Ethics of Euthanasia - Part 1

What is the dose for euthanasia solution?

1cc/10 lbs of 390 mg/ml solution

True or false, - in emergencies, veterinarians have an ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering (euthanize)

True

Euthanasia

Ending the life of an individual animal in a way that minimizes or eliminates pain and distress. A good death is tantamount to the humane termination of an animal’s life

Voluntary active euthanasia

A physician administers a lethal dose of medication in response to a request for help in ending life by a competent patient

Physician assisted death/suicide

A physician prescribes a lethal dose of medication that is self-administered by a patient who has requested the means to end his or her life

Moral stress and the killing-caring paradox

(Shelter workers) are faced with a daily contradiction between their ideal occupational selves (protectors of animals) and the reality of having to kill healthy but unwanted animals

What can burnout and compassion fatigue result in?

Atypical responses and behaviors such as rough handling and apathy

True or false - the AVMA recognizes the need to euthanize animals that are unwanted or unfit for adoption

True

The “ideal” or easy animal euthanasia

• Poor welfare or quality of life

• Poor-grave prognosis

• Poor response to treatment (futility)

* usually at least two of the following

Medical futility

Interventions that are unlikely to produce any significant benefit for the patient. There are two kinds, quantitative, and qualitative.

Quantitative futility

the likelihood that an intervention will benefit the patient is exceedingly poor

Qualitative futility

The quality of benefit an intervention will produce is exceedingly poor

What percent of veterinarians (according to a study) are asked to provide care that they consider futile?

79%

Compassionate deatachment

The concept that medical education should inculcate detachment alongside compassion so as to prevent the constant contact with suffering that can overwhelm or paralyze a compassionate veterinarian.

* controversial

When is euthanasia indicated?

• If the animal is harmed more by its continued life than by its death

• Continued existence is not an attractive option for the animal as perceived by the owner and veterinarian.

What is the “ultimate prognosis?”

A life not worth living

Why is euthanasia an ethically important issue?

The finality of death

• death forever cuts off future positive states, benefits, or opportunities

• However, death also extinguished permanently any and all future harms associated with poor welfare or quality of life

Refused/delayed euthanasia

The delaying of euthanasia (sometimes until the last possible moment), typically do to an owner’s emotional attachment/delayed processing of what’s happening to their pet

If you think euthanasia is indicated, what should you do?

Push for it. Let the client know: it is OK and the right thing to do.

What are challenges with large animals that may indicate that they need to be euthanized?

• inability to control/minimize pain

• the dangers of being recumbent

• can’t fix orthopedic injuries/disease

Why is there a general inability to control/minimize pain in large animals a lot of the times?

Medical pain management has very limited options, especially in food animals

Cattle and horses “timely” euthanasia

Euthanize if down and unable to rise after 12-48 hours, not eating/drinking, not improving with treatment

Swine “timely” euthanasia

Animals that have no prospect for improvement or not responding to care and treatment after two days of intensive care must be humanely euthanized unless otherwise recommended by a veterinarian

“Timely” euthanasia - euthanize cows down for 24 hours or more if she:

• cannot support her own weight after assistance lifting

• makes no attempt to rise

• not alert or aware of surroundings

• is not eating or drinking/severely dehydrated

• cannot sit up on her own

• her pain cannot be controlled

• is not improving with medical treatment and supportive care

AAEP Euthanasia Guidelines for Horses

A horse should not have to:

• endure continuous or unmanageable pain from a condition that is chronic and incurable

• endure a medical or surgical condition that has a hopeless chance of survival

• remain alive if it has an unmanageable medical condition that renders it a hazard to itself or its handlers

• receive continuous analgesic medication for the relief of pain for the rest of its life

• endure a lifetime of continuous individual box stall confinement for prevention or relief of unmanageable pain or suffering

Is it typically easier to define ethically how euthanasia should occur or when/which animals should be euthanized?

how it should occur

Euthanasia methods - different classes

• acceptable

• acceptable with conditions

  • aka “adjunctive”

• unacceptable

How can death be caused by for proper euthanasia of animals?

