Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

When euthanasia is an option : the experience of making end-of-life decisions for companion animals Horn, Laurel 2000

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-ubc_2000-0206.pdf [ 4.38MB ]
Metadata
JSON: 831-1.0089433.json
JSON-LD: 831-1.0089433-ld.json
RDF/XML (Pretty): 831-1.0089433-rdf.xml
RDF/JSON: 831-1.0089433-rdf.json
Turtle: 831-1.0089433-turtle.txt
N-Triples: 831-1.0089433-rdf-ntriples.txt
Original Record: 831-1.0089433-source.json
Full Text
831-1.0089433-fulltext.txt
Citation
831-1.0089433.ris

Full Text

WHEN EUTHANASIA IS AN OPTION: THE EXPERIENCE OF MAKING END-OF-LIFE DECISIONS FOR COMPANION ANIMALS by LAUREL HORN B.A., Simon Fraser University, 1996 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Educational and Counselling Psychology and Special Education) We accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA April 2000 © Laurel Horn, 2000  In presenting this  thesis  degree at the University  in partial  fulfilment  of the requirements for an advanced  of British Columbia, 1 agree that the Library shall make it  freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department  or  by his or  her representatives.  It  is  understood  that  copying or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department of E ^ C a - v i c w M The University of British Columbia Vancouver, Canada  Date  DE-6 (2/88)  Apr, m a n n o  A- Co^rv'SPVUVv^ ^  pS^cUolo^^  }  ^ f ^ I ' i a \ ^ d v J C a.ffo^  ii  ABSTRACT  It's only a dog! You should just get another cat. You waited too long to take him to the vet as it is. These are some of the common attitudes and reactions that pet owners must often contend with when their companion animals die. Though they may be trying to be understanding and supportive, it is often difficult for people who have not experienced the death of a companion animal to understand the potential significance of such a loss. The present study explores one of the factors that often complicates and makes the death of a companion animal especially difficult: the possibility and expectation of euthanasia. What is it like to make life and death decisions for companion animals? What thoughts and feelings are experienced in the decision making process? What is it like after the animal dies as a result of euthanasia? These questions are the focus of this study. The study focuses on the experiences of eight companion animal owners and utilizes a case study design. Information was gathered through interviews and researcher observations. Each case is presented individually and themes and a general discussion of the cases are also included.  T A B L E OF CONTENTS  Abstract  ii  List of Tables  v  Dedication  vi  Acknowledgements  vii  Preface  viii  CHAPTER 1  Introduction Rationale for the Study Research Objectives  CHAPTER 2  Review of the Literature: "Setting the Stage"  1 1 4 5  The Human-Animal Bond 5 Why Do People Keep Companion Animals? 5 "Some of Our Best Therapists Are Animals" 7 The Phenomena of Grief and Loss 7 When the Human-Animal Bond is Broken 10 Bereavement Following the Death of the Companion Animal . .10 What Information is Missing? 13 Euthanasia and End-of-Life Decision-Making 13 Summary 15 CHAPTER 3  Methodology Overview of the Study Assumptions and Rationale for a Case Study Design Role of the Researcher: The "Research Instrument" Who is the Researcher? Research Design Participant Recruitment Delimitations of the Study Procedure The Final Product "Quality Control" Ethical Issues  CHAPTER 4  Case Presentations Carolyn: "In 36 hours he was gone." Katherine: "I've second-guessed that decision ever since." . . . Susan: When an assistant makes euthanasia more difficult. . . Tim: When it seems too soon to let go Jennifer: After a tragic injury Joyce: "The veterinarians never really listened to me..." . . . Kelly: "Even with my best efforts and intentions..." Mia: "I don't want to do this."  16 16 16 17 19 21 21 22 22 24 24 26 27 27 29 31 33 35 37 39 42  iv  CHAPTER 5  Member Checks  44  Emerging Themes  45  Across Cases: Background Similarities  45  Type of Relationship or Bond  45  Willingness to Sacrifice  46  Experiencing a Profound Sense of Loss  47  Euthanasia is Our Responsibility  48  Euthanasia is a Very Difficult Decision  48  Did 1 Do Something Wrong?  49  T i m i n g is Difficult and Important  50  Importance of a Good Veterinarian  50  It Helps to Know that I Did Everything I C o u l d  51  Could the Vet Come to M e ?  51  Being Able to Talk About H i m / H e r Helps  52  Discussion  53  Revisiting the Literature  55  Conclusions and Recommendations  61  Advice for Animal Owners  61  For Veterinarians  62  For Counsellors Ideas for Future Research References  64 65 67  Appendix A  Ethics Approval  70  Appendix B  Cover Letter for Flier  71  Appendix C  Flier for Participant Recruitment  72  Appendix D  Informed Consent Form  73  Appendix E  "Preparing for our interview" (Form sent to participants)  74  Appendix F  Interview Protocol  75  Appendix G  "Reliability check" (Letter sent to participants)  76  Appendix H  A Transcript of an Interview  77  V  LIST OF TABLES  Page Table 1. Carolyn and Keisa: Demographic and Case Information  28  Table 2. Katherine and Sean: Demographic and Case Information  30  Table 3. Susan and Tootsie: Demographic and Case Information  32  Table 4. Tim and Ellie: Demographic and Case Information  34  Table 5. Jennifer and She She: Demographic and Case Information  36  Table 6. Joyce and Pepper: Demographic and Case Information  38  Table 7. Kelly and Leo: Demographic and Case Information  40  Table 8. Mia, Malibu and Soda: Demographic and Case Information  43  vi  DEDICATION  Sean  Clow your eyey now, my lon^Cme/friend/, and/lettn^ytim^/ofyuffev-iv^ comes to- cv pecvcxfub end/.  We-'U/ waXhtogethev V yoon, I'm/yore/, cvy w inter turny to- yp rvnfy, whervthe/ynow giveyway tobuddAn^lecwey and/ bird^ybe^vnto yinfy.  x  Webster  Soda  They gentle/ breeze/ yncdh caXb your ncvme/ along/ the/ water'y edfye/. for what we/ Shared/ cvnd/ whatyow meant yhaXh never be-forgot.  Keisa -Leo ~ Pepper ~ Tootsie  Your friendship ypany the/y eary behind/ your memory ahead/. You/Xh always be/ there/ next to- me/, cxmipanlcrn and/ good/ friend/. (Tony V'Agneye)  Ellie ~ She She ~ Malibu  Vll  ACKNOWLEDGEMENTS  There are a number of people who contributed to the completion of this thesis who deserve recognition.  To Marcel Horn, my husband, and John and Anna Scharfenberg, my parents, thank you for standing behind me through eight years of university and for your unfailing support through both the good and the difficult experiences I have had working with animals.  Many thanks to Donna Olver, my friend and fellow horse enthusiast. In early January 2000, my second horse, Shady, was diagnosed with the same condition that Webster died from. Without Donna's incredible support and tireless effort during the 6 weeks that Shady was struggling to survive, I would not have been able to finish this thesis on time. Her willingness to share the responsibilities involved in caring for a very sick horse, and to listen to a worried horse owner, were truly admirable and invaluable.  To Dr. Norman Amundson, the primary advisor for the study, thank you for your encouragement and willingness to supervise a thesis about animals... Thanks also to Dr. Maria Arvay and Dr. Carl Leggo for being on my thesis committee and for your valuable feedback along the way.  To the eight participants in this study, thank you for your willingness to share such important stories and thanks to Dr. Ross Clark, a veterinarian who really helped to promote the study.  Vlll  PREFACE  Euthanasia. Few people ever really need to give this concept much thought. Until one is actually faced with it, it is impossible to know what it is like to consider that it might be in a loved one's best interest to be assisted to die. For millions of companion animal owners, euthanasia is far more than an issue to debate. It is an unwritten obligation. It is expected. In North America, it is not socially acceptable to let an animal suffer from an incurable disease or condition. To illustrate this: what were you thinking the last time you witnessed an animal who was "incurable" and in unimaginable pain and distress? What happens when your companion animal is your best friend? Or, when he is the only "child" you have ever known? What happens when it is too hard to say goodbye, when the very thought of euthanasia terrifies you? How can you give permission for someone to help your animal die? These are some of the questions that are explored in this study. It is my privilege to share the stories of eight companion animal owners and their experience of making end-of-life decisions for their animals.  The Case That Inspired This Study I was 23 and approaching the end of my first semester at graduate school when my world changed. When I arrived at the barn that rainy day in November, someone came up to me and said, "Something's wrong with Webster..." My heart sunk when I saw him. He looked like he had laminitis, a condition that causes extremely painful swelling in the horse's front feet. Knowing that laminitis can lead to founder, a permanent and sometimes irrecoverable injury to the feet, I called the vet. In the back of my mind I thought, "I might never be able to ride him again." So when the vet said, "Give it a few days and call me on Monday if he's still limping," I thought that maybe I was making more out of this than I should. She said, "Even if it is laminitis, there is no way of treating the condition except to keep the horse as immobile as possible."  I think it is fair to say that I know what it feels like to be a parent, though my husband and I have yet to start a family. I got Webster when I was 16 and he was still losing his baby teeth. For almost every day for the 7 '/ years I worked with him, I would spend between 2-4 hours working with or caring for him. He started out as a young, inexperienced, and unpredictable horse who would eventually end up teaching me more about patience and persistence than I would have ever imagined. I remember when he broke my arm and my first thought was, "What happened, is he okay?" as I scrambled to assist him. Putting him first was automatic, I did it without a moment's hesitation. When he eventually had to be boarded off my parents' acreage, I felt like a parent who had dropped off their child at daycare. What if he gets hurt and they can't get in touch with me? Will they put the right blanket on when he goes outside? Will they be patient enough with him? 2  The weekend passed and Webster seemed to be in more pain than ever. Imagine a 1000-pound animal trying to keep weight off feet that are red-hot with swelling that has nowhere to go (the hoof can't stretch to relieve the building pressure). When the vet came and said, "It's just an infection- he does not have laminitis," I was equally as skeptical as I was relieved. Ifiguredthat she'knows more than I do, so I put my doubts to the side. For the next few weeks my sister, my dad, and I diligently followed the intensive treatment protocol for the "infection" and Webster seemed to be improving. I didn't think much of it at first, but I noticed a change in the shape of the soles of Webster's feet about 2 Vi weeks into the treatment. However, I knew something was seriously wrong when my farrier (blacksmith) cancelled his entire day to come and have a look after I called him for his opinion. With one look at Webster's feet, he confirmed my worst fears. He said, "Webster has foundered . . . He might have only a 50% chance of living through this." Living through this! "But he's walking better," I thought. The vet has been out 3 times and we've followed her recommendations precisely. He is a young, healthy horse... What do you mean he might not survive this? Our farrier recommended that we consult with a different vet, one with more experience with this condition. Through x-rays he confirmed that Webster's founder was so severe that the blood supply to his feet had been effectively cut off. The new vet said, "From this day on, things will get worse for him. He will become more painful. There is nothing we can do to help him. If he were my horse, I'd euthanize him, he has no hope for recovery." I went completely numb, though my mind was racing. My husband, dad, mom and I were crying uncontrollably as I asked, "How could this happen?" I decided that I needed a few days to spend with Webster before he was to be "put down." Because I hadn't realized the severity of his condition until he received this terminal diagnosis, I had spent those precious weeks trying to stay on top of my school work and had not spent nearly enough time with him. I am so thankful that I finally had the courage to ask for extensions on my school papers- something that I  X  had never done before- and spent those few days with him. I was able to tell him that he was going to be okay, that he wasn't going to hurt anymore. I was able to apologize for all of the pain he had endured over the last month and for not getting a second opinion earlier. I still wonder if things would have turned out differently if I had insisted on a second opinion from a more experienced vet...  I decided to include my experience right at the beginning for two reasons. First, I wanted to start with a case that I knew intimately so I could attempt to write it in such a way that a reader might begin to understand what the experience of making end-of-life decisions for animals is like. Secondly, I felt that it was important to detail the experience I had to elucidate my interest in this topic and to enable readers to understand more about who was conducting the research interviews. For example, I believe that my experience with Webster increased my sensitivity to salient details in the stories that were shared during the interviews and also facilitated the rapport I was able to develop with participants.  Euthanasia and Companion Animals  1  CHAPTER 1 INTRODUCTION It's only a dog! At least he lived a full life. You waited too long to take him to the vet as it is! You should get another cat. Cliches and minimizing comments seem to be fairly commonplace when a companion animal dies. Though they are trying to be understanding and supportive, it is often difficult for people who have not experienced the death of a companion animal to understand the potential significance and impact of such a loss. Additionally, what many people may fail to recognize is that animals often occupy very significant roles in their owners' lives. To name a few, animals are often valuable family members, loyal companions, confidantes, exercise partners, "child substitutes" to nurture, and even caregivers in that they can be protectors, sources of unconditional love, and service-providers for people with physical limitations. Considering the wide range of roles that pets occupy, it is easy to anticipate an equally wide range of responses to a companion animal's death (Kotch & Quackenbush, 1988). In order to better understand how pet owners respond to the death of companion animals, and to eventually develop ways to intervene or assist this population, it seems important to explore aspects of the experience that may be especially difficult for owners. Having personally experienced what it is like when a companion animal dies, and conducting a review of the existing literature, I feel that I have gained some valuable insight into what some of the difficult aspects of losing a significant animal are. Specifically, endof-life decision-making and euthanasia seem to be consistently endorsed as some of the most painful aspects of coping with a companion animal's death (e.g., Levinson, 1984; Quackenbush & Glickman, 1984; Weirich, 1988; Weisman, 1991).  Euthanasia and Companion Animals  2  After receiving a terminal diagnosis for my horse, Webster, I experienced firsthand how emotionally-laden and difficult end-of-life decision-making can be. For me, having to make the choice to end Webster's life was the most difficult decision I have ever made. I was not only faced with the fact that he was dying, but also that I had to be the one to decide when and how this death should occur; all for a friend who could not provide any reassurance or consent for such a decision. This experience, coupled with gaps in the existing literature, gave me considerable incentive to investigate questions that have received very little attention to-date. What is it like to make life and death decisions and consent to the euthanasia of a cherished companion animal? How does one choose between continuing to treat or accepting that nothing more can be done? What feelings and thoughts are experienced during the decision-making process? What is it like to adjust to the death of a pet that has occurred as a result of euthanasia? These questions form the basis of this research project. A study conducted in 1993 estimated that 58% of American households have at least one pet (Turner, 1997) and Lagoni, Butler and Hetts (1994) suggest that more people today have pets than have children. Unfortunately, because most animals do not live as long as humans, experiencing the death of a pet becomes an inevitable aspect of pet ownership. In terms of euthanasia, it is estimated that about 2.5 million companion animals are euthanized each year in the United States (Fogle, 1981), with estimates reaching up to 10 million when euthanasia in animal shelters is also included (Lagoni et al., 1994). Because euthanasia is accepted, and, in many cases expected when an animal is suffering and has little or no chance for recovery, companion animal owners are placed in a unique dilemma: they are thrown right in the middle of the ethical debate between whether it is life, itself, or the  Euthanasia and Companion Animals  3  quality of life that is most important (Savishinsky, 1988). Not surprisingly, "Owners often ride a roller coaster of ambivalence in reaching a final decision" (Kay, Fudin & Cohen, 1984, p.118). Elucidating the experience and impact of this roller coaster ride is indeed the major goal of this study. Further complicating things, society generally does not see the death of a pet as an event worthy of much grief (Weisman, 1991), so that the grief that these pet owners experience is often kept secret, rationalized, minimized or trivialized and the grieving pet owner often becomes isolated or feels unsupported (Sharkin & Bahrick, 1990). To illustrate the experience of one pet owner: "I couldn't express my feelings to anyone because I thought that I was the only person who had ever grieved this deeply for a dog" (Lagoni et al., 1994, p.36). More often than not, pet owners feel embarrassed by their grief and even apologetic about it (Weisman, 1991). Usually referred to as the study of "pet loss," there has been increasing interest in how the deaths of companion animals impact their owners by researchers, veterinarians, counsellors and pet owners. Reviewing the existing literature, it seems that almost all of the research conducted to-date has been quantitative and questionnaire-based. While a number of chapters and articles have been based on the clinical experience and anecdotes of pet loss counsellors and veterinarians, only Thomas (1996) has used a systematic qualitative methodology to investigate how people respond to the death of a companion animal. In order to better understand this experience, it would seem that more qualitative research is warranted. For example, Rosen (1990) suggests that the process of grief is not linear or quantifiable, rather, it must be understood qualitatively. The present study utilizes a qualitative, case study approach in order to address this concern.  