EUTHANASIA - GENTLE DEATH, PAINFUL DECISION
Copyright 1993, 2000 Sarah Hartwell

There are good reasons and bad reasons for choosing euthanasia. Good reasons put the cat's wellbeing first - wellbeing meaning the cessation of a now painful existence. Bad reasons are those chosen purely for the owner's convenience with no regard for the cat.

• Organ failure; when internal organs fail, toxins build up in the cat's body, killing it slowly.
• The cat has become vicious, dangerous or unmanageable; if it cannot be rehomed there may be no alternative but euthanasia.
• Progressive illness have made it so weak that it cannot reach its litter-box or food bowl.
• Recurrent infection or condition responding less and less to treatment or occurring more and more often.
• Your circumstances have changed so that you can't keep your cat, but feline overpopulation means it stands no chance of finding a new home - it will either be destroyed by a shelter when its time is up or live long-term in a cage.
• You liked your cat when it was young and active, but have become bored of it now it is old.
• You don't wish to spend money on the cat, you say you can't afford it, but you can afford your mobile phone.
• You are moving and can't take the cat, or don't want to take the cat, and don't want the trouble of finding it a new home.
• You make it a condition of your will that your cat be destroyed when you die; even if it is healthy.

Boredom, poorly prioritised economics and convenience are poor reasons excuses. The cat does not deserve this sort of treatment and most vets are reluctant to euthanize an old but healthy cat just for the convenience of the owner. Vets are often given no choice if the owner threatens to abandon the cat, kill it himself (blackmail) or if cat cannot be rehomed due to feline overpopulation or behavioural traits.

An irresponsible owner may abandon their unwanted cat on the street or close to farms, believing it will hunt and scavenge. Discarded cats often starve, die of disease, are killed by traffic or by a larger predator/stray dog. Many become someone else's cat problem. The lucky ones are picked up by animal control - destruction is at least preferable to starvation. Many pet cats cannot fend for themselves as the hunting instinct has been bred out of them. Older cats are not in suitable physical condition to hunt. One of my pets was a cat which had been abandoned at the age of 18 to fend for herself. She had respiratory problems, a heart murmur and a benign mouth tumour. She ended up in the vet starving and dehydrated. In my home, she lived to the age of 21 before her heart failed altogether.

Some people believe that life is sacred and will not take a life even if the animal is in misery for example paralysed from the neck down or a multiple amputee. They judge animal life by human standards and insist on a natural death, however miserable the quality of life. They consider that ending a life for any reason other than to eat, is the right of god alone. Most religions depict a god (or gods) who has trusted humans to take wise decisions. Where euthanasia is concerned, the challenge may be for the owner to be an instrument of their god and choose euthanasia to prevent further suffering. For example in the Judaeo-Christian belief system, God gave man stewardship over the animals - refusal to make a humane decision is a prime example of passing the buck!

At the other extreme are those who place so little value on a non-human life that animals are considered disposable - they may be ill-treated, tortured for sport and destroyed or abandoned the moment they become an inconvenience or surplus to requirements.

A responsible owner has power of life and death over your pets; this power must be used wisely and not abused. The owner can choose between a quick and humane release from a poor-quality existence or a lingering, suffering end. In many countries, humans are not accorded this right to choose their own death and may be condemned to linger in unnecessary pain.

It is easy to become emotionally caught up in keeping a pet alive when common sense tells you there is no hope of it regaining its health. Sometimes it seems that your own life can't go on when you have to make the decision to euthanize a long-term feline companion. It is hard enough to end the life of an old and frail cat; perhaps if you give it another day, or another week, the cat might die naturally in its sleep even if you know that it will linger uncomfortably until it succumbs to dehydration, starvation or to the gradual poisoning of its blood by liver or kidney failure. If the cat appears outwardly healthy, but has an untreatable medical condition, the decision is made yet harder.

A good vet will help you to weigh up the pros and cons of further treatment versus euthanasia, but ultimately it is your decision. It is never easy, but it helps if you are prepared. The following are common guidelines:-

• A cat is in incurable pain which cannot be alleviated by drugs.
• A cat has severe injuries from which it will never recover or which severely compromise its quality of life.
• A kitten is born with serious defects which cannot be surgically corrected and cannot be endured by the cat; it may not survive weaning or it may not reach maturity (e.g. progressively worsening hydrocephalus)
• A cat has unresolvable behaviour problems which mean you cannot keep it and which mean that it is not rehomeable; the problem behaviours have not responded to behaviour modification therapy or to drugs e.g aggression towards humans which result in people being physically injured (Note: some behaviours are due to neurological conditions/brain damage and are incurable), soiling behaviour
• A cat has an age-related condition which cannot be alleviated and which causes misery e.g. advanced senility, incontinence.
• A cat is terminally ill and will deteriorate. Euthanasia may not be an immediate concern, but will be later on. Euthanasia may be chosen immediately to prevent suffering later on.

