Kathleen A. Cooney This book is written to be a practical guide for veterinarians and all professionals performing or assisting with euthanasia, especially during times they find themselves in unfamiliar situations. It is meant to help readers form a foundation of euthanasia best practices, while building confidence in the procedure and all it entails. To achieve this goal, it’s important to understand a bit of euthanasia’s history and appreciate how veterinary medicine has evolved to protect the animal’s experience and support those who witness the death. As with any significant movement in the right direction, changes take time. Euthanasia is a very old term, Greek in origin, combining the words εὖ (eu), meaning good, and Θᾰ́νᾰτος (thanatos), meaning death. The first use of it dates back to around 121 CE to describe the ideal human death; loved ones gathered around, affairs in order, and comfortable. It referred to a natural passing, not tied to the act of purposefully ending life like it is today (Dowbiggin 2007). The meaning changed in the late 1800s when it was suggested that suffering persons of the world would be better served with a quick death. Veterinary medicine eventually took on the word to describe intentional, active (not passive) animal death. It reflects the veterinarian’s desire to bring about the best possible outcome for the animal, including to end its life if mental and/or physical suffering persists (Figure 1.1). Early euthanasia methods were physical in nature (e.g. blunt force trauma, drowning) until pharmaceutical drugs, both gas and injectable, became available. Some poisons were tried as euthanasia agents (e.g. strychnine, cyanide) but proved to be highly distressing to the patient. With attention placed on reducing pain, anxiety, and fear, euthanasia methods began to put more emphasis on producing rapid unconsciousness, the hallmark of any safe killing method. Some of these early euthanasia methods were less than ideal and understandably resulted in what today would be referred to as “dysthanasia,” or a bad death. Dysthanasia is what practitioners aim to avoid, not only for the animal’s sake but for those who are present during the procedure and may experience emotional harm. The following illustrates the terms’ differences: Figure 1.1 A cat owner grappling with the reality of the euthanasia decision and hoping things progress smoothly. Source: CAETA (2025). Euthanasia: Dysthanasia: Through improved research, euthanasia methods and techniques are more reliable than ever before. While there is always room for improvement, evidenced by new research coming out each year, practitioners find themselves with effective options for a multitude of circumstances. Many euthanasia methods are the same as they were decades ago to great success. However, others are set to change for the better or fade out of use altogether. To help euthanasia practitioners, animal industries have developed guidelines that follow the collective body of euthanasia research. These industries (e.g. food animal production, research, wildlife management, small animal general practice) create euthanasia best practices for the species they care for, with the vast majority of them drawing some, if not all, of their information from the American Veterinary Medical Association (AVMA). When the first AVMA Euthanasia Panel report was published in 1963, the panel members drew from only 14 known reference articles related to euthanasia. It was clear there was much to improve upon, and in time, more research and superior euthanasia methods would emerge. By 2001’s AVMA panel report, the number of utilized articles, presentations, and books had grown to over 200. The 2020 document, titled Guidelines for the Euthanasia of Animals, took the expertise of more than 70 individuals and included references near the 700 range. The AVMA developed categories to help classify euthanasia methods for veterinary practitioners to follow. The euthanasia methods are either “acceptable,” “acceptable with conditions,” “unacceptable,” and “adjunctive.” The following description is shared directly from the 2020 AVMA Guidelines for the Euthanasia of Animals: Euthanasia methods are classified in the Guidelines as acceptable, acceptable with conditions, and unacceptable. Acceptable methods are those that consistently produce a humane death when used as the sole means of euthanasia. Methods acceptable with conditions are those techniques that may require certain conditions to be met to consistently produce humane death, may have greater potential for operator error or safety hazard, are not well documented in the scientific literature, or may require a secondary method to ensure death. Methods acceptable with conditions are equivalent to acceptable methods when all criteria for application of a method can be met. Unacceptable techniques are those methods deemed inhumane under any conditions or that the panel found posed a substantial risk to the human applying the technique. The Guidelines also include information about adjunctive methods, which are those that should not be used as a sole method of euthanasia, but that can be used in conjunction with other methods to bring about euthanasia. Practitioners determine which euthanasia method to use based on their knowledge of these categories and what they feel is suitable for their patients. The methods themselves have already been reviewed by experts using a criteria checklist with these considerations: Most euthanasia technique publications around the world use these criteria as their basis for