Euthanasia and Companion Animals  4  Research objectives. It is my intention to explore and provide rich, detailed description of the experience of making end-of-life decisions for companion animals as well as how these pet owners who consent to euthanasia respond to the impending and actual death of their animals. Stated in another way, what is the nature and impact of the end-oflife decision-making process? Exploring potential coping strategies and elucidating what is helpful for people when making these decisions and after a companion animal dies is also an objective of this study. Interviews with 'primary caregivers' and researcher observations are the main sources of information for the case studies. The following literature review will further discuss the theoretical rationale underlying the study as well as outline some of the relevant research findings in the area of coping with the death of companion animals.  Euthanasia and Companion Animals  5  CHAPTER 2 "SETTING THE STAGE" The Human-Animal Bond Attachment. The concept of attachment signifies the propensity of human beings to make strong affectional bonds to particular others (Bowlby, 1980), where the goal of these bonds is to maintain a sense of felt security (i.e., emotional support and stability). In other words, an attachment relationship is demonstrated when there is a desire for proximity with the attachment figure (especially under stressful conditions), there is a sense of felt security derived from contact with the attachment figure, and distress or protest occurs when threatened with the loss of this figure (Bartholomew, 1993). I have included this theory because human-animal relationships could be considered to be potential attachment relationships, evidenced by the above criteria. If people form true attachment relationships with their companion animals, one would predict that the strong, affectional bond that develops may contribute to the sense of loss and grief when these relationships end or when animals die. Why Do People Keep Companion Animals? It is estimated that 58% of American households include at least one companion animal (Turner, 1997). Reviewing a number of studies, Friedmann and Thomas (1985) found that over 80% of the families studied considered their animals to be family members. Some aspects of modern society also seem to contribute to companion animal ownership: there are more marriage break-ups, more people are choosing not to have children, extended families are often geographically distant, and many elderly people live alone (Lagoni et al., 1994). In each of these situations, companion animals could potentially become key sources  Euthanasia and Companion Animals  6  of continuity, stability and emotional support in owners' lives (Lagoni et al., 1994). Not surprisingly, when an animal is perceived to be a significant source of social support, a stronger human-animal bond forms (Lagoni et al., 1994). This sense of support is evidenced in statements like, "He is the only one who truly accepts me, " or, "1 can always count on him. He never lets me down." I have used the descriptor "companion animal" instead of "pet" in recognition of the growing trend in the literature to use more accurate terminology to describe the changing relationship between people and animals. While "pet" may imply ownership of property, "companion animal" alludes more to a mutual relationship that goes beyond ownership or possession (Lagoni et al., 1994). Indeed, in North America, most people choose to keep animals specifically for companionship and the loving bond that develops (Stern & Cropper, 1998), not for a "working" relationship where an animal is bought primarily to "guard" or be a service-provider in some way. Stronger human-animal bonds seem to develop when animals are seen to possess human qualities (Lagoni et al., 1994). For example, concluding that your animal knows when something is wrong or when and how to "cheer you up" suggests that he or she is actively and consciously caregiving (human abilities). On the other hand, animals are also dependent on their owners and are in many ways "perpetual children" as domesticated animals indefinitely rely on people for food, shelter, and companionship. Animals seem to elicit caregiving because of this; it is basic human nature to take care of the vulnerable (Endenburg, 1995).  Euthanasia and Companion Animals  7  "Some of Our Best Therapists Are Animals" Companion animals seem to help maintain the health, well-being, and enhance the quality of life of their owners (Lagoni et al., 1994). The human-animal relationship "is an easy and safe relationship. It is low risk. An animal is accepting, openly affectionate, honest, loyal, and consistent. All of these wonderful qualities fulfill a person's basic need to feel loved and worthwhile" (Nebbe, 1991, p.365). To review, animals can occupy significant roles in people's lives; they can be sources of unconditional love, confidantes, exercise partners, someone to nurture, and sources of social support. In addition, animal ownership has been associated with decreased loneliness and a source of meaningful daily activities (Friedmann & Thomas, 1985); increased autonomy and self-esteem in preadolescents (Van Houtte & Jarvis, 1995); and with lowered blood pressure for people in stressful situations (Lagoni et al., 1994). It seems that we are just beginning to acknowledge and uncover the healing and special qualities of the human-animal relationship. The Phenomena of Grief and Loss Loss. Shane (1998) explains that "loss is intricately woven into the fabric of life . . . (however) it remains as mysterious and ominous as it is common and inevitable" (p. 125) and that "facing death is something like facing the sun. For a moment we can peer into its brilliant glow, but inevitably we must turn away because it is blinding and painful" (p.3). Death, grief and loss are words and situations that are intimidating for most people and are therefore things that people spend very little time preparing for or talking about (Lagoni et al., 1994). This is something that I kept in mind in doing the interviews. Asking participants to journal to prepare for our interview (see Appendix E) also was intended to  Euthanasia and Companion Animals  8  address the possibility that talking about grief and death may be a very new, difficult experience for participants. Definitions. Grief is the process of psychological, social, and somatic reactions to the perception of loss; it is an automatic, natural, expectable, universal reaction (Steinberg & Youngner, 1998). Grief reactions are based on perception and are therefore unique to every individual; what elicits grief in one person may not in another. For example, each member of a family system will have his or her own way of expressing and tolerating feelings; some may be more expressive than others, some may be more likely to deny or rationalize their feelings, and some will be more affected by a particular loss. Also evident in this definition of grief is that the expression and duration of grief is something that people do not have control over; if a loss is perceived to be significant, some form of grief is automatic. Grief is normally associated with the experience after a death of a loved one, however, grief may be elicited for losses that occur in other ways, for example, after a move or a debilitating injury (Rando, 1986). Grief is part of the larger mourning process, a term that recognizes that grief might be expressed differently in different cultures, that it is socially influenced (Rando, 1986). Bowlby (1980) outlines four phases of mourning: numbing; yearning and searching; disorganization and despair; and reorganization. While the phases seem to describe what people often experience during the grief and mourning processes, different people are expected to move through the various phases at different rates and in different ways. The first phase, numbing, characterizes a time when the loss doesn't seem real, feelings are out of control with bursts of anger and panic, and a sense of shock predominates. The yearning and searching phase commences as one slowly begins to feel the impact of the loss. People  Euthanasia and Companion Animals  9  in this phase are often preoccupied with thoughts of the loved one, experience intense pining, and intermittent hope. The disorganization and despair phase seems to peak at 4-6 months after the loss; this is where full awareness of the loss occurs and often this realization leads to depression and the struggle to start over begins. Moving into the final phase, reorganization, involves redefining the self and situation, where new roles and realizations need to be developed, and there is a sense of acceptance that the loss has occurred. Bowlby (1980) further elaborates that beliefs and cognitive biases affect the length and course of the mourning process. For example, according to Bowlby, the following beliefs facilitate the mourning process: it is okay to cry, it is okay for other people to help me, it is okay to ask for help, 1 can take some time off if I need to, I don't have to try to be strong, I don't have to deal with this on my own. Disenfranchised grief. When grief is experienced, but the expression of grief and the enactment of mourning rituals are discouraged, this is called disenfranchised grief (Doka, 1989). It occurs with a loss that is not openly acknowledged, publicly mourned, or socially supported and often intensifies the already-present feelings of isolation and loneliness that occur after a loss (Doka, 1989). The death of a pet is increasingly being recognized as an example of a disenfranchised loss (e.g., Doka, 1989; Neimeyer, 1998; Stewart, Thrush & Paulus, 1989). Anticipatory grief. Anticipatory grief begins whenever a person senses that they may potentially lose a significant relationship, it is "the phenomenon encompassing the process of mourning, coping, interaction, planning, and psychosocial reorganization that are stimulated in part in response to the awareness of the impending loss of a loved one and the recognition of associated losses in the past, present and future" (Rando, 1986, p.24).  Euthanasia and Companion Animals 10  Bowlby (1980) suggests that "the greater the danger of loss appears to be, the more intense and varied are the actions elicited to prevent it" (p.42). This anticipatory process involves an awareness and gradual accommodation to the threat of the loss, affective and cognitive processes, and planning for the future (Rando, 1986). Some of the factors that influence the experience of anticipatory grief are: specific qualities of the illness, roles the ailing (person) occupies, concurrent stresses in the griever's life, the griever's past experience with loss and illness, specific fears and expectations about the treatment and death, and how much the griever is involved in the patient's treatment (Rando, 1986). Because end-of-life decision-making seemingly occurs within the context of anticipatory grief, I listened for these factors during the interviews and included as much of the context surrounding each case as I could in the case presentations. When the Human-Animal Bond is Broken Bereavement following the death of the companion animal. The vet looked at me, then I put my arm around my wife and led her out to the car. We talked on the way home, but our voices sounded strange to each other, and we didn't really say anything. I think we must of felt as parents do when they have lost a child . . . I am not a man who cries easily, but picking up her bone and her rubber ball, her food and her water dishes, I cried as I haven't cried since childhood. I'm glad my wife wasn't there to see me cry that way, because I would have had to stop then, and the hurt within me would have been worse . . . (cited in Fogle, 1981, p.339) This recollection illustrates many of the aspects of coping with the death of a companion animal that people seem to encounter. First, for many people, there is a profound sense of loss. Research has supported that the experience of losing a companion animal can parallel the loss of a human companion or relative. For example, several questionnaire-based studies have found that the stronger the attachment between owner and animal, the stronger the grief  Euthanasia and Companion Animals 1 1  reaction was following the animal's death (e.g., Brown, Richards & Wilson, 1996; Gerwolls &Labott, 1994; Gosse & Barnes, 1994; Stallones, 1994). Gerwolls and Labott (1994) found that despair, anger, guilt, social isolation, rumination, and death anxiety often were experienced after the death of a companion animal. Similarly, Archer and Winchester (1994) found that over half of the 88 people that they interviewed felt numbness and disbelief and were preoccupied with thoughts of their pets or the circumstances of their deaths. Disruption in daily routines, for example, sleep disturbances, decreased social involvement, and needing to take some time off of work, have also been commonly reported after the death of a companion animal (e.g., Carmack, 1985; Gage & Holcomb, 1991; Quackenbush & Glickman, 1984; Weisman, 1991). As illustrated in the opening quotation, owners often feel embarrassed and even apologetic about the grief reactions that they experience when their animals die and often attempt to hide their true feelings (e.g., Carmack, 1985; Weisman, 1991). One potential explanation for this is that owners may have a sense that people will not understand or recognize the significance of their loss, that the death of companion animal is a disenfranchised loss (Stewart, et al., 1989). Society seems to wonder: why get so upset? Why be miserable when you can buy a new animal so easily? Without societally-sanctioned mourning rituals or acknowledgement that the death of a companion animal is a significant loss for many bereaved owners, owners are often left to grieve unsupported, isolated, and will attempt to minimize or rationalize away their feelings. Unfortunately, when the expression of grief is self- or societally-restricted, the healing time for recovery may be prolonged (Lagoni et al., 1994). It seems that the impact of disenfranchised grief may indeed  Euthanasia and Companion Animals  12  be far-reaching and is important to remember in any study investigating bereaved animal owners' experiences. More intense grief reactions after the death of companion animals were found for owners who were living alone (e.g., Carmack, 1985; Planchon & Templer, 1996; Stallones, 1994) and for people who had experienced more concurrent or recent negative life events (e.g., Gosse & Barnes, 1994; Stallones, 1994). Interestingly, the intensity of grief experienced has not been associated with the cause or type of death that animals had (e.g., Gerwolls & Labott, 1994; Planchon & Templer, 1996). In other words, whether a death was sudden or unexpected, this did not predict the intensity of the human grief that would follow. It may be that the key to understanding the degree of intensity of grief is to learn: what did this animal mean to this person? What roles did it occupy? (Kay et al., 1984). These questions were included in the interview protocol for this study because learning about these things elucidates what it is that a participant is grieving for, what exactly has been lost. In the qualitative study, The Human-Animal Bond and Grief: A Phenomenological Perspective, Thomas (1996) asked the question: what is it like to grieve the loss of a companion animal? Three themes central to the phenomenon of grief were described and included: 1. Quality of relationship (duration and intensity of bond, animals as family members, companionship, human loss, life transitions) 2. Sense of responsibility (life and death decisions, euthanasia, blame and guilt) 3. Loss (types and timing of