History and Status of Companion Animal Euthanasia;

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DEFINITIONS

 

ATROCITY; an extremely wicked or cruel act, typically one involving physical violence or injury. (Google Dictionary)

EUTHANASIA; The practice of intentionally ending a life in order to relieve pain and suffering. The word "euthanasia" comes straight out of the Greek -- "eu", goodly or well + "thanatos", death = the good death. MedicineNet.com

"IN VETERINARY MEDICINE, euthanasia means to end life painlessly." (From "Euthanasia and Thanatology in Small Animals", in the "Journal of Veterinary Behavior".)

COMPANION ANIMAL EUTHANASIA; the entire procedure, including every step, beginning with the administration of any sedative at home prior to the arrival of the practitioner for a home euthanasia or such administration prior to departure for the facility where it’s to be completed. Exception to this definition can occur in cases of emergency euthanasia or when client and practitioner agree that a euthanasia procedure is to consist of fewer steps, such as when they agree to attempt a direct intravenous lethal injection that is to be free of distress or pain without sedation.

PERFECT PET EUTHANASIA; A procedure that results in the intended death of any animal that served primarily as companion and is completely free of any sign of increase in any emotional or mental distress or physical pain that may have existed before the euthanasia began.

DYSTHANASIA; in veterinary medicine, a euthanasia attempt which causes distress and/or pain in addition to that which may have previously existed...a “bad death”. (dysthanasia; from the Greek: δυσ, dus; "bad, difficult" + θάνατος, thanatos; "death": from Wikipedia)

CAREGIVER; Provider of care such as feeding, watering, and medicating, when an animal or pet is home or in its territory.

 

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HOW, WHEN, WHERE AND WHY DID COMPANION ANIMAL EUTHANASIA (CAE) BEGIN?

 

SPECULATIONS ON ITS HISTORY

 

First of all, CAE vary extremely in quality, all the way from perfect to some for which the only "good" thing about it is that the patient's suffering is ended, but with the likelihood that the psychological suffering of any witnesses continues. I have heard of the former and witnessed the latter. This discussion includes CAE of all qualities.

 

I became very curious about the history of CAE only after witnessing Tinkerbell's euthanasia atrocity and after learning of many others. I thought researching these questions could shed light on why this is happening and how to prevent it. Any discussion of the written history of CAE is very simple; the only histories found so far deal only with its ethical and legal aspects. Jessica Pierce's findings are similar when she explains in her article "Moving Beyond the Euthanasia Imperative".

 

"Nor have I been able to find any discussion of the historical development of the practice of euthanizing animals. One of the only references to euthanasia’s history in veterinary medicine is in Lagoni, Butler, and Hetts’s excellent book The Human-Animal Bond and Grief. They say simply, “it has just always been there” and that’s about as much history as we have."

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The unwritten history of CAE has either been lost, unpublished or unrecorded by earlier practitioners who have died, or resides in the minds of those who are practicing it or have witnessed it. This is where you enter. What, if any, are your earliest memories of CAE? The comments you leave on the “Additional Resources” page of the Message Board can form the basis of a written history of CAE for anyone with the necessary abilities and qualifications. The way in which our animal companions die may be the most important aspect not only of their lives, but also of our memories of them; their legacy. A history of CAE, the way many of them have died, is a history that should be written.

 

Speculating on the unwritten history of CAE, it seems likely that CAE became part of a veterinarian's duties only when it was requested by enough keepers of companion animals who wanted to provide them with a painless peaceful death. In an article from pedigree.com entitled "The Evolution of Pet Ownership" we find that;

 

"Pet keeping wasn't generally accepted in Europe until the end of the 17th century, and it wasn't common among the middle classes until the late 18th century. Pet keeping in its present form is probably a 19th century Victorian invention."

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As you may know, since that time the number of cats and dogs kept as pets has increased to the point that a veterinarian CAE specialty has arisen. 

 

In "A Quick History of Veterinary Medicine" by Linda Cole, found at Canidae.com, we read;

 

"The first veterinary school was founded in Lyon, France in 1761 by Claude Bourgelat, and that’s when the profession of veterinary medicine officially began. The school focused on studying the anatomy and diseases of sheep, horses and cattle in an effort to combat cattle deaths from a plague in France."

