain responses. This means that the final injection will not be felt by the animal. It will also minimise any unusual movement, like the eye rolling or gasping mentioned above, which is a positive for the owner watching. On the other hand, an anaesthetic is not a single point, but a sliding scale. An animal can be under a deep general anaesthetic and unable to feel the pain of a surgical scalpel (or in this case an injection of barbiturate). But they may also be quite light and still able at some level to perceive sensations; even if they cannot react. 

Assuming Quietus Vet does not do any monitoring for anaesthesia like they would for a surgery, it may be difficult for them to ensure a sufficiently deep anaesthetic plane has been met. They may mitigate this by using higher doses of anaesthetic drugs (since safety is not a concern at this stage), but we do not know. Anecdotally, this author has also noted animals seem more prone to unwanted behaviour, like moving or gasping during death, when given drugs prior to the pentobarbital. Personally this author prefers not to utilise any sedative/general anaesthetic agent if possible. There is also the concern that inducing anaesthetic in an already very ill animal may result in a premature death before the owner is prepared. Obviously death was the desired outcome regardless, but if premature it causes some consternation; pre-warning the owner of this risk would be sensible on the part of Quietus Vet. 

There is also the concern of slowing down the euthanasia process

Though the 3-step process might be kinder for some animals, in many cases euthanasia should not be delayed. Animals may be suffering, in immense pain, and need to die urgently. By slowing down proceedings, waiting for drugs to take effect, suffering will be prolonged, despite the drugs minimising pain and stress. Is it less kind to give an animal a potentially uncomfortable but quick injection to cause death in less than a minute, versus taking 15 or more minutes for the pain to slowly subside before achieving an acceptable level of comfort? 

However, the biggest umbrage this author takes with Quietus Vet’s technique is the costs, both in time and money

It’s no secret that veterinary care can be costly, and we’ve discussed why many times in the past. The more time and equipment that is used for a euthanasia, the more it will cost an owner. When combined with the costs of a home visit, transport of a deceased animal, and burial/crematorium fees, for many owners this technique is simply unaffordable. 

It seems somewhat manipulative to claim that all other techniques are incorrect, which puts pressure on an owner to spend more than they might otherwise for the ‘correct’ euthanasia. 

And going back to time costs, many general practice vets are constantly busy and overworked. While spending half an hour or more gently inducing sedation, then anaesthesia, then death in an animal might be preferable, we simply do not have the time for this. Vets should always aim to reduce time pressure on owners around euthanasia, to minimise stress. But realistically there is a limit to how much time a vet can spend on this sort of procedure.

Final Thoughts 

This has been a long article, so let’s sum up our final thoughts. Euthanasia is an incredibly emotional procedure. As vets it can be hard to have both clinical professionalism and knowledge, while also being considerate of the emotional point of view of the owner. We should always strive to ensure all parties fully understand the procedure, however it takes place; which is why this author again wants to emphasise the importance of early discussions of euthanasia. There are many ways to perform euthanasia, and every animal and owner will have a different experience. Despite our best intentions, not all will proceed perfectly, but understand we will do everything in our power to minimise this risk. Talk to us if anything concerns you. 

There are pros and cons to both traditional intravenous injections in a practice-setting, and bespoke approaches such as those offered by Quietus Vet. As we hope you can see we have a lot of positive things to say about their 3-stage approach, but we also have some concerns. Ultimately, we believe that their method is not an option for every pet. And to claim therefore that vets utilising the more common method is not being done ‘properly’ is arguably unfair on thousands of vets up and down the country. At best, this language could hurt feelings. Or at worst cause some owners to unnecessarily believe they are not receiving appropriate care. 

Speak to your vet…

There is often no one way to do something in veterinary medicine, and euthanasia is no exception. It may be argued that some techniques have advantages, or could even be considered ‘gold standard’. But this does not make other techniques inappropriate. For any owners reading, for the final time, please go speak to your vet about euthanasia when the time is getting close. By talking about it early, we can stop any unnecessary stress at a time when hearts are already under a lot of strain. 

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