loss, process of grief, letting go). While quotations were included in each of the 22 case presentations, the three themes were not elaborated on very much beyond the above synopses. The present study investigates the second theme in more detail and expands on Thomas' study as participants were also asked to share their experiences from the moment a terminal prognosis  Euthanasia and Companion Animals  13  was given. To my knowledge, no studies have specifically focussed on the experience of both the impending and actual death of a companion animal. What information is missing? More research is needed to explore the significance of individual differences in influencing reactions to the death of a companion animal (Sharkin & Bahrick, 1990), a task which a case study seems well-suited for. Also, there seems to be a deficit of qualitative studies on the topic of adjusting to the death of a companion animal. Almost all of the existing literature is either quantitative and questionnaire-based or based on clinical anecdotes where little context is included; while this existing information is important, it seems that the depth and rigor of a good qualitative study is definitely warranted at this time. One key advantage of a qualitative study is in its recognition of context. By providing the context which surrounds the decision making process, readers should hopefully be better able to actually understand the experiences and issues at-hand. In addition, end-of-life decision-making with animal patients has not been specifically addressed, nor has the emotional impact of this process. Lastly, no one has explicitly investigated what it is like to adjust to the death of a companion animal that was euthanasized, where the owner has had to decide when and how the death would occur. These gaps in the literature form some of the impetus for my study. Euthanasia and End-of-Ljfe Decision-Making If I have to make the decision (to euthanize) based on her suffering, how do I evaluate whether she has suffered enough? Is it my greed? Am I doing the best thing for her? What's the best thing? . . . It is really hard to say that the best thing for anything is to die . . . I wondered if I had put (the decision to euthanize) off too long. That is the worst of it. . . probably that's the hardest part for me is just wondering if just to suit me, just to have her around, that I waited so long, (cited in Thomas, 1996, p.44)  Euthanasia and Companion.Animals  14  Overwhelmed with guilt and remorse, I kept apologizing to him, confiding that we never meant for him to suffer . . . and when he gazed up at me with that confused sort of expression, I felt as though I had betrayed him . . . the tears streamed down my face as I gently kissed him goodbye, (cited in MacEwen, 1988, p.98) I have started this section with these anecdotes because they begin to capture how euthanasia impacts people; it is clearly much more than an ethical debate for the people who are forced to consider it for a cherished companion animal. A sense of betrayal and guilt often accompany the act of consenting to euthanasia (Levinson, 1984; Thomas, 1996; Turner, 1997; Weirich, 1988; Weisman, 1990). Further complicating things, society places guilt on owners who do not consent to euthanasia, as well, implying that it is cruel to let an animal suffer (e.g., Cowles, 1985; Levinson; 1984). "Executioner's guilt" and "signing a death warrant" are vivid ways to describe how many people feel after agreeing to euthanasia. (When) the pet has become a member of the family, the decision to put it to death feels somewhat like telling one's grandmother that she has outlived her usefulness and the investment one is willing to make in her, and that it is time for her to die. (Levinson, 1984, p.55) Also, owners may be preoccupied with nagging questions like: what if I had noticed the symptoms earlier? What if 1 had consulted the vet earlier? Did I do everything possible? (MacEwen, 1988; Weirich, 1988). It seems that guilt may center around the degree of uncertainty of the evidence provided by the veterinarian (McMahon, 1988)- has the vet really done everything possible? Lastly, it is important to note that euthanasia affects entire families. "The illness of a pet can bring a family together as much as it can highlight its fragility" (Stern & Cropper, 1998, p.49). "If euthanasia is considered, finding the right way to discuss it is a major challenge" (p.117). While my focus was not on family processes, I  Euthanasia and Companion Animals  15  did ask about who else was involved with the decision making and caring for the animal and who was supportive during this experience? Factors influencing decision-making. With euthanasia, "owners often ride a roller coaster of ambivalence in reaching a final decision" (Kay et al., 1984, p.118). When animals have received long-term medical care, or extensive time, effort and money have been invested in the treatment, it may make both the death and euthanasia even more difficult as a stronger bond develops and people's routines have become more centered around the animal (Lagoni et al., 1994). The certainty of the animal's prognosis, effectiveness of available treatments, owner's financial resources, previous experience with loss and death, and the ability to accept the loss all likely impact end-of-life decisions with animals (MacEwen, 1988). Because of this, it seems that euthanasia decisions must be handled case-by-case as they are met with a wide range and depth of emotional responses (Savishinsky, 1988). I listened for all of these factors during the interviews to provide some of the context for the emerging stories. Summary. I have tried to use direct quotations in this literature review to foreshadow the way I have chosen to write the case presentations and themes. The personal experiences enhance the issues by adding rich, intimate description. It is my intention that this literature review has "set the stage" for the presentation of the case studies. The literature review has also alluded to some of the context or information that I listened for when conducting the interviews and it helped me to design my interview protocol (see Appendix F).  Euthanasia and Companion Animals  16  CHAPTER 3 METHODOLOGY Overview of the Study What is it like to make end-of-life decisions and consent to the euthanasia of a cherished companion animal? How are such decisions made? How do pet owners respond to the impending and actual deaths of their animals when euthanasia is both considered and completed? Lastly, what is helpful for pet owners during this decision-making and after the animal's death? These are the questions that formed the basis of this study. A case study design was used and eight cases are included. Information was gathered through interviews, researcher observations, and indirectly through participants' journal entries. While I never asked to view the journals, I believe that they had an important function in preparing participants and enhancing the accuracy and content of the interviews (see the Procedure section for a complete description of the journaling rationale). Assumptions and Rationale for a Case Study Design Creswell (1994) outlines a number of assumptions about the process of and rationale for conducting qualitative research. First, qualitative research is often chosen for exploratory topics where the underlying variables are unknown or have not been adequately investigated. Qualitative researchers see reality as subjective and context-bound; therefore, they attempt to observe and record as much as possible about context and individual perceptions. It is also assumed that the researcher interacts with what is being researched, that the researcher cannot be independent of the research process. Lastly, qualitative research usually aims to provide rich description of an experience through in-depth, multidimensional information about a limited number of cases. All of these aspects fit both  Euthanasia and Companion Animals  17  the topic under investigation, as well as my own beliefs and preferences as a researcher (see section titled the Role of the Researcher). Why utilize a case study design? The topic of end-of-life decision-making with companion animals has not been investigated in much detail. Existing studies are primarily questionnaire-based and do not look at the process involved or the surrounding context of this experience. Because euthanasia decision-making and the impact that this process has on pet owners are exploratory topics, it seems most advantageous to utilize an emergent design that placed as few preconceptions and restrictions on the experience as possible. This study utilized a fairly eclectic, emerging case study design. The design incorporates suggestions from Stake (1995) and Creswell (1998), as well as emerging procedural ideas that seemed to be important to fit this particular topic. For example, one of these "emergent" aspects was to ask participants to journal or prepare ahead of time for the interviews. In addition, acknowledging and recording the contextual factors and the chronology of events that frame end-of-life decisions seem to be an important part of adequately describing this experience. A case study design also enabled me to consider and include multiple sources of information. As Stake (1995) recommends, issues surrounding each case are also included to provide additional context for the study. For example, one issue that surrounds the present study is that the death of a companion animal is often a disenfranchised loss, where society does not recognize the event as one worthy of much grief or mourning. Role of the Researcher Myfirstpriority was to give participants the opportunity to share their experiences in an open, nonjudgmental, and caring environment. I tried to keep the interviews almost  Euthanasia and Companion Animals  18  conversational so that participants would feel comfortable sharing their unique stories with as little interruption as possible. Recognizing that some participants may not be able to articulate or elaborate as well as others, I was prepared to use probes to facilitate the storytelling process (see Appendix E). Probes were also used to ensure that contextual information was included in the story and so that each participant had the opportunity to address the specific research questions of this study. Having said that, I was also interested to learn what aspects of the experience each participant initially focused on (before more specific probes were given). I see this as a definite advantage of the exploratory focus of a qualitative study and it helped to ensure that I did not limit participants' holistic experiences to the specific questions with which 1 started. In recognition that the probes I asked and how I responded to each participant would impact the stories that were told (Kvale, 1996), I recorded personal observations, reactions, insights and assumptions throughout the study. Many of these observations are included in the case presentations. In many ways I felt like a journalist who was researching and writing a story. I wanted to ensure that the stories or experiences would be portrayed accurately, completely, and in an interesting way. I was responsible for gathering and including supporting contextual details gathered from various sources and types of information. The key difference that I see between a journalist and myself (a qualitative researcher) is that I attempted to portray stories that reflected the perceptions and experiences of the participants, not my interpretations of them. One way that I confirmed this was to have participants read and provide feedback on the case presentations I developed. Sensitivity seems to be a necessary component in doing interviews and research with a bereaved population for both ethical reasons and because of the general reluctance in our  Euthanasia and Companion Animals  19  society to talk about feelings of weakness, grief, and death. Riches and Dawson (1996) interviewed parents whose children had died of cancer and discussed some of the challenges about doing research on bereavement. Mirroring my own goals, they concluded that during these interviews we were not scientists researching social processes but ordinary people talking intimately about children who had lived, mattered, and needed remembering . . . for a short while we shared a small part of the tragedy of their deaths, but we also helped celebrate their lives, (p.363) This research was a collaborative process that acknowledged the expertise of the parents in the facts of their lives and experiences, it gave permission for parents to tell their story and normalized that people often have reactions that they are embarrassed to share and emotions that don't make sense. I tried to mirror this kind of process in doing my interviews. Who is the Researcher? I am a Master's student in Counselling Psychology at the University of British Columbia. I have been around animals all of my life and find great enjoyment and satisfaction observing and spending time with animals of all species. In my family of origin, our two dogs, one cat, and two horses were definitely considered to be family members and were important to all of us. Currently, my husband and I still have one dog and one horse. In my own experience, the species of animal that one has is irrelevant to the strength of the bond that forms between person and "pet." I feel that it depends entirely on the person; I have observed people who have the same depth of feelings toward their turtles, fish or birds as people more typically seem to have toward dogs or cats. For this.reason, species of animal was not used to delimit my study. I have had several experiences with the death or loss of companion animals. Our first dog developed cancer when I was about 12 years old and was euthanized, and our second  Euthanasia and Companion Animals  20  dog was given away when I was 16 after my sister developed severe allergies to her. In both cases, a strong memory I have is how my parents tried to make all decisions privately in an effort to shield my brother, sister, and I from the pain of pet loss. As a family, we rarely discussed these losses, though I felt and saw how profoundly they affected us. Most recently, about two years ago, my horse (Webster) sustained an irrecoverable injury and this time I was faced with the prospect of euthanasia (see Preface). Even though I was now 24 years old, married and not living with them, my parents once again wanted to somehow shield me somehow from the pain of the decisions I was being forced to make. Being older, 1 did gain control of the decisions and was completely involved in what was happening. Although the official (terminal) diagnosis came 3 weeks into the process, the roller coaster of emotions, doubts and fears that I was on for those weeks was without a doubt the hardest thing I have ever been through and has definitely been the most difficult part of losing my horse. For me, realizing that I was intervening in the process, deciding if euthanasia should be done and when death should occur almost still seemed surreal. Guilt for me centered around the "what ifs?" What if I had noticed the symptoms earlier? What if I had called a more experienced vet? Did I do everything possible? Did Webster know what was going on or feel that 1 had given up on him? For me, what I found to be the least helpful during this process was the experience of having other people say that I should not feel guilty or that there was nothing to feel guilty about. People who listened to whatever I wanted or needed to talk about were definitely the most helpful part of my experience. In the subsequent literature review that I embarked on, companion animal euthanasia decision-making and the impact of a euthanasia death surfaced as aspects that many people struggle with. Learning that existing information is almost entirely questionnaire-based, this  Euthanasia and Companion Animals  21  provided further rationale for an in-depth qualitative study. I have three goals in doing this study: 1. To explore and record rich descriptions of the experience of adjusting to the death of a companion animal that has occurred as a result of euthanasia as well as to describe what it is like to make end-of-life decisions for animals.  2. To learn what aspects of the  experience were helpfulforpeople to provide some useful information for interventions with this population in my eventual role as a counsellor. 3. To add more knowledge to the existing literature by conducting a rigorous qualitative study on a largely ignored topic. Research Design Participant recruitment. I posted fliers describing the study in veterinary offices' waiting rooms, at local humane shelters, and pet stores (see Appendix C). I also put a similar announcement in the pet section of local newspapers. The cover letter I gave veterinarians (see Appendix B) outlined a brief description and rationale for the study, as well as a phone number to call for more information. Participants were recruited as significant "co-researchers" who have valuable experiences to share, as opposed to "subjects" whose experiences would be measured or evaluated. In appreciation of their participation, participants were offered an information package about coping with "pet loss" which also included lists of books and websites on this topic. Additionally, if requested, participants were offered a copy of the results of the final study. Of the 12 people who responded to my advertisement, one person was ineligible because his dog was still living, one simply wanted to express his support and interest in this topic, one went out of town before he was interviewed, and one called after I had finished the interviews. The remaining 8 people were all interviewed and are the 8 case studies that comprise this study.  