Symposium explores psychological impacts of euthanasia, depopulation

AVMA working group supports dialogue and provides resources

Participating in the euthanasia or depopulation of animals has psychological impacts on both veterinary professionals and animal owners.

Speakers at the AVMA Humane Endings Symposium, held January 26-29 in Chicago, shared their personal experiences with depopulation of cattle and sheep for disease control and euthanasia of pigs after a fire. Other speakers discussed how to help pet owners know when it is time to euthanize a pet and how veterinary professionals can learn to grieve.

The AVMA Steering Committee on Human-Animal Interactions created the Working Group on the Psychological Impacts of Humane Endings more than two years ago to bring the veterinary profession together for dialogue on these issues and to provide resources. The AVMA working group started by addressing the psychological impacts of depopulation.

Dr. Don Hoenig, a member of the working group, presented an overview of the group and research in this area, while reflecting on his experience with depopulation of sheep and cattle during the 2001 outbreak of food-and-mouth disease in the United Kingdom.

Dr. Don Hoenig delivers the session “An Overview of the AVMA Working Group on the Psychological Impacts of Humane Endings and Related Guidance Documents” during the AVMA Humane Endings Symposium, held January 26-29 in Chicago. (Photo by Malinda Larkin)

Serving as the Maine state veterinarian at the time, Dr. Hoenig was in the first group of 10 veterinarians who volunteered to help with the FMD response on behalf of the U.S. Department of Agriculture.

Soon after arriving, Dr. Hoenig saw the remains of a fire that had been burning for a week to dispose of depopulated animals. He had seen pictures like that in 1967, when he was in veterinary school and the U.K. had its previous outbreak of FMD.

“I was there for a month, and it changed my life,” Dr. Hoenig said.

He committed to trying to change FMD response as a result of the 2001 outbreak in the U.K. “They handled it as best they could, and they eliminated it in a shorter period of time, but it meant great expense.”

Dr. Hoenig got involved with the United States Animal Health Association to improve the U.S. capacity to respond to FMD with a better approach, including vaccination.

Psychological impacts of depopulation

At the symposium, Dr. Hoenig cited research showing that performing depopulation can result in perpetration-induced traumatic stress, a condition that was first identified in Vietnam veterans.

Thus far, the AVMA working group has produced a webinar available online via AVMA Axon, “Psychological Impacts of Depopulation in Crises,” about the mental and emotional impacts of depopulation. The group also published a Viewpoint paper in the February issue of JAVMA, “Psychological implications of humane endings on the veterinary profession,” focusing on depopulation, which can be necessary for multiple types of animals in a range of facilities impacted by high-consequence diseases and other disasters.

The paper’s call to action advocates for fostering wellbeing through increased understanding and cohesiveness in the veterinary profession, providing practical resources to support veterinarians, increasing the depth of related education in the veterinary curriculum, and leveraging support from mental health professionals.

Elizabeth B. Strand, PhD, an associate clinical professor and founding director of the Veterinary Social Work program at the University of Tennessee, also presented on a newly developed tool that she helped create for stakeholders who are preparing for, participating in, and recovering from animal depopulation (see sidebar).

A "worst day ever" experience

Dr. Sarah Probst Miller got the call on May 25, 2018. The pig barns of a client were on fire, and his primary herd veterinarian was out of town.

She was wearing a black dress, getting ready to go to a cousin’s funeral. She changed and headed straight to the farm, where her job was to triage which pigs needed to be euthanized, because of burns and smoke inhalation.

The farmer’s veterinarian also called another colleague to help. He and Dr. Probst Miller euthanized pigs together for hour upon hour.

Dr. Probst Miller recounted the entirety of that day and how it has haunted her during a session at the symposium. She has over two decades of experience in swine practice—a decade in traditional practice and another decade plus with her own educational development firm. She established AgCreate Solutions Inc., which creates educational materials for the pork and agriculture industries, 12 years ago.

During the AVMA Humane Endings Symposium, Dr. Sarah Probst Miller shares her personal experience with euthanasia of pigs after a massive fire. (Photo by R. Scott Nolen)

At the scene of the fire, the farmer told Dr. Probst Miller that ideally, he wanted his workers to focus on saving the animals that could be saved and asked if she and her colleague, as veterinarians, could handle the triage and euthanasia.

Dr. Probst Miller and the other veterinarian went into a partially burned barn. They used his cylinder-style captive bolt gun initially. All the farm’s captive bolt guns, which were pistol style, were destroyed in the fire. She called around for more, which eventually arrived, but they started with the other veterinarian’s gun.

The two veterinarians worked together triaging, identifying healthy animals to be moved and then snaring and euthanizing dying pigs. Toward the end of the day, after firefighters removed a roof from a collapsed barn and found pigs alive, the veterinarians realized there were more pigs that needed to be euthanized as soon as possible and that the day was not yet over. They continued euthanizing one pig at a time.

At this point, they started to see and feel physical and emotional wear and tear in themselves and others. Most of the farm staff members were moving animals healthy enough to be saved, but one employee had worked with the veterinarians on euthanasia for some of the day. When he saw the additional barn full of pigs needing euthanasia, he became exhausted, grew angry, and lost his temper. Worried about his wellbeing, Dr. Probst Miller talked with him and encouraged him to take a break, which he did.

When talking to a colleague about sending additional euthanasia equipment, he asked if she needed him to help. She said she thought they were OK. He said, “No, Sarah, I hear in your voice right now that you do need us, and I want you to know that we’re on our way.” He came to help, and other veterinarians also showed up to assist until it became too dark to work safely.