 

It goes on to say;

"Over the next ten years, veterinary schools were established in Germany, Sweden and Denmark. In 1791, the London Veterinary College was established and developed veterinary science at a professional level dedicated to animal medicine. The well-being and health of horses was their initial focus for years, because of the use of horses in the Army. Eventually they turned their attention to cattle and other livestock, and finally added dogs and other animals."

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Pet keeping first becoming common during the late 1700's coincides with the official beginning of the veterinary profession. This coincidence of common pet keeping with the beginning of the veterinary profession indicates that CAE may have been a significant part of the profession from the time of its official beginning. But the initial focus on the ability of captive and enslaved large animals to fulfill an economic role suggests that wasn't a significant part until some as yet undocumented later period. Perhaps an enterprising researcher will sometime unearth in the archives of colleges and schools of veterinary medicine the daily logs of some of the early alumni and document the beginnings of CAE.

 

SUMMARY ON THE HISTORY OF COMPANION ANIMAL EUTHANASIA

 

No written history has yet been found. It must be inferred from other sources. 

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SPECULATION ON EARLY METHODS OF COMPANION ANIMAL EUTHANASIA (CAE)

 

Since prehistoric times, a means of causing painless death that has always been available was a blow to the head. That can also only cause loss of consciousness which would then allow the use of other methods to cause a painless death that would otherwise be painful for a conscious animal.

 

A history of firearms, from the HIstory Detectives series on PBS,shows that for about the past 600 years, painless death could also have been delivered by gunshot to the brain. The production of mass-produced, affordable firearms, first in 1835, probably made this means of death more common. The quote "They shoot horses, don't they?" may well have originated during this time. This was a common form of death for companion animals even when I was growing up on a dairy farm in the 1950's. But neither a blow to the head or gunshot to the brain could be described as peaceful!

 

A history of chloroform and ether, from History.com, shows that their use as anesthetics became common in the early 1800's. Could their use as lethal inhalants provide the death both painless and peaceful that pet keepers wanted for their companions? Their use for this purpose would probably have required the use of force whenever the patient was conscious as inhaling them would probably have been resisted. Since the use of force isn't peaceful and results in mental distress or pain, a painless and peaceful euthanasia would be impossible while trying to use these or any inhalants.

 

 

I both cared for and knew of many companion animals before the euthanasia of Miss Kitty in 2010 followed by the euthanasia atrocity of Tinkerbell in early 2019. Yet I recall how only a few of them died. I don't know why. Maybe I didn't think the way the others died was important. I do now. I know that none of the deaths I do recall were by CAE. 

 

SUMMARY

 

Speculation on the early methods of CAE is very difficult due to the current scarcity of data. Your comments left on the Message Board regarding recent CAE can begin reducing this scarcity. 

 

The Miss Kitty and Tinkerbell euthanasia and later, the work on this website made me extremely curious about the status of CAE. What is its relative effective professional standing? 

 

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SPECULATION ON THE STATUS OF COMPANION ANIMAL EUTHANASIA (CAE)

 

Answers to questions like the following may help in evaluating the status of CAE.

 

What's the demand for animal or pet euthanasia? How many are performed by veterinarians?

 

What is the CAE education for veterinarians? How and what are they taught about it.? 

 

Is there a standard protocol that reliably results in a painless, peaceful CAE in most cases; one that will inflict no additional distress or pain on a patient already in distress and/or pain? Should there even be a standard protocol for CAE for which conditions can vary so extremely?

 

What's the level of satisfaction with drugs that are currently available for use in CAE?

 

 

SPECULATION ON DEMAND FOR COMPANION ANIMAL EUTHANASIA 

 

First this finding from an abstract of a survey from 2011 entitled "A Survey of Veterinarians in the U.S.: Euthanasia and Other End-of-Life Issues" in the journal "Anthrozoos". 

 

" A survey of 463 veterinarians in the southeastern United States (return rate = 75%) found that they average euthanizing 7.53 animals per month."

 

Then from "Market research and statistics: U.S. Veterinarians 2018",from the American Veterinary Medical Association, we can find that there are about 75,000 U.S. veterinarians in private clinical practice, the sector most likely to be called on to perform CAE.

 

If these 75,000 veterinarians perform an average of 7.5 euthanasia per month, that means they perform about 562,500 euthanasia per month or about 6,750,000 euthanasia per year in the U.S. This figure represents euthanasia of all types of animals and for all types of reasons. Assuming most euthanasia are performed without increasing any distress and/or pain that may have existed, these euthanasia prevented a great deal of suffering.