acceptable methods. If a particular technique does not meet one or more criteria, the technique becomes less acceptable, therefore requiring additional reflection and precaution to be taken. For example, an intracardiac (IC) injection of a euthanasia drug must be preceded by the administration of an anesthetic because, by itself, the euthanasia drug injection will induce pain in the animal. Another example is the gunshot technique of a client‐owned horse. This may have an emotional effect on the observers but may be necessary to keep euthanasia drug out of the body when burial is the aftercare choice (Figure 1.2). Figure 1.2 A deceased horse following firearm euthanasia. Afterward, loved ones were invited to approach and safely say goodbye. Source: CAETA (2025). It is the practitioner’s responsibility to examine available methods to make the best judgment on how to proceed. It is important to remember that guidelines are not considered the law or legally bound. However, practitioners would be expected to justify why they performed euthanasia outside of a guideline’s recommended methods, especially since the methods are rooted in scientific justification. Note that euthanasia methods are viewed differently from slaughter or depopulation killing methods. The AVMA deliberately created separate guidelines for them, and they are not described further in this book. In 2017, the Companion Animal Euthanasia Training Academy (CAETA) created the 14 Essential Components of Companion Animal Euthanasia for private practitioners to follow (Table 1.1). The components are appropriate for a variety of euthanasia settings when bonded clients are present and are meant to be a blueprint for veterinary teams to follow as they prepare for the euthanasia appointment. They can be used to help develop a euthanasia manual, discussed later in this chapter. Euthanasia techniques are divided by methodology, relating to how death is achieved within the body. Based on current knowledge of the body, death can occur through three mechanisms: Table 1.1 The 14 essential components of companion animal euthanasia. Source: Author’s / with permission of Companion Animal Euthanasia Training Academy / www.caetainternational.com. The goal is to achieve permanent, irreversible death using one euthanasia method. However, sometimes multiple euthanasia methods will be needed. If the patient is only rendered unconscious from the primary technique, another one must be immediately performed. All of the various euthanasia methods may or may not be available to the veterinary practitioner. They will choose their preferred techniques and obtain the necessary supplies to perform them. From a moral point of view, veterinary practitioners must examine all possible life‐sustaining options before euthanasia is chosen. Practitioners have the right to euthanize patients without attempting therapeutic interventions (e.g. pain medication). However, ethically they should be offered for clients to consider (Mota‐Rojas et al. 2023). Anyone performing euthanasia has the potential to slow down and give critical thought to the permanency of ending life. Once the procedure is carried out, there is no reversal. In other words, the best time to reflect on the morality of euthanasia is always before, not after. Questions need to be answered by the practitioner before proceeding with euthanasia: Those performing euthanasia may harbor guilt and resentment toward their decisions if the answers to these questions have not been explored. One may need to ask themselves if their reason for euthanasia became public, would they feel certain events played out in the best interest of the animal and client? Ethically‐indicated euthanasia has been defined as “euthanasia performed in what are believed to be the animal’s interests and which is not considered to be primarily motivated by convenience, economics or reasons to which veterinary team members object” (Quain 2021). Ethical dilemmas arise when practitioners are asked to euthanize an animal when it is not in the animal’s best interest (Kipperman et al. 2018). It’s a reminder of how complex euthanasia decisions are and that having the skills to perform euthanasia is only part of the picture. When a client does elect euthanasia for their pet, practitioners will need to hear the reasons before passing judgment as to whether it is ethically right or wrong. They can help clients determine if euthanasia is the best option for everyone. Veterinary training should provide the necessary tools to assess the animal and determine what physical changes will worsen as the end of life approaches. Age, disease, species, financial reserves, beliefs, etc., can all play a role in the decision to euthanize. The client may be considering euthanasia as the only option. It is the practitioner’s role to identify suffering and make sure all options are explored. Clients typically understand their animals very well, especially pertaining to quality of life, and their contributions to the conversation are crucial (Figure 1.3). The trick is not to let fear of the unknown be the guiding factor but rather have logical reasoning and knowledge be the prevailing rationale. Animal welfare relates to what an animal needs throughout life, including its death. The mission during euthanasia is to maintain the patient in a neutral or positive affective state, meaning the patient is void of negative thoughts and feelings. All sentient animals have some level of cognition, and most, if not all, have the ability to feel pain (Mellor 2010). Therefore, in order to achieve the