The day following the fire, Dr. Probst Miller woke feeling despondent, alone, depressed, exhausted, and very sad. She felt unable to talk to her family but did reach out to another swine veterinarian via a simple text.

Her colleague instantly empathized and texted simply, “Fire. I had one in a nursery barn. Ug. I can still smell that day. Worst day ever. I am so sorry.” In his instant and simple response, she found much-needed compassion and connection that let her know she was not alone. This helped her rise and face the day.

But a year plus after the event, she still hadn’t talked with her husband about how hard that day was. Her silence and compartmentalization of something so difficult in her professional life were affecting their relationship.

In addition, she wasn’t always sleeping well because in her dreams, she sometimes would relive the experience. She dreamed that she had killed healthy pigs, whereas the reality was that the pigs euthanized that day were suffering from smoke inhalation or severe burns and needed the gift of euthanasia. There was a disconnect between the reality of the day and how her mind was remembering and processing it.

Eventually, Dr. Probst Miller was able to make progress on healing. She went to therapy, and her husband joined in on a few sessions, too, to talk about the day. She spent time with her children. She worked, and she exercised, and she meditated. She learned to let herself be present in the waves of emotion instead of trying to compartmentalize it away.

“My colleagues were so important as a part of this journey,” Dr. Probst Miller said. “And I think one thing we can do as a profession is practice being kind and empathetic to one another so that we can be present for each other when we each have our own worst day ever.”

After the symposium, she added, “We must commit to better communicate with our loved ones when we have hard days, so we don’t inadvertently lose what matters most in our lives along the way.”

Tender conversations

“How will I know it’s time?” is one of the most-asked questions by pet owners, according to Dr. Sheilah Robertson, senior medical director for Lap of Love Veterinary Hospice, a network of over three hundred veterinarians who specialize in end-of-life care and in-home euthanasia for pets.

During her presentation, Dr. Robertson suggested that the veterinarian should be the first to bring up euthanasia as a viable treatment option. “The big question is how do we bring it up? How we do that is going to have an impact on how everything else goes,” she said.

“I think talking about euthanasia must be done in a tender way, with a lot of empathy for the owner. Explaining what’s going to happen with their pet takes away their anxiety, and this is really what we’re aiming to do.”

Clients want the truth, Dr. Robertson added, and they won’t be harmed by talking about end-of-life issues. In fact, giving clients an opportunity to express their fears and worries about their pet and what might happen can be very therapeutic, she added.

Research shows most small animal practitioners have been asked to provide care they consider to be medically futile, defined as providing interventions unlikely to offer a reasonable expectation of recovery or achieve a desired therapeutic goal. In some instances, these interventions satisfy an owner that all treatment options were exhausted, but this is not always in the pet’s best interests, Dr. Robertson said.

Performing quality of life assessments with the owner can often help them make a difficult decision. These assessments should be patient centric. “Sometimes it’s as easy as asking ‘What would (pet’s name) want?’” she said.

Learning how to grieve

Working with animals exposes anyone in the veterinary field to death on a regular basis because most animals don’t have long lives, said Julie Squires, who has spent 30 years in the veterinary field and is a life coach and founder of Rekindle LLC.

During her session “Grief as a Second Language,” she shared this quote from Rachel Remen, MD: “We burn out not because we don’t care but because we don’t grieve. We burn out because we have allowed our hearts to become so filled with loss that we have no room left to care.”

Grief is the natural response to any loss, Squires said, and is the internal experience of external events. She teaches that life is meant to have ups and downs. People will not be happy all the time.

“When we can come to the understanding and the acceptance that life is 50/50, then we can start to see that our negative emotions aren’t a problem,” Squires said.

She listed these six needs of the grieving:

  • To have your pain witnessed
  • To feel your feelings
  • To release the burden of guilt
  • To be free from old wounds
  • To integrate the pain and the love
  • To find meaning in life after loss

“Grief doesn’t take a lot of time, but it takes dedicated time,” Squires said.

Among the strategies for grief are social support, individual support, journaling, giving meaning to death when possible, memorials, self-care, and self-compassion.

Squires said: “Be willing to ask yourself on a regular basis: ‘What do I need right now? What do I need for me?’ And be open to listening to what the answer is.”

To help stakeholders involved in animal depopulation identify related emotions or feelings, veterinary and mental health professionals have created the Animal Depopulation Resiliency Check-in Tool (PDF). It is a five-question quiz that can be administered by laypeople and is available for free to anyone. A Spanish version is forthcoming.

The tool was presented at the AVMA Humane Endings Symposium, January 26-29 in Chicago. The quiz is meant to promote social support and coping among people involved in depopulation and to assist individuals who may need mental health intervention by providing referral information for additional support.

Elizabeth Strand, PhD, a clinical assistant professor and founding director of the Veterinary Social Work program at the University of Tennessee, helped develop the tool. She worked with Dr. Abbey Canon, director of public health and communications for the American Association of Swine Veterinarians (AASV); Sherrie Webb, former director of animal welfare for the AASV; and Dr. Meghann K. Pierdon, assistant professor of clinical production medicine at the University of Pennsylvania School of Veterinary Medicine.

The AASV received funding for the tool through the National Animal Disease Preparedness and Response Program of the U.S. Department of Agriculture Animal and Plant Health Inspection Service.