Euthanasia and Companion Animals  22  Study delimitations. When a potential participant called for more information about the study, I asked several questions to ensure that the personfitthe criteria for the study. I also used this phone call as an opportunity to establish some rapport with prospective participants and tried to determine whether people were ready to talk more in-depth about their experience. My questions were: 1. Would you consider the loss to be a significant one? (Was it difficult to adjust to?) 2. Was (your pet) euthanized or "put to sleep"? and, 3. When did (your pet) die? Only people who answered "yes" to thefirsttwo questions were invited to participate in the study. While I had originally advertised that the animal's death must have occurred in the last two years, to try to recruit participants with more recent, perhaps more detailed memories, several cases include animals who died earlier than this. Procedure. During ourfirstphone contact, I asked for participants' mailing addresses so that I could send them an informed consent form (see Appendix D) and a sheet called "Preparing For Our Interview" (see Appendix E). This form encouraged participants to start a journal to record thoughts and feelings about their deceased companion animals, the way the animals' treatment decisions were made, and any other information or recollections about their experiences that they wanted to include. It was my intention that working on the journal prior to doing our interview would enhance participants' recollections and make the process more meaningful for them because they could reflect without interruption or unintentional researcher biases. For example, Kvale (1996) suggests that it is a well-known challenge in doing interview research that the wording of questions and the verbal and nonverbal responses of the interviewer can inadvertently shape the content of a participant's answer. While this is likely still a potential criticism of the present study, I believe that the advance preparation that participants had and the effort I made to use open-  Euthanasia and Companion Animals  23  ended questions address this concern. Participants were not required to disclose what they wrote about because the purpose of the journals was to help prepare participants to share the personally meaningful and significant aspects of their experience. Reflecting on the interviews and how openly and thoroughly participants spoke (with very few probing questions), I believe that the advance preparation was useful; in hindsight, I should have asked participants directly if the journaling or opportunity to prepare ahead of time was helpful to them. In-depth, semi-structured, open-ended interviews were conducted between October and December 1999 and these averaged about 2 hours in length. An outline of the Interview Protocol is included in Appendix F. It is interesting to note that rarely did I have to follow my list of questions; as I had hoped, most interviewees covered all of the questions at their own pace, in their own order. (I believe that the journaling ahead of time made this clarity and level of detail possible). Seven of the interviews took place in the participants' homes, located everywhere from North Vancouver to Langley, and one was scheduled at UBC. Interviews were tape-recorded and transcribed. After each interview I also recorded observations, or "field notes," and personal memos about the research process. Recognizing that the researcher is the "research instrument" in qualitative designs, these notes are important for understanding the final cases and any assertions that I make. Participants were also invited to bring or discuss whatever else might help them to share their experiences. For example, in a study that investigated the experiences of parents who had lost a child to cancer, Riches and Dawson (1996) found that parents' personal momentos, photographs and scrapbooks often enriched their interviews and made them more meaningful for the parents. Indeed, participants in my study seemed very eager to share all  Euthanasia and Companion Animals  24  of these things with me and this seemed to really facilitate our rapport, helped me to relate more to what participants were saying, and seemed to spark memories and emotions which I felt greatly enriched our interviews. There were many tears and smiles and the sharing felt very genuine; it was an honour for me to participate in this process. The final product. I decided to present each case separately in the final study with direct quotations being utilized as much as possible. It was my intention to enable readers to draw their own conclusions from the cases before I summarized or listed the themes and meaning I have drawn from each case. I started each case with quotations that seem to capture some of the unique and central aspects of the participant's "story." The quotations were organized in order to tell the story of what happened, not by the order that they were expressed in the interview. I did to this to try to make each case "readable," succinct, and powerful. (See Appendix H for an example of a complete interview transcript). I decided to list the demographic and some of the contextual information in a table format so that the information would be easily accessible and was organized in a concise way. Lastly, noting how the casesfitwith, or depart from, the existing literature was included in the discussion section. "Quality Control" Thefirstway that I facilitated the trustworthiness of the cases that I presented was to constantly ask myself: is this the story that the participant is telling? How are my own beliefs and reactions affecting what I focus on and write? I also used research process memos for this purpose and have included these in each case study so readers can understand the "lens" that the cases were written through. In addition, Stake (1995) outlines a number of questions that could be asked to determine the quality of case study research. Is the report  Euthanasia and Companion Animals  25  easy to read? Is there a sense of story to the presentation? Is the reader provided some vicarious experience? Have quotations been used effectively? Were data sources well chosen and in sufficient number? Is the role and the point of view of the researcher apparent? I kept each of these criteria in mind throughout data collection and in writing my research findings. Feedback I received from my thesis committee members suggested that I realized these criteria. I was especially pleased to hear that the report was easy to follow and that these readers were drawn in to the stories both cognitively and emotionally. Many of the ways to ensure that my study has rigor and is a "good" qualitative study were adapted from suggestions that Creswell (1998) and Kvale (1996) have made. I utilized a holistic approach, where I remembered to listen for and ask about the context surrounding each case. I conducted "member checks" where participants were given the developing case studies to ensure that stories portrayed were accurate and that they had the opportunity to expand on anything that they felt was missing (see Appendix G for the letter I mailed to participants). I included rich description in the written report, using direct quotations to support stories and themes, and tried to make sure that enough information was included so that readers would be able to understand the stories and personally engage with them. With the interviews, themselves, 1 asked open-ended questions and tried to maintain an exploratory focus. For example, I did not ask, "How long did you grieve?" because this would have already made two assumptions: that grief was part of their experience and that it has ended. I spent considerable time and effort to establish rapport with participants and make the interviews client-centered, positive experiences.  Euthanasia and Companion Animals  26  Ethical Issues Kvale (1996) outlines three major ethical areas to consider in an interview-based study: obtaining informed consent, ensuring participant confidentiality, and ensuring that the benefits of the study outweigh the risks or harm that the interviews could potentially cause. With my study, identifying information was disguised in thefinalpresentation of the cases (unless participants said otherwise) and participants had the opportunity to read developing stories and take out any information that may breach their confidentiality or that they are not comfortable disclosing beyond the interviews. Informed consent was obtained and participants were recruited as co-researchers; they were aware that the purpose of the research was to capture their experiences surrounding the death of their companion animals in a interesting and detailed way so that other people may be able to learn from them. I am also aware that this research was investigating a sensitive topic. Talking about loss and the death of a significant companion animal proved to be an emotional experience for the participants. I had referrals to provide if participants needed to talk further and encouraged them to call me, as well. While no one called in need of support, several people called back to ask when they would be getting their cases to review and one wanted to add information to her case. I had planned to stop the interviews if someone indicated they could not continue or seemed to experience undue stress, though this did not end up being a problem. In fact, almost every participant commented on how nice it was to share their story and express some emotions. Participants were told that they could chose to not answer a question if something was asked that they are not ready to talk about, and I spent some time with each person debriefing the experience of participating in the study.  Euthanasia and Companion Animals  27  CHAPTER FOUR CASE PRESENTATIONS  1, Carolyn: "In 36 hours he was gone." It would have been easier if he was older. It would have been easier knowing he's had a long life, that it's his time. I mean cats I've seen being 22. It's just not fair— that's when they're supposed to die, not at 6 years old . . . When the vet said it was congestive heart failure, not even knowing totally what it meant, I knew it was bad and instantly I started bawling. I couldn't believe that this was happening to my cat and how come there weren't any signs prior? To this day I can't remember the doctor's name. . . . (The next day was my birthday and I took him to the vet clinic I worked at). Keisa was having a harder time breathing. He was depressed and not fussing or fighting so in the back of my mind I knew it was his last day, but I still wanted to do everything I could . . . It was probably about 3 when I was able to take a break and spend 15 minutes with him. I guess he never did show signs he'd get better . . . In 36 hours he was gone, there was nothing I could do differently. The vets tried the different medications and nothing helped . . . I still wonder: shouldn't there have been signs that he was sick? I wondered if 1 had watched him close enough. . . . I was willing to do anything. There were so many more things I could have done but I didn't want to put him through i t . . . I did not want to prolong his life because I was not big enough or strong enough to put him down. I knew from the moment I got him that I would never do that to him— that I'd keep him alive just for me . . . So when he couldn't get enough air in, and started going into real distress, I made the decision to have him euthanized. Thank goodness it was quick . . . I haven't shared this experience with a lot of people— they don't see animals the same way as I do, they don't care as much. I don't want to bother them with it. I know people wouldn't have spent all of the money I did . . . (But) if it ever happens again, I won't do anything differently.  Euthanasia and Companion Animals  28  Table 1 Carolyn and Keisa: Demographic and Case Information CASE INFORMATION Type of Animal Average Lifespan Animal's Age (at time of death)  cat  Length of bond (ownership) When did the animal die? What medicalproblem(s) had the animal been struggling with?  almost 6 years  14-17 years almost 6 years old  7 months ago (at the time of the interview) Congestive heart failure  Interviewee/Animal Owner Demographic Information Age Gender  female  Occupation  receptionist in a veterinary clinic  27  Supportive People coworker, my vet, husband Was he/she present during the euthanasia? yes Was this his/her first euthanasia expe "ience? yes Living Situation (al time of animal's death) married, no children, owned a second cat  Carolyn's Interview Who died? Carolyn got Keisa when he was 8 weeks old and he was her first cat. Carolyn said: "1 can still see him there, sitting on the counter. He'd follow me everywhere and we'd play hide and seek . . . He used to fetch q-tips (like a dog might fetch a stick). It was hilarious . . . He had a lot of personality, he was very cuddly and playful. Yet, he seemed to have kind of a split personality- I had to warn other people to be careful around him." What helped? Carolyn said that she was very thankful for her veterinarian: he was very informative, spoke in a language she understood, showed her textbooks to support what he was saying, did not rush her, and explained everything. She said that she was also glad for every photograph she had of Keisa. Also, knowing that she tried everything, that there was nothing else she could have done also helped. Lastly, she was thankful for her coworkers, the people who worked in the vet clinic, for all of their support and understanding. General observations. This was thefirstinterview 1 did and it lasted for about 2 hours. Throughout the interview, I remember feeling truly honoured to be there, to hear and help facilitate the telling of such an intensely personal story. We looked at some great  Euthanasia and Companion Animals  29  photographs at the beginning which really seemed to bring me into the story. I was also struck by a number of similarities between this case and my own experience with my horse, Webster. I felt tears well up as she described the suddenness of her young cat's condition and in witnessing how much emotion was expressed as she talked about her last moments with him. I found that 1 did not need to ask a lot of questions; Carolyn had her journal notes onhand and spoke candidly with very little need for probing questions. As she spoke, I found myself thinking about how hard it must have been to go through this experience with the intimate "insider's" knowledge she had about euthanasia (as she had worked in veterinary clinics for a number of years). She also asked me to share my experience with Webster and she seemed to appreciate hearing about it and was actively comparing details to her own story. Of the interview, Carolyn said, "It's been good-it's thefirsttime I've shared my story from beginning to end. Not too many people are interested in all of the details."  2. Katherine: "I've second-guessed that decision ever since." Where I made my mistake, I maybe should have waited until I was sure. I felt a time pressure- my animal was suddenly exhibiting signs of pain, he was going downhill... I couldn't really think it over for too long because it's distressing to know that your animal is in pain. But there was no clear path and that made it hard . . . I didn't want his last moments here to be one pain experience after another. As a rodent owner, I have found that there isn't a heck of a lot that even a wellmeaning vet can do to help- they either heal or they don't. . . When Ifirstgot Sean, I had decided ahead of time that I wouldn't pay for expensive surgeries- of course, it all changes when your pet gets sick . . . At some point I started hearing yelps of pain when he went to the bathroom . . . the vet said it could be an infection or kidney stones or a tumor and that exploratory surgery would help diagnose for sure . . . If they had said definitively, "This is it, this surgery will fix the problem," it would have been different. But when an exploratory surgery may lead to nothing, it could be needlessly cutting up my pig in what could be his last few months of life. I did end up having him euthanized because I did not want his life to end up being just one painful day after the other while I held on . . . It was just awful. Even though he had this problem, the feeling was that I had just taken a healthy animal who really trusted me and killed him. Objectively I knew that wasn't true, but emotionally that  Euthanasia and Companion Animals  30  is how I felt. It's outside of what you normally have to do and I've second-guessed that decision ever since . . . One thing I wonder about now, because he was my first guinea pig, well maybe if I had been a more experienced pig owner, when he was younger, maybe I would have seen something and maybe had a vet look at him . . . A part of me knows that if I had gone for the operations it would have been one after the other to no avail at the end, that that would have been the pattern, but another part of me thinks maybe it was as simple as a tumor that could have been removed . . . Either way, I felt like I was letting him down.  