• direct depression of neurons necessary for life function

• hypoxia

• physical disruption of brain activity

Methods of euthanasia

1. Inhaled agents

2. non-inhaled agents

3. physical

Inhaled agents used for euthanasia

anesthetic gases, CO, CO2, nitrogen gas, etc

Non-inhaled agents used for euthanasia

Intravenous, immersion (fish, amphibians)

Physical agents used for euthanasia

gun shot, captive bolt, cervical dislocation, decapitation, electrocution, exsanguination

Who performs euthanasia in small animal private practice?

Veterinarian

Who performs euthanasia in a shelter setting?

Often technicians, veterinarian supervised

Who performs euthanasia in large animal practice?

team of individuals

Euthanasia location

• Should have all equipment and supplies in one location

• Adequate space

How and why should adequate space be provided in the location of a euthanasia?

• able to move around

• out of main traffic patterns

• if indoors (SA), well ventilated

  • reduce odors

  • consider airborne pathogens

Comfort Room (SA)

• well-lit, but not overly bright

• better to have a movable light when more is needed rather than attempt to illuminate every corner

• Avoid fluorescent lights if possible

• Natural light is ideal

  • as long as public can’t see window

Why is it a good idea to avoid fluorescent lights if possible in comfort rooms?

They flicker/hum out of human range of detection, but it is believed that cats and dogs can detect them

Preparation for euthanasia

• greet the animal as you would any other circumstance (for non-fractious animals)

Dogs

• treats, petting, etc.

• happy voice

• if housebroken, maybe a quick walk for elimination

Cats

• kitty scritches, treats, catnip

• place bedding from cage in the carrier

What should you do before bringing the animal to the euthanasia location?

Prepare as much as you can (flush, pre-meds, euthasol)

What should you do during the euthanasia?

Focus on the animal

• calm, reassuring, happy voice

• not angry, loud, frustrating

True or false - when performing a euthanasia by injection, you should use as much physical restraint as you possibly can

False - you should use the least amount of physical restraint necessary

For fractious, aggressive, or severely distressed, or frightened animals, what should be done to safely handle them for a euthanasia?

Pre-euthanasia drugs should be administered

What much happen before a body is disposed of?

Death must be verified

Unacceptable euthanasia means for all species

• Manually applied blunt trauma to the head as a large hammer

• Injection of any chemical substance not labeled for use as a euthanasia agent

• injection of air into a vein

• electrocution as with a 120 or 220 volt electrical cord

Small animal euthanasia - acceptable euthanasia methods

Intravenous (IV), intraperitoneal (IP), sodium pentobarbital (oral)

Where to administer IP euthanasia

• caudal and right of umbilicus

• midabdomen, flank region

when might be a good time to administer euthanasia orally?

When an animal is highly aggressive or needly averse

What are the best scenarios to use IP euthanasia in?

• cats

• young puppies

• small animals

• debilitated and/or low blood pressure

Time until death after administering euthanasia (IP)

7-15 minutes

When does loss of consciousness happen after administering euthanasia (IP)?

2-3 mins

Dosage for IV euthanasia

1ml/10 lbs body weight

What is the time until death after administering IV euthanasia (TTD)?

<1 min

What is the dosage for euthanasia IP?

3x (min) 3mL/10 lbs

What is the dosage of euthanasia used administered PO?

255 mg/kg

What are all of the IV, IP, and PO euthasol dosages based on?

390 mg/mL pentobarbital concentration

What are small animal euthanasia methods that are acceptable with anesthesia?

• intrarenal (IR)

• intracardiac (IC)

• IH

Intrarenal euthanasia guidelines

1”-1.5*, 18G, palpate for kidney

Intracardiac euthanasia guidelines

1”-3” needle, PMI (3rd-6th intercostal; use elbow)

IH euthanasia guideline

Locate xyphoid process, 45^o angle

IC euthasol dosage

1 mL/10 lbs

IR euthasol dosage

3 mL / 10 lbs

IH euthasol dosage

2 mL / 10 lbs

IC TTD

<1  min

IR TTD

< 1 min

IH TTD

< 5 min

In the instance of needing to euthanasia an animal who is a mother with her littler, in what order should you euthanize animals?

euthanize the mother first, and then the litter

When can an animal be slaughtered instead of euthanized?