 

Yet, this figure seems astounding. Can it be anywhere close to accurate? As a check, the following data reveals about how many cats and dogs only may be euthanasia candidates because they’ve reached the end of their normal lifespan only.

 

"U.S. pet ownership statistics", also from the American Veterinary Medical Association shows us that in 2017-2018, the latest figures available at this writing, there were about 58 million cats and 77 million dogs kept as pets in the U.S. for at total of about 135 million. To calculate the number of cats and dogs that should reach the end of their normal lifespan and die each year, possibly as a result of CAE, we must know their average lifespans. For cats, we find this from The Spruce Pets.

 

"Cats can live a long time. The average lifespan of a cat is about 15 years, so they often outlive most of our pet dogs. A teenage cat, or even one in their twenties, is not uncommon to see. Many factors can play a role in determining how long your cat might live."

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This shows that one of every 15 cats (or 6 and 2/3%) should reach the end of life each year. Six and 2/3 percent of the U.S. cat population is about 3,886,000.

 

For dogs, we find this from Pet MD.

 

"A recent analysis of veterinary records revealed that dogs under 20 pounds had an average lifespan of 11 years while those over 90 pounds typically lived for only 8 years. Medium and large dogs fell in the middle at around 11 years. (State of Pet Health 2013 Report, Banfield Pet Hospital)."

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This shows that one of every 11 dogs (or 9 and 9/10%) should reach the end of life each year. Nine and 9/10 percent of the U.S. dog population is about 7,623,000.

 

Combining the numbers of cats and dogs expected to die each year yields 11,509,000 which far surpasses 6,750,000, the number of CAE performed each year, and some of that number must be animals other than cats and dogs.

 

So yes, it seems possible that at least 6,750,000 of these 135,000,000 cats and dogs, or 5% (5 of every 100, or one out of 20) could be euthanized by veterinarians each year. About 11,509,000 cats and dogs could be expected to reach the end of life each year and be available for euthanasia. But vets perform only about 6,750,000 euthanasia per year, some of which are for animal other than cats or dogs and for reasons other than having reached the end of normal lifespan, indicating that at least 4,759,000 die from causes other than CAE. It seems that the demand for CAE could be about double of what it is, just for cats and dogs if all their caregivers made use of the service.

 

Incidentally, this begs the question; what are the causes of death for those 4,759,000 cats and dogs who do not die by CAE and how much suffering is involved? Even imperfect euthanasia may greatly reduce suffering experienced by fatally injured or terminally ill animals. Hopefully, the caregivers of companion animals, including those of the cats and dogs above who now die without their time of suffering being shortened by euthanasia, will be able and willing to make use of this service for their companions in the future. If so, a great amount of suffering may be prevented.

 

Dr. Kathleen Cooney, CAETA Director of Education says in a personal communication about the demand for CAE performed by specialists both in the clinical setting and at home.

 

"It's hard to give percentages for demand of those specializing in euthanasia. In the clinic setting, since all vet teams can euthanize, there will not feel like a shortage. These vet teams will not be specialists in CAE but to the client, most don't know the difference until they experience euthanasia the right way. Therefore demand can only build the more ideal euthanasia appointments are being carried out. In the home, I would say most communities are under-served and the reason is that CAETA receives many emails from lay people hoping to learn how to deliver home services. This is my 'fuel' to keep pushing for advanced training and home services."

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Lastly regarding demand; four major veterinary pharmaceutical companies were asked about their level of awareness of the demand for CAE. None of the companies reported any such awareness.

 

SUMMARY OF DEMAND FOR COMPANION ANIMAL EUTHANASIA

 

Veterinarians in private clinical practice perform about 6,750,000 CAE per year. That number is about 56% of only the pet cats and dogs expected to reach the end of life each year. Information on whether or not there is an unmet demand for CAE remains to be discovered. Have any potential CAE clients been unable to make use of the service? 

 

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SPECULATION ON COMPANION ANIMAL EUTHANASIA EDUCATION

 

Knowledge of the current state of formal companion animal euthanasia education could shed significant light on the status of its practice. An account of the history of companion animal euthanasia could do the same for the route to its present status. If the route from the past is unknown, it’s often difficult to plot a course into the future.