Table 2 Katherine and Sean: Demographic and Case Information CASE INFORMATION Type ofAnimal Average Lifespan Animal's Age (at time of death) Length of bond (ownership) When did the animal die? What medicalproblem(s)  had  the animal been struggling with?  guinea pig 5-7 years almost 2 years old almost 2 years 1 Vi years ago (at the time of the interview) Unknown, possibly a tumor or kidney problems  Making urination painful  Interviewee/Animal Owner Demographic Information 48  Age Gender  female  Occupation  works from home / schedules computer consultations  Supportive People some of my friends Was he/she present during the euthanasia? Was this his/her first euthanasia experience? Living Situation (at time of animal's death)  yes no lived alone in a high-rise apartment  Katherine's Interview Who died? From the photos, I could see that Sean was a guinea pig with an adorable three-colored face. Katherine described him as a "lap pig," in part because he liked to settle in and watch TV with her. She said that pigs talk or "mutter" and that "Sean could make sounds to fill the room . . . As time went by, he trained me to read his body signals . . . I think I actually ate better when 1 had Sean because I'd shop sometimes 6 days a week for the fresh vegetables that he liked . . . he was a great companion animal who adapted right into my schedule."  Euthanasia and Companion Animals  31  What helped? Katherine said that deciding ahead of time to let nature take its course and to not perform exploratory procedures helped her with the decision to euthanize. She also said that talking about Sean with people who showed interest and support helped after he died. General observations. Once again, in this interview I found that my primary role was to listen. Katherine needed few probing questions and definitely seemed to have a complete story to tell. Our interview was in her apartment and lasted about 2 hours. I remember going to the interview, never having owned a guinea pig, wondering if this type of loss would be as difficult as a dog or another (larger) animal. I definitely sensed that even with Sean's very short life, Katherine's sense of loss was as profound as any of the people I interviewed. 3. Susan: When a Veterinarian Assistant Makes Euthanasia Much More Difficult (When the vet assistant brought him back in the room with the catheter in place for the euthanasia procedure) she asked, "Why do you want to do this?" She said, "He's healthy and there's nothing wrong with him." I explained to her, "It's like you guys told me (in the vet appointment 3 months ago), he's 15, there's his temperament- he's biting people and attacking, he's lost weight, he's dirty (having accidents) in the house . . ." He just wasn't himself. She said again that "there doesn't seem to be anything wrong with him," and so many things are running through my mind at this point. She told me it would be really fast, that he'd take a deep breath and it would be over, so I said "okay." As she put the needle in the catheter, she said, "Are you sure?" Then she did it anyway and I was shocked— why would she do that? I didn't want him to get to the point where he was suffering and get really sick cause I know people who have been selfish and kept the pet because they couldn't deal with letting him go, that they've kept him suffering for their benefit. I didn't want to do that to him . . . Though, it did take me a long time to do it (decide to euthanize). . . Everyone had kept asking me what I was going to do with him and I wanted to just keep putting it off. . . Because it was a combination of things: a year of weight loss, accidents, attacking, I guess that helped make up my mind. It was the hardest thing I've ever done. My dad's been through triple bypass and that was a breeze compared to putting him down . . . It feels like I have lost a child— I was totally responsible for him . . . I try to believe I made the right decision, I really knew him and saw the changes. It would have been better (in thatfirstvet appointment) if they would have explained my options better— not just say I could put him down or wait and see if he improves. The vet could let you know you're making the right decision or say if you're having  Euthanasia and Companion Animals  32  doubts to postpone it. I felt I was sent off alone and unsupported after both appointments . . . (After he was euthanized), I went out hysterical, crying, paid my bill and I've never been back there . . . It took 2 years for me to get another cat because I was doubting myself- maybe it was just me who saw his problems, maybe I had made a mistake and did something wrong- I really questioned myself. Table 3 Susan and Tootsie: Demographic and Case Information CASE INFORMATION Type of Animal A verage Lifespan Animal's Age (at time of death) Length of bond (ownership) When did the animal die? What medicalproblem(s) had the animal been struggling with?  cat 14-17 years 15 years old 15 years 1  I/2  years ago  (at the time of the interview)  weight loss; personality changes (attacking people); accidents (incontinence)  Interviewee/Animal Owner Demographic Information Age 29 Gender female Occupation dental receptionist Supportive People sister, mom, boyfriend Was he/she present during the euthanasia? yes Was this his/her first euthanasia experience? yes Living Situation (al time of animal's death) lived  with sister  Susan's Interview Who died? Tootsie was a large, 15 year-old cat who was originally acquired when Susan was 13 years old. She said, "He was like my child. He had the run of the house. At Halloween he'd walk kids to and from the house . . . (At Christmas) he'd sleep in the presents. He loved to lounge in boxes . . . He was very affectionate and funny but he was not very playful- though he was quite tolerant. . . When I was upset, he knew and he'd come and cuddle and try to comfort me." What helped? Susan said that her boyfriend saying, "You need to do this- if you were suffering wouldn't you want it to stop? For someone to help you out?" really helped her make the euthanasia decision. Also, being able to talk about him then and now has been a big help, she said that she has never held any of her feelings back because "holding things in just makes it worse."  Euthanasia and Companion Animals 33  General observations. Susan was very open and elaborative throughout our 1 Vi hour interview and her new cat was entertaining us throughout. Being my third interview, I definitely found that I rarely needed to refer to my interview questions and that the interview was feeling more "conversational." I remember experiencing building anger and disbelief about how poorly Susan had been treated at the vet clinic, how the vet assistant's actions may have complicated her grief process by unnecessarily contributing to self-doubts about whether euthanasia was the right choice. One of the best parts of this interview for me was being able to offer a new perspective on why the vet assistant handled the euthanasia the way she did. I wondered out loud, "Maybe her hesitation and unsupportive questioning had more to do with her discomfort with euthanasia and had nothing to do with you (the fact that you were making the wrong decision)." This statement seemed to soften some of the regrets and self-doubts almost immediately and it felt great (for me)! Of the interview, Susan said, "It felt very good. I'm even remembering more things about him talking this length of time. It was very good talking about him." (The complete transcript of this interview is included in Appendix H to provide an example of what the interviews were like).  4. Tim: When It Seems Too Soon to Let Go The seriousness evolved the longer she was in it, so initially I thought, "It's just a fungal infection," so my whole framework was not, "Oh, this is the end." I guess over time you lose sight of it so it takes someone from the outside to come in and say, "Your dog is too sick, it's not fair for her." You just lose sight of it. . .You're trying to focus on the positive. You resist the severity of what's going on sometimes because you're just not ready . . . In some ways I was selfish because she was such a big part of me . . . I thought we had overcome so much because we had moved here together, she was with me in a previous relationship, and we had gone through all of that. I thought, "We just can't let this happen now, we've come too far." Here's a 3-legged dog who had been abused as a puppy and 1 just thought that this isn't the way it should end . . . There has to be a treatment for this . . . The realization (of needing to euthanize her) was as difficult as the event. That understanding, that decision-making I guess sets the stage for your actions- maybe it helps disperse the pain a little because maybe if you experienced it all in one sitting it would be just overwhelming and you'd be totally incapacitated.  Euthanasia and Companion Animals  34  . . . I had decided to wait for some sort of a sign from her, and when she fell again getting out of the car, it was just horrible and that was my sign. I'll tell you it was very difficult and emotional and you abandon every sense of what might be appropriate in a public place cause you're so overwrought... I think that I got to the point where I realized that the next step would be complete immobility and I couldn't think how I'd be able to take care of her. . . . (After she died) I was so troubled and had horrible nightmares and things- that maybe I had done it too early and maybe I hadn't explored all of the options and could I have done anything else? . . . I believe it is our responsibility to look out for animals . . . Euthanasia is caring for an animal who is suffering . . . It is a kind thing, it is our ultimate responsibility to ensure a high quality life for animals. Table 4 Tim and Ellie: Demographic and Case Information CASE INFORMATION Type of Animal dog Average Lifespan 10-15 years Animal's Age (at time of death) 8 years old Length of bond (ownership) 6 Vi years When did the animal die? What medicalproblem(s) had the animal been struggling with?  3 Vi years ago (at the time of the interview)  Lupus; and she was a 3-legged dog  Interviewee/Animal Owner Demographic Information 36 Gender male Occupation teaching; Ph.D. student Supportive People partner, some friends  Age  Was he/she present during the euthanasia? Was this his/her first euthanasia experience? Living Situation (at time of animal's death)  yes no  lived alone in a basement suite  Tim's Interview Who died? "Ellie" was a three-legged German Shepherd cross who Tim rescued from the SPCA when she was 1 Vi years old. He said that she was wonderfully behaved and came with him wherever he went, 24 hours a day. "She was my shadow . . . there was just this connection that everyone saw. She was such a unique dog, such a kindred spirit. . . No one could replace her." What helped? To start to think about euthanasia, "it took a friend to say 'enough already- it's not fair to her.' Before that, I wasn't influenced by other people." After she  Euthanasia and Companion Animals  35  died, "I remember a woman hugging me and we didn't say anything. That was good, I knew she understood . . . You need animal-insightful support at this time, people who know what you're going through." General observations. Because of Tim's busy schedule, this was the shortest of the interviews at about 1 hour in length. This was the only interview which was not in the participant's home; the differences that I noticed were that we were not able to look through photographs and we were a bit more rushed. Having said that, I felt quite satisfied that we covered everything that we needed to and I really enjoyed our conversation. I could definitely sense the magnitude of Tim's loss and could hear in his voice just how important Ellie had been to him. Of the interview, Tim said that my study was important and worthwhile and should help advocate for animals and the care that they should receive.  5. Jennifer: After a Tragic Injury The most difficult part is knowing when it's time . . . and having the momentum to carry it through and put your emotions to the side once the decision is made, and to know you're doing the right thing. She She was 13 and every morning I'd give her a dog cookie and this one morning she stood up on her hind legs as she always did and one of the lower vertebrae in her back just collapsed. She was paralyzed from the waist down. It was so horrible to see her.writhing around on the kitchen floor screaming— it was like she was having a seizure. Being a nurse I knew that any sort of spinal injury was an emergency but I had to wait for an hour before the vet opened . . . I guess I was ready to have her put down right there because she couldn't move, even though she had stopped screaming. But I respected the compassion and clinical ability of my vet and he suggested that given some time and some cortisone shots, the swelling may let up enough to give her some movement back. I was kind of skeptical but I thought as long as she's not in pain, it's probably worth trying. (After about 4 days) I finally decided this isn't going to work and it isn't fair to keep her going any longer because you can't explain to a dog that "your body's wrecked, and you have to lie still" and she was frustrated being locked up, and she wasn't eating . . . A $5000 spinal cord operation was discussed but with a 13 year-old dog, it didn't make a lot of sense to put her through that. . . One of the hardest things was that the vet's receptionist didn't quite understand that (on her final day) I was bringing She She in to be euthanized, when I got there I ended up having to wait for about an hour and a half in the waiting room with all of the other healthy dogs, sitting there with my dog in a cage . . . Once you make the  Euthanasia and Companion Animals  36  decision you just'want to get it over with. Finally I was just dying inside and I went up and said, "She She is here to be put to sleep," and the lady was horrified that she hadn't picked up on this. . . . In hindsight, I kind of regretted that I didn't just insist on having her euthanized on the first day because having her go through those 4 days was so unpleasant for her and for me . . . It's still not easy though, but you sort of feel like it's the last thing you do for them, it's still hard that she had that accident and had to die that way. Table 5 Jennifer and She She: Demographic and Case Information  CASE INFORMATION Type of Animal Average Lifespan Animal's Age (at time of death) Length of bond (ownership) When did the animal die? What medicalproblem(s) had the animal been struggling with?  dog 10-15 years 13 years old 13 years  4 years ago (at the time of the interview) spinal cord injury/paralysis due to collapsed vertebrae  Interviewee/Animal Owner Demographic Information 52  Age Gender Occupation  female nurse  Supportive People  family and extended family  Was he/she present during the euthanasia? Was this his/her first euthanasia exper'ence? Living Situation (at time of animal's death)  yes no married, 4 grown/almost grown children, 2 additional dogs  Jennifer's Interview Who died? She She was a 13 year-old black Pekingese dog. Jennifer said it was "great having a companion animal with an attitude" and described how She She could be disdainful of people and "seemed to feel very regal riding around in a wheelbarrow- kind of like a Chinese empress looking down on the world. It was her favorite thing to do." What helped? Jennifer said that previous experiences with euthanasia and animal deaths helped her make decisions for She She. For example, deciding to be present for the euthanasia so that there would be no unanswered questions was something that she had learned through previous experiences. She also indicated that her nursing background helped her to understand the severity of She She's condition and the treatments that were suggested.  Euthanasia and C o m p a n i o n A n i m a l s  37  General observations. What I found most unique about this interview was how Jennifer's huge, 120-pound Malamute dog reacted during the interview. It was as though he knew what we were talking about! He walked over and put his head on Jennifer's lap as she started to recall some of her most difficult memories about the euthanasia of one of her previous dogs. She said, "I think he understands everything I am saying- he's never been like this before, he seems worried." From what I saw, I drew the exact same conclusions. It was amazing. Compared with She She, the euthanasia of this previous dog we were talking about had been different because the dog had not been sick and was not dying. In this case from almost 20 years ago, euthanasia seemed to be the only option because the dog had become unmanageable, despite every attempt Jennifer had made to try to train him. She said, "I tried absolutely everything I could think of and I couldn't adopt him out because he snapped at people . . . So I took him to the vet to be put down. (Afterwards) I started crying as soon as I got to the car and kept crying for a week. I was devastated." I definitely sensed that this loss was equally as difficult, if not more so, than her experience with She She. Our interview lasted about 2 Vi hours. Of the interview, Jennifer said, "If I can help other people, I feel good about that- it's an area that is under-researched and important."  