gentlest death possible, the animal must be handled in a way that matches their tolerance. To help ensure the animal has a death free of unnecessary harm, only those trained in euthanasia should perform the procedure. This includes veterinarians, shelter staff, trained farm personnel, and other professionals that the government (state, province, or federal level) deems appropriate. Only those with these rights should attempt euthanasia, as a matter of animal welfare. There are numerous animal cruelty cases that resulted from animal owners attempting to euthanize their own animals, with painful results, e.g. burning, drug overdoses, and misplaced gunshots. To prevent such attempts, practitioners and support staff can talk openly with clients about the importance of proper euthanasia methods by trained professionals. Animal welfare utilizes what’s known as the five freedoms (freedom from pain/injury/disease, discomfort, fear/distress, hunger/thirst, and freedom to express normal behavior). During the final moments of life, one must consider how to provide the animal with a sixth freedom – the freedom to die a good death (Pierce 2012). All efforts are made to ultimately prevent animal suffering before and during the final moments of life. Figure 1.3 A young boy bonded to his rabbit. One of the wisest ways to provide euthanasia and avoid dysthanasia is to know how to perform the procedure. As this book shows us, there are many layers to euthanasia that can take years to master. Seasoned veterinary practitioners have seen all manner of cases, some easy, some challenging, and some that have made them question if they ever want to perform euthanasia again. The more a practitioner knows about the procedure, the better prepared they are to meet and exceed the needs of the patient and client (Figure 1.4). In 2019, a survey of 30 US veterinary colleges revealed that the average number of hours devoted to euthanasia methods and techniques was 2.8, yet euthanasia facilitation was considered a core competency by all schools responding. The most frequent methods taught for euthanasia were intravenous and intracardiac injections for dogs, cats, horses, livestock, and/or exotics (Cooney et al. 2021). In this author’s opinion, it can appear that as long as future veterinarians are taught how to give an injection during schooling, they know how to perform euthanasia in practice. A lack of euthanasia education places veterinary practitioners, especially new graduates, in a risky position and less qualified to end life. Ideally, learning institutions require a minimum of 4 hours of detailed technique training, with additional hours dedicated to client communication and handling moral dilemmas. It would also be good for veterinary students to be present during euthanasia appointments within clinical rotations. Figure 1.4 A client prepares to say goodbye to a beloved pet. The dog has significant health issues that could lead to a more challenging euthanasia procedure. Source: CAETA (2025). Depending on the type of animal and the setting, each euthanasia will have its own story and outcome. A smart euthanasia appointment increases the knowns and decreases the unknowns. When euthanasia practitioners are able to plan ahead, they set the stage for greater technical accuracy, reduced patient struggle, and improved client satisfaction. Let’s consider the who, what, when, where, why, and how of a euthanasia appointment to paint a clearer picture of the available options and the details that should be addressed. Entire books have been written about the struggles clients and veterinarians face when deciding to euthanize an animal. Making the decision to euthanize is hard, even when it seems easy, i.e. the animal is clearly suffering, and death will be a welcome release from pain/misery. Justifying the decision to euthanize is based on one’s cultural norms, previous experiences, and beliefs. These have to align with what other stakeholders think too. Many animal industries use quality‐of‐life scales to help veterinary teams and animal owners assess how well an animal is coping with a life‐limiting disease or age‐related changes. The purpose of a scale is to reduce subjectivity and give a rank or number to show how well the animal is actually doing. In chronic or long‐term situations, quality‐of‐life scales can be used repeatedly until it’s obvious the animal is no longer able to cope with symptoms. Whether the animal in question is client‐owned or is kept for production‐based purposes, the veterinarian will need to consider the following factors regarding disease before deciding to proceed with euthanasia:
1
Euthanasia Standards in Modern Times
1.1 A Brief Look at Euthanasia’s History
1.1.1 Defining Euthanasia and Original Methods
1.1.2 The Guidelines We Follow
1.1.3 How Death is Achieved
G
Grief support material provided
O
Outline caregiver and pet preferences
O
Offer privacy before and after death
D
Deliver proper technique
E
Establish rapport
U
Use pre‐euthanasia sedation or anesthesia
T
Thorough complete consent
H
Helpful and compassionate personnel
A
Adequate time
N
Narrate the process
A
Avoid pain and anxiety
S
Safe space to gather
I
Inclusion of loved ones
A
Assistance with body care
1.2 Ethics and a Focus on Animal Welfare
1.2.1 Ethical Considerations
1.2.2 Euthanasia and Its Relationship to Animal Welfare
1.2.3 The Importance of Training Euthanasia Methods
1.3 Writing Today’s Euthanasia Story: The Who, What, When, Where, Why, and How
1.3.1 Deciding to Euthanize an Animal Is Hard
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