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Does euthanasia impact the mental health of veterinary care providers?

Almost every time I euthanize a client’s pet, one of the family members says to me “I don’t know how you do this…I could never do what you do.”  As a veterinarian who takes pride in saving the lives of animals, I find myself struggling to know what to say in response.  Very often I respond with something along the lines of “Although it’s very difficult, I consider it a gift to be able to peacefully end the life of an animal who is suffering.”  They usually nod with understanding in return, but I wonder if they think I am in some way cruel and disturbed under the surface because I can take an animal’s life, something they say they could never imagine doing.

This situation is not unique to me, as I have had conversations with several veterinarians whose clients have questioned how they are able to perform emotionally charged and frequently difficult euthanasias.  While people recognize that these situations are not easy, they might not realize that it is not the euthanasia itself that is difficult, but rather, the intense discussions and deliberation that go along with it.  Handling these situations requires emotional labor, which is the process of managing feelings and expressions to fulfill the emotional requirements of our job.  For veterinarians, technicians, and other veterinary clinic staff members, this sometimes means showing feelings that do not match how we are feeling inside.  For example, in circumstances when we wish the client had the financial means to provide the necessary care for their pet or that the client had brought their pet in to the hospital sooner.  Sometimes emotional labor is because we are triggered during emotional situations and are forced to “re-feel” our own feelings from previous events.  For instance, if we had a similar situation that was distressing or if we recently euthanized a pet of our own.  Emotional labor is typically much more demanding than the physical and intellectual labors of the work that we do as veterinary care providers. 

Given the high rate of depression and suicide in the profession, experts have questioned what impact euthanasia has on mental health and suicidal ideation among veterinarians.  A study published in 2014 surveyed more than 500 Australian veterinarians to investigate the association between euthanasia frequency and depression and suicide risk.  The study found that the frequency of euthanasia performed was associated with an increase in depressed mood, not necessarily due to the euthanasia itself, but because of the client counseling (emotional labor) that goes along with it.

Another finding was that veterinarians working in low income communities had a risk of suicide four times higher than veterinarians working in high income communities.  The reason for this likely relates to the moral stress those veterinarians face on a more regular basis.  A higher percentage of their clients might ultimately elect euthanasia if their pet becomes seriously ill, because while treatment is available, it is unaffordable.  The moral stress results from the veterinary team’s internal conflict that arises when their desire to promote the wellbeing of animals is in opposition with the client’s ability to pay for that care.  This can leave veterinary teams feeling helpless, frustrated, upset, and even depressed.

Probably the most interesting finding of the study was that veterinarians performing more than 11 euthanasias in a week had a lower risk of suicide compared to those who were performing fewer euthanasias.  The authors of the study speculate that veterinarians experiencing so much death and loss would not want to put their own family through a similar loss, or that the thankfulness of clients after a euthanasia somehow buffers its negative effects.  They also wonder whether veterinarians performing euthanasia often have a more profound sense of the finality of death, compared to others.

While the study did not show a causal relationship between euthanasia frequency and depression and suicide among veterinarians, there is no doubt that euthanasia has an emotional impact on the entire veterinary team.  Being aware of this impact is the first step in giving team members permission to acknowledge the emotional toll that euthanasia takes and recognize that we can lean on each other for support.  Acknowledging the emotional labor that’s involved and debriefing euthanasias that result in moral stress are needed to allow the veterinary team to continue to provide compassionate care.