6. Joyce: "The veterinarians never really listened to me..." I had to make this decision without any help from the vets and Pepper's mind was still active and alive. How can you put a cat down when his mind is still alert and healthy-even with all of his medical problems? How can you look in his trusting eyes? . . . There's still guilt. We use words like "put them down" and "euthanasia," but we're killing, we're taking their life. It's very hard to take a living being's life. . . . I wish cats could talk, I wish I could have asked him what he wanted. The vets never really listened to me . . . I remember feeling so helpless at the end. Not knowing what to do was the worst; he had so many problems . . . I can remember going over things in my head over and over again. If there had been one big, major thing that was clear-cut, maybe it would have been easier, but it was so many little things going wrong. I knew it was more than urinary tract disease, this cat had paw problems, skin problems, eye and ear problems- none of which he ever fully recovered from. So when he got urinary tract disease, I was spending $300 with each visit to the vet, averaging $90 a week . . . I came to realize that there wasn't much quality left in  Euthanasia and Companion Animals  38  Pepper's life and I just couldn't keep up with the vet bills . . . I felt so helpless. It had been 3 V2 years of one medical problem after another so I thought the time had come. My vet at the time said he wouldn't put a cat down just because of urinary tract disease. But he also had lab results that said he had some sort of bacteria that wasn't responding to medication and I thought "that's kind of scary- what if my other cat gets it? Or if I get it?" . . . Knowing that he might pose a danger to my other cat and that Pepper'slife was deteriorating— it was a lot of things that added up. I was all over the map and my mind was racing. It was horrible. I felt helpless because I had no idea what to do for him . . . The hardest thing was not having anyone to talk to, having to make these decisions on my own. You can really torture yourself with the "what ifs." I wish I had known more, took him to a more holistic vet. . . I guess that I intuitively knew that his problems stemmed from years of being over-vaccinated- that's where the immune system problems came from. 1 wish the vets were more supportive and responsive and listened to the owners- we love these animals. We may be stumbling along trying to figure out how to do best for our animals but we do want what is best for them. We may at times disagree with vets because we sense something because we really know our animal. . . People have asked me if I would have adopted him that day if I would have known what was going to happen- I say, "Without a doubt, yes." He gave me so much. Table 6 Joyce and Pepper: Demographic and Case Information CASE INFORMATION Type of Animal Average Lifespan Animal's Age (at time of death) Length of bond (ownership) When did the animal die? What medical problem(s) had the animal been struggling with?  cat 14-17 years 8 years old 4 V2 years 8 months ago  (at the time of the interview)  urinary tract disease (and incontinence); eye, ear, skin and paw problems he had developed over the years  Interviewee/Animal Owner Demographic Information Age Gender Occupation  retired  Supportive People  son, some friends  immune  system problems- never really recovering from  57 female  Was he/she present during the euthanasia? Was this his/her first euthanasia experience? Living Situation (at time of animal's death)  yes no lived alone, 1 additional cat  Euthanasia and Companion Animals  39  Joyce's Interview Who died? Pepper was a 20-pound Norwegian Forest cat. Joyce said, "That cat was more special to me than any cat I've ever owned and I only had him 4 Vi years. He was smart and cuddly and was my special friend . . . We had a game of unplugging the sink; he'd sit and watch the water drain out after he pulled the plug . . . He also had fun teasing my other cat. . . He was so accepting about all of his problems, so trusting . . . If people were as kind and as gentle as Pepper, the world would be a better place." What helped? (After Pepper died) "reading a chapter about pet loss really was helpful to see that someone else had been through the same agony- I was not the only one who had been through this . . . It would have been nice to have some sort of network of people that I could have called who had been through similar experiences to help make those decisions." General observations. Our interview lasted about 2 hours. As with every interview to this point, only rarely did I need to ask questions as the story seemed to flow without hesitation. We spent some time looking at the photographs and memory books that Joyce had compiled and I really enjoyed seeing the ways in which she has chosen to remember Pepper. I could really sense just how much Joyce's cats meant to her. She said now that her children are grown, the cats are her family. I also came to the conclusion that if even one of the veterinarians had ever really listened to her, and heard how much effort and thought that she was putting in to making the right treatment decisions for Pepper, things could have been a lot easier for everyone involved. For example, instead of the experience that Jackie described of both sides getting increasingly more frustrated with each other, recognizing that they are on the same side and both simply wanting what is best for the cat might have helped everyone involved. 7. Kelly: "Even with my best efforts and intentions, I could not save them." I really believe that making a commitment to an animal is making a commitment to try to treat them as well as you can and give them a good quality of life . . . Because of the way that it happened and I was willing to try anything- I mean, we ended up spending almost $1000- I would have gone bankrupt trying to save him. The good thing is I didn't really feel a whole lot of guilt because I really felt that I had done everything that I could and he was in such obvious pain at the end.  Euthanasia and Companion Animals  40  (When Ifirstnoticed something was wrong) it was his breathing, it kind of sounded like he had hiccups . . . Because I was leaving the next day for my holidays, and my ex-husband was coming to look after the kids, I asked him to watch Leo and take him to the vet if the breathing problems continued. (About 3 days later) Leo's breathing had become really labored and he was actually gasping for breath . . . The vet found fluid in his chest that was making it hard to breath, so here I'm out of town with my car broken down and I'm talking long distance to the vet every few hours to see how my cat is doing . . . (After I got back) an ultrasound later confirmed that it was his heart which was enlarged, making its walls very thin and they said there are some medications which may help . . . (After a few weeks) he actually started perking up and responding to the treatment and I started to have some hope. I thought that we've pulled through all of the other things he's had, maybe this will be just one more thing he'll pull through and he'll live until he's 20 . . . I was home by myself one morning and I heard a very weird meowing and I saw Leo pulling himself along with his front paws and his back legs were off to the side and he was dragging himself... I guess that's when I knew he wasn't going to pull through this . . . The vet said it was likely a blood clot that formed because of his heart and that there was absolutely nothing more that could be done for him (so I made the decision to have him euthanized). . . . (When my son's guinea pig got sick shortly after Leo died) I know it was really important for me to try to save her because I hadn't been able to save him. I was blending up all kinds of things that guinea pigs love and syringing it in her mouth to make sure she was eating, but she was still getting thinner and the vet said I was only delaying the inevitable . . . I'm still easily moved to tears and I'm a little surprised by that because it's been over 2 months since Leo died- I never would have guessed that it would take this long . . . One thing I really struggled with, that really hit me in the face, was that even with my best efforts and intentions, that they could still die.  Table 7 Kelly and Leo: Demographic and Case Information  CASE INFORMATION Type of Animal Average Lifespan Animal's Age (at time of death) Length of bond (ownership) When did the animal die? What medicalproblem(s) had the animal been struggling with?  cat 14-17 years almost 10 years old almost 10 years 2 months ago (at the time of the interview) Enlarged heart leading to partial paralysis due to a blood clot that formed  Euthanasia and Companion Animals  41  Interviewee/Animal Owner Demographic Information Age 3 4 Gender  female  Occupation  outreach counselor  Supportive People  friends mainly  Was he/she present during the euthanasia? yes Was this his/herfirsteuthanasia experience? yes Living Situation (at time of animal's death) single mother (separated form husband 6  months ago), 2 sons ages 1 0 and 1 2 both living with her, owned guinea pigs, also  Kelly's Interview Who died? Leo was a 10 year-old cat who had never been very healthy, Kelly said. In fact, within 2 days of picking him out at the local SPCA, he started to have medical problems. "He was a very affectionate cat, a 'lap cat' . . . He slept by my legs and would come out and sit in the sun with me even though he was a black cat- I don't know how he did i t . . . He came with us on many moves . . . He once managed to cause a downstairs neighbor to complain because he loved to run up and down our hall at night." What helped? Kelly said, "I tried to give myself permission to accept whatever emotions I was feeling and it seemed to help. Also, having the time to take pictures and spend some time with Leo also helped, being able to spoil him . . . Also, I knew I had done everything that I could." General observations. Our interview was about 2 hours in length. It was great that as Kelly talked, she could show pictures and point out Leo's favorite spots; it seemed that these contextual things really enhanced our discussion and once again brought me right into the story being told. Similar to the other interviews, I really felt comfortable to let Kelly talk about whatever aspects of her experience she wanted and only needed to ask a few questions at the end to ensure my "agenda" had been covered. Of the interview, she said, "I'm feeling really drained. I haven't gone through everything point by point and I'm drained because of the emotions expressed. I felt like I could say whatever it was I wanted to say."  Euthanasia and Companion Animals  42  8. Mia: "I don't want to do this." I knew that it was the right thing to do. I've always thought it's not fair to let an animal suffer because they don't know why they're suffering- you can't tell them like you can tell a person- and why draw it out? It would be more painful to see her get sicker and suffer even more, it's better to let her go peacefully before it gets bad. I've always been an advocate for not letting an animal suffer, but when it comes to your turn it's like, "Oh god- I so don't want to put this animal down." And it's selfish because you love them and you think it would be good to keep them around... We raise them, we keep them, we love them- we might as well continue this love right until the end . . . I sure toyed with (the decision) though, what if a miracle happens over night and she's okay? . . . With (my dog) Malibu, once she turned 14, I was starting to mentally prepare cause I knew she was old, so I'd spend extra time with her, and extra "I love yous." She had it really good anyway but I did that much more . . . (When she got cancer in her spleen) it came on very suddenly, she died within a few weeks of the first symptoms of pain . . . I was really glad she died naturally because over the few days (after cancer was diagnosed) I couldn't see how I could put her down because she was so perky- she looked great considering. She seemed happy. I didn't want to put her down, I didn't want to lose her. When I first got Soda she was thin and mangy so I was very excited that I was able to nurse her back to health— and then she got sick. I thought, "Okay, we can get through this," but then my vet said, "She's dying" and I lost it. It was like being hit by a truck. I said, "How?" It was awful. I had no time, no warning. I had thought, "She's just a little sick" but my vet said there's nothing you can do . . . I wish I had more time, it was a whirlwind of gathering information, making a decision, and doing it. I had no warning to think and to absorb and I knew if I waited longer she'd suffer longer. . . . People know that they have lived their life and that this is the end, but with animals, they don't. Well, I assume they don't, and they don't know the affect that they've had on you and how wonderful they've made your life. Even though you say goodbye, they don't know you're saying goodbye.  Euthanasia and Companion Animals  43  Table 8 Mia, Malibu and Soda: Demographic and Case Information  CASE INFORMATION Type of Animal Average Lifespan Animal's Age (at time of death) Length of bond (ownership) When did the animal die? What medicalproblem(s) had the animal been struggling with?  ferret;  dog  8 -10 years; 7 years old; 9 months; 4 months ago; unknown;  10-15 years 14 'A years old almost 5 years 1 'A years ago cancer of the spleen  Interviewee/Animal Owner Demographic Information Age 26 Gender female Occupation office administrator Supportive People boyfriend, mom, some friends Was he/she present during the euthanasia? yes Was this his/herfirsteuthanasia experience? yes Living Situation (at lime of animal's death) lived alone  Mia's Interview Who died? Soda was a ferret who Mia had agreed to rescue. While she only had Soda for about 9 months, it was easy to see that she had established a close bond with her. I would guess that managing to nurse Soda back to health from the awful condition that she was in initially likely facilitated the close relationship. Malibu was Mia's first dog that she owned by herself. She got her as a 10 year-old from a family who could no longer keep her. Mia said, "When I first saw her, I knew she was my dog. I just put her in my car." What helped? Having a good vet and a lot of pictures! She said, "It was helpful that vets showed me her x-rays and test results and explained everything like I was a human- not just a credit card. They talked to me about feelings and had a lot of compassion . . . It was also helpful to hear my boyfriend say 1 was doing the right thing." General observations. This was the last interview I did and it lasted about 2 hours. Mia's three dogs played very enthusiastically throughout our interview; at times they were making so much noise that it was hard to hear what Mia was saying! Like the other interviews where pets were present, I found that this "animal presence" seemed to enrich the interviews- it certainly reminded me about the bonds that we have with animals and I found it fun to include animals in the process. Of the interview, Mia said, "It's sad to talk about  Euthanasia and Companion Animals  44  them. I cry because I miss them, but it's nice to talk about them . . . I feel like I've just had a therapy session. It feels good."  Member Checks Each participant was mailed a copy of his or her "case" and was asked to consider a number of questions to determine the accuracy and credibility of the written account of our interview (see Appendix G for the instructions mailed to participants). I did a follow-up phone call with anyone I did not hear from to ensure that he or she received the mail-out. I received overwhelmingly positive feedback from participants. For example, "I thought it was a very good summary. It was really well done- I couldn't have put it better myself. You really captured the essentials." Another participant said, "(The case presentation) was good, succinct, and impactful. Your training as a counsellor probably helped you focus in on the key parts." Two people pointed out a few minor grammatical changes they wanted to be made; however, no changes to content were needed. I was happily surprised that everyone felt so comfortable with what I had composed and that they felt it was such an accurate portrayal of their "story." Keeping in mind that the longest interview was only 2 !