I write this with a very heavy heart. One of my professional colleagues – although I never knew him personally – has just been struck off by our regulator, the Royal College of Veterinary Surgeons (RCVS). And the biggest tragedy of all is that I think they were absolutely right to do so. It is profoundly distressing that a vet could make such a massive error and not realise that what he had done was wrong – we all make mistakes, but not accepting and learning from them is the cardinal sin in our profession. In this blog, I want to look at what he did, why he shouldn’t have done it, and what the ramifications are for us as vets and as pet owners.
Just so you’re aware, this blog will go into details which some pet owners may find unpleasant, but which we know others will want to know about, so as to understand all the things that may happen.
The charges against this vet boiled down to the fact that he was called to put an elderly dog to sleep; he didn’t have all the equipment that might have been appropriate for euthanasia, but the biggest issue was that he decided to put the dog to sleep by an injection into the heart, without any sedation. When the owners complained, he told the RCVS disciplinary committee that this was his normal approach to euthanasia.
This, the RCVS agreed – rightly in my opinion – was completely unacceptable. Euthanasia means “a good death”, and inserting a needle into the heart of a fully conscious animal is profoundly painful. It’s also frequently much slower than people think, as the unsedated, frightened and in pain animal “fights” the anaesthetic.
What does this mean in future?
Well, I’m sure that any vets who might have been tempted to do anything similar – maybe for the best of reasons, such as trying to save the client money, or in an outdated belief that this procedure is not painful – will think twice now.
However, I also think it’s an opportunity for us as a profession to have a conversation with the rest of the pet-owning public (remember, almost all of us have our own pets too!) about not just when it’s right to put an animal to sleep, but how we do it – because there are lots and lots of options.
What are the options?
There are a number of questions the vet and the client need to consider.
Firstly, one-shot or multiple-drug euthanasia?
It is quite acceptable to use a single drug – we usually use a potent anaesthetic agent called pentobarbitone (AKA pentobarbital). This is given by injection (see below), and the animal goes to sleep, gets deeper and deeper and then simply stops, peacefully and quietly.
However, there are a limited number of places the injection can be given in a conscious animal and if the patient is very stressed, or in pain, the drug doesn’t work as quickly. As a result, many vets prefer to give some sedation – or even a full anaesthetic – first. In most cases, this will be a small injection under the skin, that takes 10 minutes or so to kick in. In some cases, it may be necessary to use an inhaled anaesthetic agent so the patient is completely unconscious before the pentobarbitone injection is given. The biggest concern is that sedatives may make it harder for the vet to find a vein afterwards; however, this isn’t usually a major problem. Of course, this can also increase the price slightly – sedative drugs are disproportionately expensive – but in welfare terms, it is often the best option.
Secondly, where can the injection be given?
As we’ve said, it is unacceptably painful and distressing to give an injection into the heart in a conscious animal. However if the animal is unconscious, sedated or anaesthetised then these intracardiac injections can be useful, especially in very small patients and those with very poor circulation or collapsed veins.
Most commonly, the injection is given into a blood vessel – “into the vein”. This is the fastest and least painful option, but not always possible, for example in very small patients, or those in shock or with very low blood pressure.
An alternative that is sometimes used in cats (if the vein is difficult to find or ‘blows’ when the injection is given) is to inject into the kidney. This is less painful than going into the heart, and easier than finding a vein, but may take a little longer to work, especially in cats with kidney disease.
In some species, some vets will inject into the brain – this used to be standard practice for birds, but again, we now think that birds should probably receive sedation or anaesthesia first in most cases.
In very small animals, it is often virtually painless to inject into the abdomen; however, this can be very, very slow to work, and needs very large amounts of the drugs.
If an injection into the vein is being used, needle or catheter?
This is a perennial debate among vets! There really isn’t one right answer to this, ultimately – it depends on the specific patient. As a general rule, injecting “off the needle” is generally easier for the vet, and inserting a needle is less uncomfortable than placing a catheter; however, the needle is more likely to slip out of the vein if the animal moves, and if so, the pentobarbitone is very irritant and can be severely painful to the tissues around the vein.
Finally, of course, we need to confirm death.
In mammals or birds this is straightforward – a loss of normal reflexes and no heartbeat. In reptiles, however, it’s much harder – some species can essentially “shut down” for hours, with no long-term ill effects. Therefore, it is usual to use additional measures to ensure that a tortoise, for example, is dead – stories of “zombie” tortoises are generally due to people burying a torpid but not dead pet. It is also unethical to freeze a reptile if you’re not sure they’ve gone – they could theoretically be aware of the process. Pithing of the brainstem is the preferred option once they are deeply anaesthetised (and probably dead) after the pentobarbitone injection.
Does it always go to plan?
Sadly, no – sometimes it may be necessary to go to “plan B” part way through – for example, if we cannot access a vein, or something unexpected happens. However, there are always options, and our first priority will always be to make sure that the patient’s welfare is not compromised during euthanasia.
The bottom line is that almost all vets are determined to give your pet the most humane, painless and stress-free end that we can. How vets do this will vary depending on a wide range of factors, but if you have any concerns, please do talk to us! Any vet will be more than happy to discuss your concerns and do anything we can to allay them.