 

An account of the history of companion animal euthanasia could answer many important questions. Did the veterinary education community learn of and respond adequately and promptly to the demand for companion animal euthanasia? Has it yet done so? Are there formal lines of communication between the veterinary education community and the practicing veterinarian so that unmet educational needs may be fulfilled for the next veterinarian generation?

 

Many surveys have found that many caregivers of animals no longer regard them as “just animals” deserving of lower care standards than themselves, especially when it comes to end-of-life care. It seems to always have been common for children to regard companion animals as family members...as siblings. But it seems that now, more adults are retaining that regard and viewing companion animals as family members, if not also as their children. Has companion animal euthanasia education kept pace with this change? Is there an obligation to do so?

 

It would seem difficult, if not impossible, for any non-professional to gain access to any resources that may answer questions such as the above. My detailed online search for any relevant data turned up nothing. It seems that a dedicated, professional historian of the veterinary profession is needed.

 

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This is what I've both incidentally encountered and searched for about recent CAE education while responding to Tinkerbell's atrocity and working on this website.

 

During a discussion with a co-owner of the clinic that performed Tinkerbell's atrocity, I asked about his euthanasia education. He said he had some, but I thought it seemed to be more about the bereavement of the client instead of about protocol and technique. An abstract of a survey from 2011 entitled "A Survey of Veterinarians in the U.S.: Euthanasia and Other End-of-Life Issues" in the journal "Anthrozoos" finds;

 

"The majority of veterinarians did not think that their veterinary school training prepared them to relate to owners of terminally-ill animals, though more recent graduates were more favorable toward their training than earlier graduates. The overwhelming majority of veterinarians felt that veterinary schools should place more emphasis on communication skills for dealing with owners of terminally-ill animals."

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The letter to deans of all accredited colleges and schools of vet medicine that I sent after Tinkerbell's atrocity (before I learned of CAETA) requested that they consider adding Low Stress Handling to their curriculum because I think the atrocity would’ve been avoided had our practitioners used it. But none of the 11 responses to the 50 letters included even one word about euthanasia curriculum or education.

 

During the summer of 2020, I emailed those same Deans requesting that they “consider adding CAETA instruction and certification to your curriculum on a required basis”. Five replies were received with all stating that euthanasia curriculum were thought adequate. Two of those noted previous cooperation with CAETA and one was working with CAETA at the time. Another contacted CAETA as a result of this email without replying to it.

 

During a phone conversation with a CAE veterinarian specialist and researcher, I said I was considering a followup to the above letters to ask deans about their CAE curriculum. I was then told that all deans would say that CAE was taught at their institution. But this person was also working with a co-worker to develop a questionnaire to be sent to deans asking for details about that education.

 

An abstract from an article entitled "A Model Euthanasia Workshop: One Class's Experience at Tufts University" from a 2004 issue of The "Journal of Veterinary Medical Education" states;

 

"Performing euthanasia is likely one of the most challenging tasks a veterinarian faces. Four students at Tufts University School of Veterinary Medicine felt that they and their classmates needed additional training on this subject. They informally surveyed the classmates to determine what topics and formats the students desired. The findings were used to develop the Euthanasia Workshop at the university, a voluntary series of lectures and discussions on technical and emotional issues relating to euthanasia. The four students then informally surveyed 30 North American veterinary colleges to determine the scope of euthanasia training in other veterinary programs. They found that euthanasia, while often covered within other courses, is rarely taught as a standalone course."

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An official of this institution has stated in a personal communication that Tufts School of Vet Medicine does now offer a standalone CAE course. It's not yet known which other such institutions offer such a course or of what any such courses consist.

 

Voicemail messages were left at two prominent vet med educational institutions asking about any CAE education they offered. Neither responded. 

 

A veterinary education official told me during a phone discussion about the teaching of CAE that two difficulties associated with that are the lack of euthanasia patients and the justification for using them for this purpose. I replied that it's very likely that there's an animal shelter nearby that would gladly offer plenty of terminally ill patients for this purpose. It seems that if this institution was teaching CAE at all, it was done without using live patients. Another potential solution to the problems associated with using actual patients in the teaching of CAE can be seen by clicking on synthetic cadavers.

 

To see a comparison by Lindsay Francis of the way euthanasia is usually in taught vet schools with the way it's taught by the Companion Animal Euthanasia Training Academy, click here to see the article edited by Dr. Kathleen Cooney. The article also describes the extent to which this academy's methods are being taught in vet schools.