/ hours 2  long, and that the resulting case studies were judged to be accurate and included all of the key parts or essentials, I believe that this demonstrates the credibility and the depth of the interviews, transcription, and report-writing process. Four participants called me back within a day of receiving their case presentation in the mail and all seemed eager to participate in these "member checks." Five participants requested that their animal's real name be used in the case presentations and 3 also asked for their real first name to be used (instead of a false name to protect confidentiality). I am proud of this because I believe that it shows that participants trust the accuracy of what I  Euthanasia and Companion Animals 4 5  wrote and my intentions in doing this research as they are not concerned with confidentiality. I think that this might also be a way for participants to memorialize or pay tribute to the animals, as well. For example, 5 of the participants also asked for their animal to be included on the commemorative page (see page vi) and felt their case would not "sound right" if the animal's real name was not used. Emerging Themes Across Cases: Background Similarities Seven of the 8 participants were women and ages ranged from 26 to 57. The cases included 4 cats, 3 dogs, 2 guinea pigs, and 1 ferret. This was the first euthanasia experience for 4 of the participants and 4 of the animals discussed had been rescued from the SPCA or a similar agency (Ellie, Leo, Soda, Pepper). All 4 of these animals required substantial medical treatments or special care from very early on. It is possible that the bonds between these animals and their owners were stronger or had a unique quality to them because of this extra effort and attention that was required, as well as the feeling of having gone through so much together. For 6 of the 8 participants, their animals died at a relatively young age and/or after a short ownership (exceptions: Tootsie and She She). Considered "untimely" and unexpected, these deaths perhaps have a particularly difficult aspect to them (for example, perhaps similar to when a child dies or someone unexpectedly succumbs to cancer in early adulthood). Type of relationship or bond. All of the animals discussed in this study were clearly true companion animals. Most of the animals slept on owners' beds and were considered to be important sources of support and companionship for owners. For example, Susan said, "He was like my child . . . He was more like a person than a cat... He knew when I was  Euthanasia and Companion Animals  46  upset and tried to comfort me . . . we were so in tune to each other." Describing his dog, Tim said, "She was my shadow . . . there was just that connection that everyone saw . . . she was with me 24 hours a day, she came to work with me ." Of Malibu, Mia said, "You could almost hold a conversation with her- she was like a little person." Several animals had accompanied their owners on moves or through difficult life experiences like a relationship break-up. Tim said, "We had overcome so much because we had moved and she was with me in a previous relationship . . . (Regarding her terminal condition) we can't let this happen now, it's just we've come too far." Willingness to sacrifice. It was easily apparent that the 8 participants in this study made incredible sacrifices for their animals without hesitation or resentment. Sacrifices included: several people spent over $1000 in veterinary bills, even though they did not have much money; following time-consuming treatment instructions, sometimes over 3 hours each day; and, accepting incontinence and still choosing to keep the animal inside the house. In each case, it seems as though owners had been willing to do 'whatever it takes' to treat their animals, provided that there was still hope for recovery. Indeed, 5 of the 8 owners had been coping with their animal's medical problems or challenges from almost immediately after acquiring them. For example, Joyce said, "He had 3 I/2 years of one medical problem after another . . . averaging $90 each week in vet bills . . . (However), people have asked if I would have adopted him that day if I would have known what was going to happen. I say, 'Without a doubt, yes.' He gave me so much." Kelly concluded, "Because of the way that it happened and I was willing to do anything-1 mean, we ended up spending almost $1000- I would have gone bankrupt trying to save him." Similarly, Carolyn said, "I was willing to do anything. Pay anything . . . My parents still  Euthanasia and Companion Animals  47  can't believe I spent over $500 on Keisa's treatment." Katherine was actually quite allergic to her animal and said, "I would have lived with the allergy no problem for as long as Sean lived." Susan said, "If I had to feed him steak and lobster for a month, I would have (to help him gain weight)." Experiencing a profound sense of loss. Tears were shed in most of the interviews, especially notable given that 5 of the animals' deaths occurred at least a year ago. Most participants could remember exact dates and timelines and spoke with vivid recollections. I really experienced the telling of each story as an example of what Shane (1998) called "crystallized moments in time;" these were emotionally-laden, critical incidents which time could not diminish or cloud the memory of what happened. Here are some quotations from the interviews which I believe illustrate this: -Kelly: "I'm still easily moved to tears and I'm a little surprised by that because it's been over 2 months since Leo died. 1 never would have guessed that it would take this long." -Katherine: "With an animal there is something really immediate about it. There is no funeral. There is no sympathetic person- well maybe sympathetic for 5 seconds . . . Even though he died in June 1998, this feels like yesterday." -Susan: "It feels like I've lost a child. I was responsible for him." -Joyce: "This loss was the worst loss I've experienced. I loved him more than any other animal I've ever had." -Jennifer: "It's time people realized people grieve when they lose something that is precious to them- it doesn't have to be human to be traumatic." -Tim: "When I lost her- just this void- it was really painful and you know people try to understand. I just don't think they did. I don't think that a lot of people understand the roles animals play in our lives . . . (After realizing she needed to be euthanized) you abandon every sense of what might be appropriate behavior in a public place cause you're so overwrought." -Mia: "I was quiet for quite a while. It was like I lost my best friend, I didn't go for walks for almost a year . . . I guess I laid low cause not everyone understands . . . People actually laugh at me for how much I care . . . People know that they have lived their life  Euthanasia and Companion Animals  48  and that this is the end, but with animals, they don't. Well, I assume they don't, and they don't know the affect that they've had on you and how wonderful they've made your life. Even though you say goodbye, they don't know you're saying goodbye." Euthanasia is our responsibility. This theme was expressed directly in 7 of the 8 interviews and seemed to be implied in the other one. Here is what participants said: -Katherine: "I did end up having him euthanized because I did not want his life to end up being just one painful day after another while I held on . . . I couldn't really think it over too long because it's distressing to know your animal is in pain . . . People live with conditions that an animal would be considered worthy of death for." Susan: "I didn't want him to get to a point where he was suffering and really sick cause I know people who have been selfish and kept the pet because they couldn't deal with letting him go. They kept him suffering for their benefit and I didn't want to do that to him." -Jennifer: "It's still not easy but you sort of feel (euthanasia) is the last thing you do for them . . . Quality of life is key." -Joyce: "I came to realize that there wasn't much quality left in Pepper's life . . . this cat just couldn't cope with life anymore." -Tim: "I believe it is our responsibility to look out for animals . . . Euthanasia is caring for an animal who is suffering . . . It is a kind thing, it is our ultimate responsibility to ensure a high quality life for animals." -Carolyn: "I did not want to prolong his life because 1 was not big enough or strong enough to put him down. I knew from the moment I got him that I would never do that to him- that I'd keep him alive just for me." -Mia: "I knew that it was the right thing to do. I've always thought it's not fair to let an animal suffer because they don't know why they're suffering- you can't tell them like you can tell a person . . .You love them and I guess it's selfish to keep them around . . . We raise them, we keep them, we love them- we might as well continue this love right until the end." Euthanasia is a very difficult decision. Whether this was a participant'sfirsttime having to decide about euthanasia or not, it was unanimously a decision that was made with a lot of careful, painstaking thought and consideration. -Susan: "(Consenting to euthanasia) was the hardest thing I've ever done in my entire life. My dad's been through triple bypass and that was a breeze compared to putting him down."  Euthanasia and Companion Animals 49  -Jennifer: "The most difficult part is knowing when it's time . . . and having the momentum to carry it through and put your emotions to the side once the decision is made, and to know you're doing the right thing." -Joyce: "Not knowing what to do was the worst; he had so many problems. lean remember going over things in my head over and over again. If there had been one big, major thing that was clear-cut, maybe it would have been easier. But it was so many little things going wrong . . . How can you look in his trusting eyes? . . . It's a very hard thing to do taking a living being's life." -Katherine: "(With euthanasia or not intervening), either way I'd be letting him down." -Tim.: "The realization (of needing to euthanize her) was as difficult as the event. That understanding, that decision-making I guess sets the stage for your actions- maybe it helps disperse the pain a little because maybe if you experienced it all in one sitting it would be just overwhelming and you'd be totally incapacitated." Regrets and Unanswered Questions Did I do something wrong? This question was expressed in some way in at least 5 of the interviews. It was my experience that this was a topic which participants found especially hard to discuss. Tears and obvious emotion often accompanied the sharing of these unanswered questions and feelings of guilt. Here are some of the things that participants said: -Susan: "It took about 2 years to get my next cat. I couldn't get another black and white cat because I was doubting myself and thinking maybe it was just me who was thinking there was something wrong with Tootsie and I made a mistake, that I did something wrong." -Jennifer: "I was kind of skeptical but I thought as long as she's not in pain, it's probably worth trying . . . In hindsight, I kind of regretted that I didn't just insist on having her euthanized on thatfirstday because having her go through the 4 days was very unpleasant for her and for me." -Joyce: "You can really torture yourself with the 'what ifs.' I wish I had known more, took him to a more holistic vet... I feel guilty for not picking up (on his over-vaccination problem) myself. Maybe I didn't do my best for him. It's stupid but I blame myself. I wish cats could talk. I wish I could have asked him what he wanted." -Carolyn: "I still wonder, 'Shouldn't there have been signs that he was sick?' I wondered if I had watched him close enough."  Euthanasia and Companion Animals  50  Timing is difficult and important. Except in clear cases where the animal experienced sudden, irrecoverable distress, deciding when to euthanize proved to be very difficult for many of the participants. Consenting to euthanasia too early or too late seemed to lead to regrets and more difficult grief experiences. For example: -Katherine: "Where I made my mistake- I maybe should have waited until I was sure. Even though he had this problem, the feeling was that I had just taken a healthy animal who really trusted me and killed him. Objectively, I knew that wasn't true, but, emotionally, that is how I felt. It is outside of what you normally have to do . . . Eve really second-guessed that decision ever since." -Tim: "I was so troubled and had horrible nightmares . . . Maybe I had done it too early? And maybe I hadn't explored all of the options . . . Could I have done anything else? Was it misdiagnosed and that's why the meds didn't work? . . . I think waiting for a signal from your animal is key. It will be different for every animal." -Jennifer: "The most difficult part is knowing when it's time . . . and having the momentum to carry it through and put your emotions to the side once the decision is made." -Mia: "When it comes to your turn it's like, 'Oh god-1 so don't want to put this animal down.' It's selfish because you love them and you think it would be good to keep them around . . . I sure toyed with (the decision) though, what if a miracle happens over-night and she's okay?" Advice for Other Animal Owners Importance of a good veterinarian. Definitely fitting with my own experiences, it seems that most of the 8 participants would endorse this theme because of the good or bad experiences that they had with veterinarians. Veterinarians perceived to be supportive, compassionate, holistic, patient, and willing to explain treatment options and diagnoses were truly appreciated and helpful for participants. Susan and Joyce's cases both illustrate what happens when veterinarians are not supportive or make matters worse while Carolyn and Mia comment on the positive experiences that they had. -Susan: "It would have been better (in that first vet appointment if the vets) would have explained my options better- not just say I could put him down or wait and see if he improves. The vet could let you know you're making the right decision or say if you're  Euthanasia and Companion Animals  51  having doubts to postpone it. (Euthanasia) is a big moment for a person- the vet could let you know you're making the right decision . . . (after the euthanasia) I went out hysterical, crying, paid my bill and I've never been back there." -Joyce: "I wish the vets had been more supportive and responsive . . . The vets never really listened to me . . . I felt so helpless. It would have been so nice to have a vet who would sit and listen to Pepper's whole story . . . Vets need to work with the owner and not treat us like we're stupid. I mean, take in to account our living circumstances." -Carolyn: "I'm thankful I had the vet I did . . . He was very informative, talked in a language I understood, looked through textbooks with me, he did not rush me, he explained everything and was very supportive." -Mia: "It was helpful that the vets showed me her x-rays and test results and explained everything like I was a human- not just a credit card . . . It is important to have a vet you can talk to and discuss options with . . . one who will listen and care and not rush you. Being compassionate makes a huge difference. It's like your own doctor- you want to be able to really communicate with them." It helps to know 1 did everything that I could. This theme is related to the regrets and unanswered questions theme. It seems that knowing that they did everything that they could to treat their animal helped to minimize regrets and the "what ifs" after the animal was euthanized. -Carolyn: "I did all that I could financially and emotionally so that kind of helps. I'm thankful that I did all that I could . . . If it ever happens again, I won't do anything differently." -Kelly: "I didn't feel a whole lot of guilt because I really felt that I had done everything that I could." -Mia: "My vet said there is nothing you can do . . . and (euthanasia) is probably the kindest thing you can do for her. I knew that it was the right thing to do." Could the vet come to me? This was an interesting option that 4 participants mentioned spontaneously, without a direct comment or question from me. Here is the rationale that was given for this possibility: -Jennifer: "I think that it might be nicer of the vet could come to the house because then (the animal) is not traumatized by going to the vet."  Euthanasia and Companion Animals  52  -Katherine: "I think one thing that would have been helpful for me would be to have a vet come into your home . . . with these little creatures, it's a trauma for them to go to a vet." -Tim: "I guess it's also hard that (euthanasia) happens in such a sterile, clinical environment and the waiting room is packed with all of these people and you're trying to deal with your own stuff... I guess it might be nice if it could happen at home." -Mia: "I think vets should come to your house. Then, (your animal's) last moments could be in their comfort zone." Being able to talk about him/her helps. This was a theme I really hoped would surface. Knowing that talking helps provides some insight into how to help someone who is facing end-of-life decisions and/or the death of a companion animal. Demonstrating what happens when talking has helped and conversely, when not having someone to talk to was difficult for people, here are some of the things that participants said: -Susan: "Being able to talk about him has helped me a lot, to just get it out. . . Holding things in just makes it worse." -Joyce: "The hardest thing is not having anyone to talk to. You have to make these decisions all on your own. It sure would be nice to talk it over with someone else, someone who's been there." -Katherine: "I think talking about the animal is really important. I talked to the vet's receptionist for 45 minutes after I got the sympathy card they sent- friends don't always cut it." -Tim: "You need animal-insightful support at this time, people who know what you're going through." -Kelly: "I knew that a vet-assisted death was going to be difficult so I tried to tell myself to feel okay about whatever I was feeling." -Carolyn: "I haven't shared this experience with a lot of people- they don't see animals the same way as I do. They don't care as much. I don't want to bother them with it. . . (However, when given the opportunity and permission to talk during this study), it's been good. It's the first time I've shared the story from beginning to end. Not too many people are interested in all the details." -Mia: "I laid low for awhile cause not everyone understands . . . I guess I put up a brave front. (However, when given the opportunity) it's nice to talk about them . . . It feels like a just had a therapy session. It feels good."  Euthanasia and Companion Animals  53  CHAPTER 5 DISCUSSION This study focuses on eight companion animal owners who have experienced what it is like to make end-of-life decisions for animals. Participants were invited to share their stories from the point a terminal prognosis was given, or when they knew their animal was dying, and to describe how they made treatment and euthanasia decisions. 