What would you do?

6 July 2021

Despite being a common procedure in veterinary practice, the pastoral aspect of euthanasia can be challenging for the veterinary professional. Given that owners will likely respond in different ways, research that seeks to understand the experience of people making end-of-life (EoL) decisions can help veterinary professionals to support owners through the process.

In the study, “What Would You Do?”: How Cat Owners Make End-of-life Decisions and Implications for Veterinary-Client Interactionsthe researchers undertook 14 semi-structured interviews over a seven-month period with New Zealand owners who had recently had their cats euthanized. The interviews explored how EoL decisions were made, how the process of euthanasia was managed and the role of the veterinarian in the process. The interviews were recorded and transcribed and the transcripts were explored for themes using template analysis.

Two main categories of themes were identified relating to considerations owners made in the EoL decision-making process: animal-centred and human-centred.

Animal-centred themes focused on the cat itself and how owners judged its quality of life (QoL), and included considerations relating to behavioural changes, pain, signs of ageing and the benefits of other people seeing what the owners could not.

  • Changes in the cat’s behaviour, particularly reduced appetite or inappropriate toileting, were well-recognized and represented a poor prognosis in the owner’s opinion.
  • Whilst owners recognized that the presence of pain was an important consideration for QoL and contributed to EoL decision-making, signs of pain were poorly recognized.
  • Owners did not consider that their cat’s age impacted on EoL decision-making, but did perceive signs of ageing negatively.
  • When a cat’s health deteriorated slowly, owners found it difficult to detect changes, which introduced uncertainty to the EoL decision-making process. Owners valued the importance of having another person’s perspective to help them evaluate how the cat was deteriorating.

Human-centred themes related to: veterinary surgeons understanding owners’ relationships with their cats, normalizing death, the need for a good clinician to manage EoL care, veterinary validation that owners were doing the right thing, and a strong desire to predict the time course and outcome for their cat.

  • Many owners had difficulty facing their cat’s death even though they perceived euthanasia to be a dignified ending. This was particularly problematic for owners if the prognosis was unclear. The vet’s opinion about their cat’s prognosis was often important to owners.
  • Cat owners had different preferences for their vet’s role in EoL decision-making, ranging from the desire for validation, wanting expert advice and to understand what would happen to their cat, through to being guided to a decision.
  • Cat owners considered ‘good’ vets to show empathy when discussing EoL decision-making, to understand the value that owners placed on their cats and the relationship with them, and to be good at performing euthanasia. Furthermore, owners considered vets to be ‘good’ if they were honest about what would happen to their pet. Owners also valued continuity of care and help with the grieving process.
  • Conversely, owners were less happy if the vet’s values or opinion about euthanasia did not align with their own, or if they came across as inexperienced.

The findings of this study provide some insight into the factors that impact EoL decision-making for cat owners. It should be noted that the sample may not be representative of the wider population of cat owners, and those interviewed were likely highly dedicated to their pet and therefore strongly motivated to participate in the study. Furthermore, the study design relies on participants answering questions accurately and there may be some degree of recall bias, which may have been compounded by asking the participants to recall what may have been a traumatic event.

For further information and resources relating to the pastoral aspects of EoL care and decision-making please visit the BSAVA End of life collection.