Euthanasia in dogs and the moral lessons for doctors

We had our dog put down yesterday.

Simon joined our family when our son was 10 years old as a two year old that we adopted from the Purdy Prison Pet Parole Program and was with us until he developed status epilepticus forcing our decision to have Simon euthanized.

Simon had been getting old, lame, nearly blind, and uncomfortable most of the time, but we felt he still had some enjoyment in life until yesterday. When we carried Simon in to our vet he said, “In your business you are not allowed to do this (euthanize patients) but in mine we are, and this seems wise.” If this had been me as a physician, and Simon a human, the process would have been much more complex, the decisions more painful, and I’m thankful that I’ve not been put in this situation yet as a physician.

The possibility that I’ll have to face this issue in Washington became real Nov 4, 2008 with the codification of the “Death with Dignity” act. For end of life situations, with careful safeguards in place and after multiple systematic steps are taken, a physician is legally allowed to prescribe lethal medication to allow a patient to commit suicide.

I was still the medical director at Sound Family Medicine at the time this law came to pass. We discussed it at length at our board meetings, and decided that this was really a personal decision for each physician to make, whether to choose to provide this care to their patient or not. We set in place a protocol to carefully assure we complied with all the explicit regulations if any of us decide to provide lethal prescriptive service for a patient.

Thankfully no patient has asked any of us for this care so far as I am aware. Personally I have very mixed feelings about this law, and participation as a physician. As a living human being, and patient, I am aware that there could be circumstances where I might choose to end my life before nature took it’s course. If I was in great pain or suffering, felt a burden to my family, knew the end was very near, and that the quality of my days was awful I could see considering suicide.

Most physicians know of patients who have chosen this route near the end. Some masked as accidents, others violent by firearm use, and others by intentional self-neglect or starvation/ dehydration. We hear things like, “They just gave up,” or “Grampa just lost his will to live and stopped eating.” Sometimes we hear the story from a surviving spouse and wonder if maybe the deceased partner decided to take too much of their pain medication on purpose and hurried nature along a bit.

As a physician I’ve made rounds in the hospital and seen a patient with severe COPD, lung cancer, terrible bone pain from metastatic disease, and had to decide how much more morphine to prescribe, knowing that if I gave enough to reduce the pain I might bring on respiratory failure and hasten death. I have easily justified the relief of suffering and not been distraught when death came in all likelihood more quickly.

This is only a short ways from this same patient asking me to intentionally be sure I gave him enough medicine to hasten his death. That’s only a short distance from a stroke patient, paralyzed, aphasic, incontinent, and yet very much aware of the situation and having the capacity to live this type of existence for a moderate period of time asking me to prescribe them a lethal dose of medication.

I appreciate the moral, religious, and highly personal issues involved in a physician making the decision as to whether to provide lethal care. I am grateful that the WA law does not mandate physician participation in this service. Yet I can also see how at least some of my patients, in some circumstances, might ask me to help them in this way.

How will I respond if they do? I‘ll definitely spend enough time with them to figure out if I believe their decision is based on reality, or not. Depression, other treatable psychiatric illness, and social, family, and economic situations can keep a patient from seeing that their situation is not as bleak as it appears to them. If I believe that their decision is reasonable, that their decision is sound, and that the medical, spiritual, social and psychiatric care that could be brought to help them will in fact be futile, then I think I could agree to help them commit suicide.

I’ve prayed about this, spent some time soul searching, and now I hope that I am never asked to act in this capacity. It certainly lends additional motivation to be sure I work diligently to give adequate pain relief and palliative care to my terminal patients. Hopefully that way I can support them to a spontaneous death before they feel a need to make assisted suicide their choice.

Maybe dogs have it better in this regard.

Edward Pullen is a family physician who blogs at DrPullen.com.

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  • jim

    In the UK , helping someone to die ( with dignity ) , is a 14 year prison sentence .

  • rezmed09

    “Grampa just lost his will to live and stopped eating.”

    I don’t believe this is in the same category as suicide. Many younger people give up, but only rarely go the route of weight loss and anorexia which leads to death. For the dwindling elderly, anorexia is very common and, in my experience, not a choice but rather a manifestation of multiple co-morbidities with age. For families of such patients, this decline if not easily treated with meds, is best viewed as a terminal illness, but not self induced.

  • http://drpullen.com Edward

    Jim, This is a state law issue in the US, and varies from one state to another. In many states, prison is the consequence here too.
    Rezmed, I don’t think many family physicians would consider the elderly not sustaining themselves nutritionally is suicide. Rather just giving up, often at the end of a long and difficult struggle. In my experience dying of dehydration is a peaceful and humane way to allow some patients to pass.

    • http://paynehertz.blogspot.com Payne Hertz

      You’ve experienced dying of dehydration? Tell me, what was reincarnation like?

      I’ve experienced dehydration, in the Army, in Panamanian jungle survival school. My whole platoon was dehydrated from a long march in the jungle heat with inadequate water. That night everyone was screaming in agony from cramps, though none of us were anywhere near death. I can only imagine how much fun it gets when death is near and your mouth, eyes and skin are dry, your heart rate and respiration have increased to the point it feels you’re running a marathon, every muscle is tightened in excruciating spasms and cramps, and you’re completely delusional.

