10 Feb 2016
Nick Marsh
Job Title
There’s a bit of a trend for blog titles at the moment – not mine, I generally go for puns. Everyone likes a good pun. Except… well, everyone except me.
Anyway, for normal people’s blogs, the trend a few years ago used to be “The five best reasons why you should change your oven colour scheme”, or similar, but that has fallen by the wayside recently in favour of the rapidly-becoming-ubiquitous formula “Why I started taking my morning coffee as an enema (… and you should too!)”.
Now, there’s nothing necessarily wrong with that – blogs are opinion pieces, after all, and that sort of title is certainly attention-grabbing and intriguing. However, I have seen a few medical and veterinary blogs have recently started using such a tactic and… well, maybe it’s because I’m British, getting old, or just plain stubborn, but the idea of “I do this (and you should too!)” sticks in my craw a little when it comes to something as complicated and delicate as veterinary medicine, balanced as it is on such a precarious evidence base in the first place.
Let me give you an example. I recently read an article entitled “Why I sedate every pet for euthanasia – and you should too”. The article implied when we decide not to sedate an animal at the end of its life, that’s a decision we’re making for ourselves – we’re putting our own interests before those of our patient.
Well, a blog is an opinion piece – so, for what it’s worth, here’s my opinion on the topic…
Whenever I’m performing euthanasia, I always offer sedation and here’s how I put it to the client: “We can sedate him for it, but it takes a little longer and might make him feel a little sick. If he seems to be getting stressed, I would suggest we’ll go that way – he’s the important one today and whatever is right for him, that’s what we’ll do.”
Not only do I say that, but – as with everything I say to clients – I mean it too.
I put it like that because, in my opinion (and I don’t think this is a controversial suggestion), there isn’t a blanket method that’s correct for everyone. Some patients are so stressed with being restrained for an intravenous injection a sedative is appropriate. Some are not. Sedatives are unpredictable, occasionally unreliable, not painless to give and not always pleasant to endure, even if it sometimes appears like it is – there’s a reason we no longer fill our patients with acepromazine for fireworks, isn’t there?
I’ve had good experiences with sedating patients for euthanasia, and I’ve had very bad ones too. If I am the only vet that has waited uncomfortably on a house visit watching an aggressive family pet filled with enough medetomidine to fell a Brontosaurus stagger unsteadily around the room while everyone present silently, desperately prays for it to finally stop pacing, sit down and give in already, then I will eat my stethoscope (and it’s a Littmann, too).
Yes, if you give pentobarbital injection intravenously, its very, very quick – so I would suggest you tell the owner it’s going to be before you give it. In fact, that would be my general advice for euthanasia – tell the owner everything that’s going to happen, explain what is happening when things aren’t going according to plan and remain calm.
Well, that’s my opinion on sedation for euthanasia, and it’s just that – my opinion. Yours may vary, and that’s fine. However, my broader point is things are very, very seldom black and white in medicine, even less so in veterinary medicine.
We are so bereft of evidence in our field – so hungry for it – if you can prove something works, or doesn’t work, we will pounce on it. Finally the stress is out of the decision! Finally we have a definitive right or wrong answer! Such blessed reliefs are few and far between for us. In everything else there’s room for debate, discourse and opinion.
We’re so unsure of so many things and we’re all just trying to get through the day. Tell me your opinion. Let’s discuss it. Don’t make me feel like a bad person because my opinion differs from yours. The job is stressful enough without that.