The first 5 points are fairly clear cut cases for euthanasia - no caring owner lets a pet suffer. The final point causes the most soul-searching and this article addresses some of the problems of deciding when to have a terminally ill cat euthanized and whether treatment to prolong life for a short while will benefit the cat. Sometimes, a terminally ill or injured cat is given life-prolonging treatment because the cannot yet come to terms with its condition. It is hard to come to terms with mortality in general.

Cost of treatment may be the deciding factor at a very early stage. Unless the cat is insured, the owner has savings or unsecured loan facilities or the vet offers a pay-by-instalments plan, any available treatment may simply be too expensive.

• How much do I know about my cat's illness or condition?
• Is it in pain, distress or mild discomfort? How feasible is it to alleviate this pain and give the cat a reasonable quality of life for a period of time?
• Are there any new treatments available for it?
• Are there any surgical advances for this condition?
• Would a second opinion be beneficial to the cat?
• Can I afford the treatment?
• Can I administer treatment at home e.g. daily tablets, daily injections, prescription diet, manually expressing cat's bladder and/or bowel, syrigne feeding through a tube into the stomach?
• Will the cat physically resist treatment?

How fast will my cat deteriorate without treatment? How fast will it deteriorate with treatment? How fast does the illness progress and what are the signs of its progression?

Some vets view disease as a challenge and death as an insult to their competence, regardless of the animal's condition. Others believe that prolonging an animal's life through treatment is inhumane. Most fall between these extremes and recommend that life be prolonged only for as long as the cat has a reasonable quality of life. While a second opinion may be helpful to you, don't prolong a cat's existence in the hope that the fourteenth, or fifteenth, or twentieth vet consulted knows of a treatment. Don't prolong its life purely in the hope that a treatment will be available before the illness or condition reaches its inevitable conclusion.

When is a second opinion useful? Vets in small-animal practices may have more up-to-date information than those who mainly treat farm livestock. In these cases the vet himself will most likely refer you to another vet. A good vet is aware of his own limitations. There is a tendency to look up information on the Internet (that's possibly why you are reading this). There is some excellent information available about up-to-the-minute treatments. There are also articles and individuals who will give you false hopes and some of those ground-breaking treatments may not mention the failure rate or whether they are still experimental.

Find out about your cat's illness or condition. Ask the vet to explain it to you in terms that YOU can understand. Ask sensible questions. He may recommend reading informational leaflets produced by animal welfare societies. Write down any questions ready for your next visit to the vet. If you have obtained information from other sources - journals or the Internet - ask your vet to discuss it with you. Treatments offered in one country or locality are not available, or feasible due to lack of expertise, or perhaps not affordable, in other localities.

Your vet may know of specialists offering experimental treatments. They may be situated some distance away which means a lot of travelling or leaving your cat with them for a while. The word 'experiment' does not mean vivisection and your cat will not be made to suffer unnecessarily. Whether the treatment is successful or not, your cat will not be made to suffer unnecessarily and lessons learnt from treating it will be useful in helping other cats in the future.

If you have any misgivings about allowing your cat to receive experimental treatment/surgery then discuss these. If the veterinary hospital offering the treatment is some distance away, you may decide that travel and separation will distress your cat. As the owner, you know your cat better than anyone else and a good vet will respect your decision if you decide against further treatment. Choose what you believe will cause your cat least distress.

When faced with the difficult choice of whether or not to attempt life-prolonging treatment with no guarantee of success, I sometimes have to say, "She's had a good life, I don't want to prolong it just because I can't bear the thought of losing her."

• What sort of life expectancy does my cat have with/without treatment?
• Will treatment prolong life or merely prolong suffering?
• Will the treatment or side-effects cause distress for either of us?
• Do my other cats risk being infected or can they be innoculated?

Having learnt that a pet is incurably ill or showing signs of advanced age, an owner usually asks 'how long has he got?' Some illnesses progress very slowly even if untreatable. Other conditions are more aggressive and progress rapidly after symptoms first appear. Cats are good at hiding early signs of illness and, even if the owner is vigilant, some are reach an advanced stage of their illness before exhibiting symptoms. Cats also differ in the way they react to diseases and to treatments so your vet probably won't be able to give you a hard and fast forecast about life expectancy. He can give you guidelines and he can tell you about the signs of deterioration.

Most vets will give estimates of life expectancy varying from days to months depending on the normal rate of progression of the illness, the stage of illness the cat is at, the cat's age and general condition. They will normally advise as to what sort of quality of life the cat can expect and for how long. Knowing whether a cat can expect a few weeks or a few years of relative health or of discomfort greatly affects the decision.

Some diseases are infectious though the cat may stay relatively healthy for a while. Cats with FeLV can remain healthy for some time. Your other cats may be vaccinated, but what about your neighbours' cats? Are you able to keep your cat indoors or segregated from other cats all the time?