• not in severe pain

• freely able to stand/walk

• capable of being transported

• are without disease (PH)

Does a captive bolt gun euthanize an animal itself?

No, an adjunctive method is required

Gunshot specifics for euthanasia

• .22 caliber long rifle (young)

• 12, 16, 20 gauge shotgun (adults)

How does PCB/Gunshot cause death?

By trauma do brainstem and cerebral hemisphere

What must PCB be followed by?

exsanguination, IV KCl, or pithing

What should you prepare for when using PCB/gunshot to euthanize an animal?

tetanic spasms

How many inches away should the firearm be held from the intended point of impact?

12-24 inches

How should the bullet be directed when shooting for euthanasia to prevent ricochet?

perpendicular to the front of hte skull

Acceptable of methods of equine euthanasia

1. Lethal dose of barbiturates (intravenous)

2. gunshot to the brain (prior sedation should be considered when possible)

3. penetrating captive bolt to the brain using an extended bolt designed for euthanasia (prior sedation should be considered when possible)

4. Lidocaine hydrochloride 2% intrathecal with the horse in a surgical plane of general anesthesia

5. A concentrated solution of either potassium chloride (intravenous) or magnesium sulfate (intravenous) with the horse in a surgical plane of general anesthesia

Equine assisted euthanasia methods that are only acceptable under a deep plane of anesthesia

• intrathecal lidocaine

• potassium chloride IV

• magnesium chloride IV

Intrathecal lidocaine

loss of cerebrocortical activity, respiration, brainstem function, and CV function

Potassium chloride IV and magnesium chloride IV

Cardiac arrest and death

Swine acceptable methods of euthanasia

1. Carbon dioxide

2. Gunshot

3. non-penetrating captive bolt

4. penetrating captive bolt

5. electrocution, head-to-heart

6. electrocution, head only

7. veterinarian administered anesthetic overdose

8. manual blunt force trauma

Euthanasia needle size for animals <300 lbs

18 G 1” or 1.5”

Euthanasia needle size for animals 301 - 700 lbs

16 G, 1.5”

Euthanasia needle size for animals >700 lbs

14 G, 2”

When performing a large animal euthanasia, what is one of the most important things that you can do for everyone’s safety?

Control the head

What vein is used in pigs for euthanasia?

Ear vein

What vein is used for poultry euthanasia?

wing vein

Poultry euthanasia - anesthesia

1. sedation: 25 mg/lb xylazine + 20 mg/lb ketamine IM, either side of keel

2. mask with isoflurane

Acceptable means of euthanasia for birds

• iso, sevo, halogen

• IV injection

Acceptable means of euthanasia for small rodents

• IP sodium pentobarbital

• inhalation (Iso/Sevo or CO2)

• decapitation/cervical dislocation

Acceptable means of euthanasia for aquatic animals

• no FDA approved drugs/cessation of opercular movement

• MS 222 for 30 minutes (tricaine methane sulfonate)

• Rapid chilling (2 to 4C)

• Beonzocaine HCl

Acceptable means of euthanasia for amphibians

• transdermally

• sodium pentobarbital (IV, intracelomically, lymph space)

Acceptable means of euthanasia for reptiles

• Injection (IV intracelomic, SC lymph spaces)

Acceptable methods with conditions for reptile euthanasia

• rapid freezing

• spinal cord severance/brain tissue destruction

• pithing

What are some challenges of reptile euthanasia?

• high tolerance to hypoxia

• IV access challenging

• confirmation difficult

Why is confirmation of reptile euthanasia difficult?

Due to slow metabolism, their euthanasia can take hours

Acceptable methods of euthanasia in rabbits

• IV barbiturate injection

Acceptable with conditions methods of euthanasia for rabbits

• inhaled (halogens, CO2)

• cervical dislocation

• PCB/NPCB

Anesthesia:

• KCl

• Exsanguination

• Bilateral thoracotomy

• blunt force trauma

What should methods of euthanasia take into account?

• socialization

• ease of handling and restraint

• response to environment

When thinking about how gentle vs distressing a death is and how rapid or slow a death is, what is it important to think of as a general rule?

A gentle death that takes longer is preferable to a rapid, but more distressing death