 

SUMMARY OF COMPANION ANIMAL EUTHANASIA EDUCATION

 

The education for CAE provided in most colleges or schools of veterinary medicine seems to be inadequate.

 

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SPECULATION ON COMPANION ANIMAL EUTHANASIA PROTOCOL

 

For a discussion of the state of euthanasia protocol for cats and dogs in 1978, see the "Introduction" to this study after clicking here. 

 

The protocol used in Tinkerbell's euthanasia atrocity is the same one described in nearly all other CAE I've encountered or found. For accounts of two similar CAE using this protocol, click here. For a videos of perfect CAE using this protocol, click here. No information has been encountered or found to indicate whether or not this protocol has been used long enough or widely enough to be called "Standard". The same situation exists for knowledge about its reliability in delivering painless, peaceful CAE.

 

Jill Breitner says in her article "Euthanizing an Old Dog: How it Works and What to Expect" from"Whole Dog Journal"; 

 

"The most important bit of information that I gathered is this: There is no single right way to administer a pre-sedation drug or drug cocktail to every animal, every time. Ideally, the veterinarian should take into consideration a number of factors:

 

- The patient’s species (cat, dog)

 

- The patient’s physiological condition (obese or thin; well-muscled or lacking adequate muscle tissue; good or poor circulation; etc.)

 

- The patient’s behavior (calm, or agitated and fearful)"

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Jill Breitner says this about "standard" CAE protocols in the same article, "Euthanizing an Old Dog: How it Works and What to Expect" in the "Whole Dog Journal";

 

"I understand that no practitioner can sedate and euthanize without causing pain or fear in every animal, every time. But now I also know that a skilled, caring practitioner should see and evaluate each animal as an individual, and customize the drugs used and the way they are administered for the unique needs of each animal."

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The only bit of documentation encountered or found so far regarding what CAE protocol is most often taught in some way in some institutional settings is this from a blog by Dr. Kathleen Cooney on the website of the Companion Animal Euthanasia Training Academy entitled "The Growing Trend of Intraorgan Injections for Pet Euthanasia"

 

"Of those who said they still preferred the IV route, the most common answer was simply that they didn’t know how to do anything else. IV injections are all they had been trained in." 

 

PROTOCOL SUMMARY

 

It appears that the standard protocol used to administer CAE, or if there should even be one, is a very unsettled issue. The only formal research on CAE protocol found is that of the Companion Animal Euthanasia Training Academy. Additional research in the administration of CAE should be a priority. 

 

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SPECULATION ON COMPANION ANIMAL EUTHANASIA DRUGS

 

How satisfied are practitioners with the CAE drugs available and in use as of late January 2020? 

 

How suitable are the drugs for CAE?

 

I came away from a phone discussion with a CAE specialist veterinarian with the impression that drugs specifically used for sedation in CAE have never been developed and that the drugs used were quite unsuitable because of the frequency of side effects. This view is supported by Jill Breitner in the "Pet Euthanasia Protocols" section of her article, "Euthanizing an Old Dog: How it Works and What to Expect" in "Whole Dog Journal".

 

Because of this impression, four major veterinary pharmaceutical companies were asked if they produced any drugs specifically labelled for CAE. None of the companies reported any such production. However, an official of Tufts School of Veterinary Medicine referred me to the National Library of Medicine which showed several drugs specifically labelled for use in CAE. None were produced by any of the companies contacted and all were labelled only for use in the lethal injection, not for sedation. 

 

The question that I should've asked of the vet pharmaceutical company officials is "Does your company produce any drugs specifically labelled for sedation during CAE?" This is because the point at which most bad euthanasia produce pain is at the injection of sedative into a muscle. (See Jill Breitner's article, "Pet Euthanasia Gone Wrong" in "Whole Dog Journal" and its following comments.) But are the extreme reactions during traumatic euthanasia incidents caused by the injection into a muscle (IM), the drug side effects or both?

 

Below is what Jill Breitner learned about this from some Fear Free Professionals when researching her article "Euthanizing an Old Dog: How it Works and What to Expect" in "Whole Dog Journal".