Assessing the side-effects of treatment (ranging from a prescription diet for first-stage kidney disease to daily injections for diabetes or even to weekly dialysis sessions under general anaesthetic) is also a major factor as is the possibility that a cat can survive comfortably for a short period without a potentially distressing course treatment.

Some conditions can be treated - but at a cost to the cat. For example, if your cat needs a special diet, can you ensure that he does not raid dustbins or eat food from another cat's bowl? I was given these choices for one of my own cats, a traditional bin-raiding, food-stealing, free-range moggy who would have been distressed by a severely restricted lifestyle imposed by kidney failure (feline kidney transplantation was not an option in those days). I chose euthanasia.

When my 11 year old showed the first signs of heart failure (collapse and loss of consciousness) I opted to try the available treatment. Some cats had lived for 18+ months using daily medication. However, after 4 days my cat began to deteriorate, refused to eat and showed signs of distress at enforced inactivity. She was depressed, suffering and the vet confirmed that she was not responding to treatment. For a previously active, happy cat there was no alternative but euthanasia, however much it hurt me to make that decision.

What matters to the cat is quality of life not length of life. A cat doesn't make plans for next year's vacation. Cats live for the moment - and for their next meal. Some treatments offer a good quality of life for many years. Sometimes, however, a 'short life and a gay one' is better than a long, miserable existence.

Ultimately, the cat's condition will deteriorate as the illness takes its toll. The emotive decision of whether to euthanize a cat becomes imminent. An owner who has opted for prolonged treatment may have built up such an emotional attachment to the cat that the decision is harder now than it was when the condition was first diagnosed. Blood and urine samples, tissue biopsies and X-rays or scans can be used to quantitatively measure the progression of the illness and can be used as an indication as to the cat's quality of life (since cats are capable of hiding discomfort sometimes until they reach the point of collapse).

The measurement of Urea and Creatinine in the blood gives an accurate measure of kidney function. The higher the levels, the worse the problem. A special diet can compensate for impaired kidneys for a while or even slow down deterioration. Once the Urea levels reach a certain threshold, death is inevitable, uncomfortable and often protracted. At this point, most vets recommend euthanasia although many owners opt for euthanasia well before this point based on cost of treatment, life expectancy and life quality (this being very subjective).

• Will other commitments (job, family, holidays) prevent me from giving medication or from taking the cat to the vet regularly?
• Is there someone to continue the treatment when I go away on vacation or am I willing to giving up vacations? What if I must travel because of my work?
• How often must my cat visit the vet - can we both cope with the travelling? Does the vet do house calls or must I take my cat for check-ups at the surgery because check-ups require specialist facilities/equipment?
• Can I afford long-term treatment for the cat? Does my pet insurance (if I have a policy) cover this sort of treatment?
• Will the cat allow me to give it tablets, injections etc? Will it become distressed when I try to medicate and how will the stress affect the cat's condition any my relationship with my cat?

Once, diabetes was a death sentence. Nowadays cats can receive daily insulin injections and live an active life. Fifteen years ago, my parents-in-law's cat was put to sleep because it had epilepsy. Many epileptic cats now have their condition controlled by tablets. Life-prolonging treatment may mean daily medication and nursing.

Not all owners can cope with giving daily treatment. With an extremely uncooperative cat, even giving tablets can be impossible. Some vets will give the daily treatment for you - if you can afford this. A determined cat may resist all attempts to nurse it until it is too weak to resist, by which time treatment may be ineffective. It may be healthy enough to enjoy a shorter life expectancy without medication, but check this with your vet.

You will also need to know what side-effects to expect and whether you can cope with them. You may decide that the side-effects outweigh the benefits of treatment. Sometimes, the economics of the situation will be a major factor. Don't feel guilty just because you couldn't afford a particular treatment. You have no guarantee that the treatment would have worked in the case of your cat. The important thing, from your cat's point of view, is that you have provided it with a good home and good care during its lifetime and that you are not going to let it suffer or allow it to lose its quality of life.

• Is my cat going downhill?
• Am I witnessing deterioration or just a hiccup?
• Is further treatment possible, or humane, at this stage?

Eventually an old or terminally ill cat's condition deteriorates. Gradual deterioration may go unnoticed unless you keep notes, weigh your cat regularly or physically examine it regularly. Discuss the normal course of your cat's illness with your vet and ask what symptoms to look for. Certain symptoms may mean the cat has reached the final stages of its illness and has nothing but suffering ahead.

It is important to recognise when the cat is deteriorating and decide whether treatment is possible at this stage and if so, whether it is humane or would be purely to benefit the owner's desire to put off an unpleasant decision.

In making the decision it is helpful for owners to understand how euthanasia is performed. Euthanasia in small animal practice is by anaesthetic overdose, usually by injection into a vein or kidney, sometimes by gas if the animal is distressed by handling. The knowledge that euthanasia lives up to its literal translation of 'easy death' and is painless and fast while a 'natural death' may involve convulsions, haemorrhaging, starvation/dehydration and, in the terminal stages of many illnesses, pain, may be that crucial deciding factor.