The end-all practice: home euthanasia
“Home euthanasia has been a passion of mine for the last eight years,” says Dr. Kathleen Cooney (Colorado State ’04) of Loveland, Colorado.
In 2006, she established Home to Heaven as an exclusively home euthanasia practice. It was only a few years before she started bridging into hospice work as well. The practice took off so fast that she now employs eight veterinarians and five office staff, including a crematory manager.
“The reason veterinarians are choosing this work is that it is very rewarding and enriching, but it’s also a way to get back into practice,” she said during a Nov. 4, 2014, session at the AVMA Humane Endings symposium near Chicago. “Most vets come from private practice, but a lot of them have come from academia and the research world.”
Euthanasia work doesn’t require a lot of medical knowledge and has flexible scheduling—more women are doing this work than men, she said. This being said, it does require a lot of skill and practice.
Besides veterinarians looking for career changes, others already in private practice are searching for something more to their work or have found euthanasia work rewarding. Home euthanasia practice is also beginning in other countries, such as Australia and Israel.
Three years after establishing her practice, Dr. Cooney started to receive phone calls from veterinarians around the country interested in learning how to establish their own pet euthanasia services. She had been writing a training manual for her own staff and decided to make it “a bit more robust” and offer it to interested veterinarians. But a publisher told her the topic was too specific, so she wrote “Veterinary Euthanasia Techniques,” which was published in 2012 and covers euthanasia in general. She still wrote a 150-page e-book focusing solely on home euthanasia, which is published on her website. It has become a must-read for those in the field.
That same year, families from Maine to Texas who had found her website were calling, wanting to locate home euthanasia providers in their community. To fill the need, she created a directory which, as of today, lists 353 services or individual veterinarian providers. Most are stand-alone services, and many of them come from two franchise groups. Pet Loss at Home has about 50 veterinarians across the country working for it, and Lap of Love is a veterinary hospice and home euthanasia service with more than 50 veterinarians nationwide. The directory even lists some Canadian and British providers.
“I had an epiphany one night thinking that if families don’t want me to come to their home, for a variety of reasons, and they don’t want to go to their vet’s office because of memories there or stress to the pet, what do they do?” she said. “At most humane societies, you cannot have owner-present euthanasia. So I built a neutral safe place where families can come, and it sits on my farm in Loveland, the Pet Euthanasia Center.”
Seventy-five percent of what I do is for the family.
Dr. Kathleen Cooney, owner, Home to Heaven home euthanasia practice
Also at the center, Dr. Cooney holds training classes on performing all techniques classified as acceptable in the AVMA Guidelines for the Euthanasia of Animals, as well as on pet hospice care and pet loss support.
These types of centers are popping up around the country, she said. Some crematories are also creating comfort rooms where independent veterinarians or veterinarians who work for the crematory can perform euthanasia. While centers like this have their place, Dr. Cooney says mobile euthanasia providers collectively think that being in the pet’s home is still the ideal situation.
The euthanasia ceremonial
First and foremost, the goal with euthanasia is to have calmer, more relaxed patients, Dr. Cooney said, “where I’m just a friend who’s come to visit, I’m not a threat, they have no memories of me.”
But only about 25 percent of the work involves ensuring the animal has a stress-free, pain-free death. “Seventy-five percent of what I do is for the family,” she said. “A big part of the reason people choose home euthanasia is they want a more enriching experience,” Dr. Cooney said. “These families are looking for more of a ceremonial feel with euthanasia.”
She usually spends about an hour with family members—15 minutes getting to know them, 15 minutes for pre-euthanasia sedation and euthanasia, 15 minutes for privacy and making a memorial paw print or imprint, and 15 minutes for transition to the vehicle if they need help with body care. She carries grief support resources to provide the family before she leaves.
Inherent challenges
Often, Dr. Cooney and her veterinarians are called to help with fractious animals, animals that haven’t been touched much, and feral animals. Traveling to and from homes can also pose a challenge, depending on weather and traffic.
Body transport can be difficult. She is constantly moving big dogs through various environments, from underneath trees to top floors and basements. The previous day, she had moved a 165-pound Mastiff. And she works in a lot of unfamiliar settings with people she has never met. For reasons of cost and speed of service, most veterinarians doing this work do not bring veterinary technicians but ask the family to help, with most families eager to get involved.
The signing of the Veterinary Medicine Mobility Act (H.R. 1528) into law Aug. 1, 2014, resolved the dilemma of the Drug Enforcement Administration allowing, according to previous law, the transporting of only enough drugs for one appointment. In her field, Dr. Cooney said, there was much discussion in the last few years about safety, security, and record keeping.
“Fortunately now, we do have permission to take these drugs in the field and take more than we need for one appointment,” she said. “Last Saturday, for example, I helped seven families, and I had begun the day with only two appointments. So I needed to carry a lot of drug with me.”
The medical side
Dr. Cooney’s locked drug box contains pre-euthanasia sedation and anesthesia drugs. She said she and most in her field use barbiturate solutions, which she noted are the gold standard in the AVMA guidelines for companion animal euthanasia with the owners present and offer more technique options than combination products.
She uses pre-euthanasia sedation or anesthesia every time to relieve pain and anxiety. “I really want to have them sleeping, and families like that, too,” she said. “Most of us are using a combination of drugs to achieve this, such as alpha-2 agonists, tranquilizers, dissociatives, and benzodiazepines.”
Catheter placement is a standard protocol in her practice. One reason is that, once a catheter is placed, she no longer needs to worry about blood pressure and can step away and give the family privacy.
Also, her practice always has a backup plan in case the first euthanasia method fails.
For cats, Dr. Cooney and her team frequently use an intrarenal injection technique and recently completed a study on its efficacy. They also use this technique on rabbits, ferrets, and other exotic animals in which the kidneys can easily be felt. They do not use it on dogs because anatomically it is difficult.
The palliative care option
What Dr. Cooney also loves about home euthanasia and the reason she thinks it’s important that veterinarians continue to do this work, rather than euthanasia technicians, is that if euthanasia is ultimately not carried out, a veterinarian is present who can help assess the patient in its home environment and offer palliative care options and hospice.
“That’s what brought me into the world of hospice in the first place was going to the home, and the family was convinced it was time for euthanasia, and we find out that really it was a lack of pain medication or other therapies. If they’re giving me a little bit of a green flag to say we can try some things besides euthanasia, I can jump on that and, hopefully, help to make a difference,” she said.
One of her first hospice patients was a female dog with a history of immune-mediated hemolytic anemia and osteoarthritis. The family called Dr. Cooney to their home, and some adjustments of the dog’s medications extended their pet’s life by 11 months of quality time.
Dr. Cooney’s biggest struggle is knowing she could often do more, which leads to compassion fatigue more often than any other aspect of her work. Asked by a symposium attendee how often she goes to a home and finds that a pet could benefit from veterinary care, she said, “All the time, and it is a struggle. I’m a healer like all of you. But I have to really listen to the family and read between the lines. If the family feels the time is right, it is critical I listen to their needs.”
Related JAVMA content:
Pet hospice movement gaining momentum (April 15, 2009)