 

"All the veterinarians who responded said they mixed Telazol with other drugs and administered it subcutaneously (under the skin, commonly referred to as “sub-q”) rather than IM, because it’s less painful that way. Some didn’t use this drug at all, preferring other drugs, such as the combination of xylazine and ketamine best known by its veterinary nickname, “pre-mix.” Several vets also noted that “pre-mix” can also sting when administered IM. When an animal is emaciated, or has very little muscle tissue (as in the case of many senior cats and dogs, including my two wards), these drugs can cause so much pain when administered IM, that many of these vets inject the drugs sub-q, instead." 

 

The following sensible summarizing commentary regarding drugs for CAE is offered by CAETA Administrator, Dr. Cooney. 

 

“At this point, specific new pharmaceuticals for sedation/anesthesia aren’t really necessary and would not be considered viable for a company to produce. The drugs produced are typically used for multiple types of procedures including euthanasia. The goal would be to improve the ones that exist because of the likelihood they would be used for euthanasia.”

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Given the above discussion of the suitability of drugs used for sedation during companion animal euthanasia, the following questions and comments regarding their administration seem a logical explanation for most traumatic euthanasia.

 

Have you ever received an injection into a muscle when that muscle was tensed, or have you gotten such an injection into a relaxed muscle, but that muscle contracted and flinched involuntarily while the needle was embedded within it? If so, you may have experienced something similar to what the patients of traumatic euthanasia may be experiencing. It seems your response would possibly be classed as "severe".

 

Now add to that experience the burning sensation of a drug with that possible side effect. It seems your response would possibly be classed as "extreme". These considerations should make the likely cause of some of the extreme reactions during traumatic euthanasia quite obvious. 

 

If a sedative is to be used in the euthanasia of an agitated or tense patient, injection under-the-skin (sub-q) of a non-burning drug would seem to be the only way to ensure that euthanasia is worthy of the term "good death". (Do such drugs exist? To find them or to test new drugs, could they be ethically tested on shelter animals that are in uncontrollable pain or have a terminal illness?) Sedatives injected this way require more time to take effect than do those injected into muscle because blood circulates more slowly under skin than in muscle. If that additional time is not taken, the results could be extremely unpleasant and irreversible for all involved. 

 

SUMMARY OF CAE DRUGS

 

No drugs specifically labelled for sedation CAE have been named. There is some dissatisfaction with sedatives used for CAE because of side effects. Documentation on the degree of this dissatisfaction and degree, frequency and type of side effects has not yet been found. Please use the Message Board to offer your contributions which could serve as the beginning of such documentation.

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SUMMARY OF THE STATUS OF COMPANION ANIMAL EUTHANASIA

 

Demand 

Veterinarians in private clinical practice perform about 6,750,000 CAE per year. That number is about 56% of only the pet cats and dogs expected to reach the end of life each year. Information on whether or not there is an unmet demand for CAE remains to be discovered

 

Education 

The education for CAE provided in most colleges or schools of veterinary medicine seems to be inadequate.

 

Protocol 

It appears that the standard protocol used to administer CAE, or if there should even be one, is a very unsettled issue. The only formal research on CAE protocol found is that of the Companion Animal Euthanasia Training Academy. Additional research in the administration of CAE should be a priority

 

Drugs 

No drugs specifically labelled for sedation in CAE have been named. There is some dissatisfaction with drugs used for CAE because of side effects. Documentation on the degree of this dissatisfaction and degree, frequency and type of side effects has not yet been found. Your contributions to this website could serve as the beginning of such documentation.

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General Summary 

This account of the history and status of companion animal euthanasia is a work in progress. CAE appears to have been the neglected stepchild of the profession and hadn’t been given the attention it deserves until the time that CAETA and perhaps a few other dedicated individuals began their work. This most important and last event in the life of every animal companion should be painless and peaceful. It's clear that not all are. The harm done to the patient, to the veterinary profession and to witnesses during those unsatisfactory incidents can never be corrected or undone. 

 

It seems there is much about the history and status of CAE that is unknown. One of the purposes of this website is to begin correcting this knowledge deficit. This is where you can make your contribution. Please add your voice by leaving your comments on the issue and by telling your story and that of your animal companions on the Message Board. Revisit to leave new information as you acquire it.

 

Another purpose of this website is to disseminate what little is known about CAE. We've tried to provide what is known about a range of aspects of CAE and will add new data and information as it becomes available. Please revisit if your questions aren't answered and bring someone with you.

 

Thank you.

 

Michael authored this page and compiled its data.

(Photos courtesy of cityslide.com, licensed from Ron Chapple Photography.)