      I can only imagine the kind of torture you’d have to be going through already to motivate you to kill yourself in such a horrible way. Humane indeed.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    Dogs do have it better.

    I had to have 5 dogs put down over the years, all after long happy lives. It was all over in less than 10 seconds with no pain and no suffering.
    Beats dying from starvation and dehydration over days and weeks just so physicians are not bothered by some misguided moral ambiguities.
    Since none of us had the opportunity to experience death by dehydration, how do we know that it is peaceful and humane? Would you do that to your dog?
    A swift painless resolution seems much more humane to me. Lucky dogs, I guess..

  • Patricia A Campbell, DVM

    As a veterinarian, I have euthanized many animals over the years. I truly believe that facilitating their passing is a privilege as they pass peacefully and appear pain free. Clients often comment about how they wish the option were available for people and tell of friends and family who have suffered tremendously as they languish with cancers and other incurable problems. I agree with Margalit…I do think the dogs (and other non-human animals) have it better.

    • http://www.twitter.com/alicearobertson Alice

      Some dogs have it better………but I think the author did a good job of sharing the deeply, introspective insights we have after putting an animal to “sleep”. We find comfort that the magnificent creature is no longer suffering……but dogs don’t have a soul, or a will worth money……these issues cause moral reflections to come upon the table.

      When we adopt a dog we realize their lifespan will not be nearly as long as a human. Few dogs own assets….and this is a real problem for doctors when it comes to ethics in death. What if they face the moral/ethical dilemna of a person facing some kind of eternal damnation through suicide? Many doctors want no part of it and will allow another doctor to make that kind of decision (some doctors are pro-life, but will recommend a pro-choice doctor……some have such a conviction they will wash their hands of it. They don’t want to help someone kill another human being because it goes against their moral conscience and the ethics do to no harm….yet, some will justify they are helping end pain. It’s an excruciating decision for many……and it should be).

      I believe the author did a good job of explaining how much he has dwelled on this……..but the comparison is on an emotional level, because even if suicide is legislated, or we justify it by comparing it to the animal who is no longer suffering ….we still have our conscience to deal with. A state law won’t sear our conscience, although I do believe the UK will be valuing animals over people soon, which means it’s coming here eventually because we usually follow in their steps.

      There is still hospice care instead of The Hemlock Society.

  • Doc99

    “Soylent Green … is PEOPLE!”

  • http://griefhealingblog.blogspot.com/ Marty Tousley, CNS-BC, FT, DCC

    As a hospice bereavement counselor who also specializes in pet loss, I find it ironic that, even as we debate the ethics of physician-assisted suicide in human beings and point to the acceptability of euthanasia in animals, the practice of providing hospice care for companion animals is growing. See, for example, Animal Hospice, http://www.griefhealing.com/animal-hospice.htm

  • DirtyJobsGuy

    When we had one of our dogs put down, the biggest worry I had was if I was doing it today for “my convenience”. In this case the illness moved faster than expected and we knew it was time. But we had a trip planned for the next week and the thought that I would do this so i could catch a plane was unpleasant to say the least. But it does say a lot about doing this for humans. Granny is keeping us a home, the treatment costs too much, docs could spend time on more productive cases etc.

    I’ve got a saying your grandparents weren’t stupid. They did things because they worked. We need to not make it easy to be the master of who lives or dies because then it just becomes very easy. People live through the pain because it helps the rest of us value that life.

  • Molly Ciliberti, RN

    I am so happy that Washington state (my state) has the death with dignity law. I want that option. As an ICU nurse, I have been asked and begged by patients to kill them or help them die so many times it staggers the imagination. Many have stated that if you can put your pet to sleep when the pain is too much, why not people. This is a sane law that gives people the final control over their own life/death. Helping someone to die in peace is an act of kindness and compassion. You can’t save everyone and this isn’t a Nazi solution, but the patient’s free choice. Speaking of grandparents, my maternal grandfather took his own life when breathing with black lung became almost impossible and my grandmother just stopped eating (at age 96 and horrible arthritis.) Pain doesn’t make you a better person. Suffering doesn’t give you some sort of heroism. There are no medals for martyrs. Those of us who care for the dying in hospitals 8 hours a day know how many of them wish for the peace of death.

  • Molly Ciliberti, RN

    I forgot to ask how one of your people commenting knew that dogs have no soul? Our cat and dog have as much right to life as I do. We are not worth more than any other animal, that is the position of the Judo-Christian religions and as an atheist I don’t agree. Therefore the use of euthanasia for animals when appropriate is not unlike the Washington state law, only the animal can’t consent but as the owner and friend you know when they can’t go on any longer.

  • Christina

    I personally am extremely glad for the Death With Dignity act. I believe that once a person has exhausted the treatments available, and the suffering is still great, they should be able to call it quits. People and animals shouldn’t suffer needlessly. I’ve never known anyone who had to use it, but if they did, I would respect their wishes as long as they’d gave a good try at recovery.

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