1 also encouraged people to talk about their favorite memories and was flexible and interested to allow them to speak about whatever aspects of their experience were meaningful to them. It was my goal in doing this research to capture each story in a detailed, interesting, readable way to enable readers to draw some of their own conclusions and gain insight into what the experience of making end-of-life decisions and coping with the death of a companion animal is like. I also wanted to learn about what is helpful for animal owners during and after this decisionmaking process and to begin to listen for any similarities across experiences. The case study design utilized seemed to be well-suited for this because context was gathered and included in the case presentations. While each participant had a unique, powerful story to tell, common themes did emerge across the interviews and these were introduced in the preceding chapter. Looking back on my experience as a researcher, many of the methodological decisions I made were based on my intention to enlist participants as co-researchers. I wanted to provide the opportunity and reason for participants to talk about their experience making end-of-life decisions for companion animals; at the same time, I made every effort to let participants talk about their experiences at their own pace and cover whatever content was personally meaningful. Participants were invited to share momentos and photographs  Euthanasia and Companion Animals  54  and interviews ended when participants indicated that they had talked about all of the important details of their experience. Feedback I received from participants suggested that I was perceived to be respectful and easy to talk to; for example, a number of participants were able to share aspects of their experience that they had not previously talked about. Methodologically, if I were to conduct a similar study in the future, I would not make any changes. I believe that the advanced preparation with journaling, being able to share momentos and photographs, and conducting the interviews in participants' homes (where reminders of the animals were everywhere) really facilitated the depth and quality of the interviews. Telling participants at the outset that they would be able to edit and add to their case studies also helped to establish rapport and seemed to enable people to speak candidly. Interestingly, no changes to content were requested during the member checks and, even though I only included a brief synopsis of our interviews in the case presentations, participants indicated that the stories presented were complete. Comments like, "It was really well done-1 couldn't have put it better myself really confirmed for me that the case presentations were accurate. I believe that having personally experienced end-of-life decision-making and the grief associated with the death of a companion animal really facilitated the rapport I was able to establish with participants and increased my sensitivity as an interviewer to the salient aspects of the emerging stories. Kvale (1996) suggests that an effective interviewer has extensive knowledge of the interview theme, yet is open to new aspects that can be introduced by the interviewee. I feel confident that I was able to achieve this balance and that my personal experiences were assets I brought to my role as an interviewer and writer of this report.  Euthanasia and Companion Animals  55  Revisiting the Literature When the human-animal bond is threatened, Bowlby (1980) wrote, "The greater the danger of loss appears to be, the more intense and varied the actions elicited to prevent it" (p.42). Montgomery (1993) adds, "Unlike grief after a loss that becomes less intense over time, anticipatory grief becomes more intense as the loss approaches" (p.9). Similarly, if our thoughts and emotions about our pets and death can send us into a tailspin when our animals naturally succumb to a terminal illness or injury, that's nothing compared to what the idea of euthanasia can do to us. (Milani, 1998, p. 19) These quotations really seem to fit with the participants' experiences in this study. In addition, "Owners often ride a roller coaster of ambivalence in reaching a final decision" (Kay et al., 1984, p.118). According to participants in this study, the roller coaster ride seems to best describe the experience between the veterinarian giving a terminal prognosis and making the phone call to schedule the euthanasia; it is the hours or days when animal owners are actively considering their options. For example, one participant said, "The most difficult part is knowing when it's time . . . and having the momentum to carry it through and put your emotions to the side once the decision is made." Here is how other participants described their "roller coaster ride:" I remember feeling so helpless at the end and not knowing what to do was the worst; he had so many problems. I can remember going over things in my head over and over again . . . I was all over the map and my mind was racing. It was horrible. I felt helpless because I had no idea what to do for him. (Joyce) I wish I had more time, it was a whirlwind of gathering information, making a decision, and doing it. I had no warning to think and to absorb and I knew if I waited longer she'd suffer longer. (Mia)  Euthanasia and Companion Animals  56  The realization (of needing to euthanize her) was as difficult as the event. That understanding, that decision-making I guess sets the stage for your actions- maybe it helps disperse the pain a little because maybe if you experienced it all in one sitting it would be just overwhelming and you'd be totally incapacitated. (Tim) Because this period of anticipation and decision-making had been the most difficult part in my own experience, I was not surprised to hear that participants had similar, painful experiences to share. I believe that this decision-making process is where animal owners could benefit greatly from having someone supportive and understanding to talk to. The nature of the bond. Reviewing the 8 cases presented in this study, it did not seem to matter what type of animal had died or how long the ownership had been; from guinea pigs, to a ferret, to dogs and cats, each loss was seemingly equally as significant and difficult. I think that this study supports the idea that it is the roles that a companion animal occupies and what he or she means to the owner that will determine the intensity of grief that will result when he or she dies (e.g., Kay et al, 1984). Previous studies have reported that the stronger the attachment one has had with an animal, the stronger the grief reaction that will follow when he or she dies (Brown et al., 1996; Gerwolls & Labott, 1994; Stallones, 1994). I believe that the 8 participants in this study had significant attachment relationships with their animals: animals were described as key sources of emotional support; all animals lived in participants' homes and were fully incorporated into their daily routine; and, all owners experienced significant distress when threatened with the loss of their animals. Future research may help to determine just how close human-animal relationships can approach true attachment relationships. For example, at this point, it is too early to say that the intensity of the bond between humans and their  Euthanasia and Companion Animals  57  animals is comparable to the bonds between parents and children or spouses. Given what participants said in this study (and what other researchers have found), I would anticipate that for many pet owners the human-animal bond that develops is very comparable to human attachment relationships. The human-animal bond may be stronger when an animal is considered to be a significant source of social support, when owners believe that they have rescued their animal from death or near-death, or when owners believe that their animals 'got them through' a difficult time (Lagoni et al., 1994). Describing the animal as a source of support, "He was more like a person than a cat... He knew when I was upset and tried to comfort me . . . we were so in tune to each other," and, "You could almost hold a conversation with her- she was like a little person." Also supporting the strength of the bonds, four animals discussed in this study had been rescued animals. Finally, one participant said, "We had overcome so much because we had moved and she was with me in a previous relationship . . . (Regarding her condition and euthanasia) we can't let this happen how, it's just we've come too far." These animals were true companion animals who were considered to be valuable family members. The nature and strength of the bonds that participants had with their animals provides important context for the case presentations and conclusions generated in this study. For example, the experiences presented are representative of 8 people who had strong bonds with their animals; one would anticipate that experiences of pet owners who rarely spend time with their animals or where animals are seen solely as service providers (i.e., owning a guard dog) would be quite different.  Euthanasia and Companion Animals  58  Experiencing a profound sense of loss. Most of the participants in this study experienced either a disruption in daily routines, sleep disturbances, wanting to take time off of work, or decreased social involvement (or any combination of these) when their animal died. Thisfindingsupports earlier research (e.g., Gage & Holcomb, 1991; Thomas, 1996; Weisman, 1991) which suggests that the death of a pet can be as difficult as the death of a human loved one. More often than not, pet owners feel embarrassed by their grief (Weisman, 1991); as one of the participants in this study said, "I haven't shared this experience with a lot of people- they don't see animals the same way as I do, they don't care as much. I don't want to bother them with it." This is supporting "pet loss" as an example of a disenfranchised loss, a loss where it is perceived that other people will not understand or recognize the significance of the loss so that the grieving person may try to keep thoughts and feelings private (Stewart et al., 1989). One participant said, "You know people try to understand. I just don't think they did. I don't think that a lot of people understand the roles animals play in our lives." Another participant said, "I guess I laid low cause not everyone understands . . . People actually laugh at me for how much I care." Considering that the 8 participants in this study were self-selected and therefore were willing to talk about their experiences, it seems reasonable to assume that the owners who experience the most profound isolation and hesitance to seek help because of the death of a pet are not included in this study. Gaining access to this population will be important; I believe that pamphlets and written material left in veterinary offices will be one way to let pet owners like these know that they are not alone and that it is acceptable and expected to grieve after an animal dies.  Euthanasia and Companion Animals  59  The importance of talking about it. For participants, it seemed to be an empowering experience to share their stories, that the research process, itself, had a therapeutic function. Neimeyer (1998) explains that the telling and retelling of personal stories of loss helps people to make sense of what happened. This is something that Riches and Dawson (1996) found to be true in their interviews with parents who had lost a child to cancer. They suggested that "talking about their child's death and subsequent feelings may be an essential creative process which allows parents to draft, re-edit and rewrite their new status" (p.360). I received really positive feedback from participants in this regard- one went so far as to say, "I feel like I just had a therapy session." This positive effect seems to relate to the theme that being able to talk about the animal helps; talking seems to rekindle the good memories and sharing the difficult memories perhaps helps to release some of the emotions and make sense of what happened. Additionally, Bowlby (1980) lists a number of beliefs that he suggests facilitate and help the grief process: I don't have to deal with this on my own; it is okay to ask for help; and, it is okay to cry. Supporting the positive impact of these beliefs, one participant said, "I tried to give myself permission to accept whatever emotions I was feeling and it seemed to help." Others concluded, "You need animal-insightful support at this time, people who know what you're going through," and, "Being able to talk about him has helped me a lot, to just get it out. . . Holding things in just makes it worse." Regrets and unanswered questions. I believe that examining the regrets and unanswered questions that participants shared provides insight into what other animal owners might do differently or at least consider before they are faced with similar decisions. First, a sense of guilt is often cited after consenting to euthanasia (MacEwen, 1988; Thomas, 1996;  Euthanasia and Companion Animals  60  Weirich, 1988; Weisman, 1990). The "what if. . .?" questions often indicate underlying feelings of guilt. What if I had noticed the symptoms earlier? Did I do everything possible? Did the vet do everything possible? To illustrate this, here are comments made in an earlier study and some quotations from this study: So (the euthanasia) was the most traumatic thing that I went through. I think back on that and it brings so much grief because I had to make that decision . . . But I have dealt with guilt as a result of it, just because it happened so quickly and because B had no say in it. (cited in Thomas, 1996, p.25) You can really torture yourself with the 'what ifs.' I wish I had known more, took him to a more holistic vet... I feel guilty for not picking up (on his over-vaccination problem) myself. Maybe I didn't do my best for him. It's stupid but I blame myself. I wish cats could talk. I wish I could have asked him what he wanted. (Joyce) If I have to make the decision (to euthanize) based on her suffering, how do I evaluate whether she has suffered enough? Is it my greed? Am I doing the best thing for her? What's the best thing? . . . It is really hard to say that the best thing for anything is to die . . . 1 wondered if I had put (the decision to euthanize) off too long. That is the worst of it. . . probably that's the hardest part for me is just wondering if just to suit me, just to have her around, that I waited so long, (cited in Thomas, 1996, p.44) (After she died) I was so troubled and had horrible nightmares . . . Maybe I had done it too early? And maybe I hadn't explored all of the options . . . could I have done anything else? Was it misdiagnosed? (Tim) A list of suggestions and advice for other companion animal owners that should help to minimize regrets is included in the Conclusions section that follows. In my own experience and in listening to the participants in this study, it is the regrets and unanswered questions  Euthanasia and Companion Animals  61  which seem to haunt pet owners after euthanasia. If tears were expressed in our interview, this was a place that was especially emotional. Unexpectedfindings.I was happily surprised by participants' willingness to share their detailed stories, and the unspoken permission they gave themselves to cry and be very genuine with me. A number of people even waived confidentiality and asked that their real names be used; they said that the story presented just did not seem right with a fictitious name. Also new findings, learning about the importance of a good veterinarian during decision-making, treatment and euthanasia and the theme that "it helps to know I did everything I could" also provide valuable insight for other animal owners and veterinarians.  Conclusions and Recommendations Reading through the case presentations and themes should prove to be useful and interesting for other animal owners. Learning how other people have responded and what they chose to do and why may provide valuable insights and should help to normalize how difficult the experience of making end-of-life decisions is. Advice for other pet owners faced with similar decisions also emerged in this study. Here are some of the suggestions that were made: Advice for Animal Owners 1. Plan ahead. Know ahead o f time what yourfinancialand emotional limits are. For example, what will be the signs that your animal no longer has a quality of life? What can you afford to spend on vet bills? Is pet insurance an O p t i o n that might help cover vet bills? If your animal were to sustain a life-threatening injury tomorrow, what would you do? Who might be able to help and support you?  Euthanasia and Companion Animals  62  2. Talk it through. Before and after your animal dies, discuss your feelings and thoughts with someone who understands what your animal means to you. As you talk, you may find support and reassurance for the decisions you are making and likely will clarify what you need and want to do. 3.  Do everything you can. Keeping in mind yourfinancialand emotional limits, consider every possible treatment, get second opinions, and decide what is best for your animal. You know your animal better than anyone; listen to all of the options and make an informed decision. Considering all options and deciding what feels like the best option (extent of treatment or when euthanasia might be best) will help to minimize regrets later.  4. Work with a good veterinarian. Ideally, before you are faced with life and death decisions, find a vet who you can really talk to, who is both knowledgeable and compassionate, who is patient and explains things in ways you can understand, and who you trust. If your vet does not have these qualities, consider finding one who does. Also, like any doctor, veterinarians likely have different specialties or levels of expertise with a particular injury or illness. What experience has your vet had with your animal's condition/injury/illness? 5. With timing euthanasia, wait for a sign from your animal. (See tip #1.) What will indicate that your animal no longer has an acceptable quality of life? For some people, this is when the animal stops eating or when they no longer seem to have any enjoyment (i.e., not interested in favorite things). 6. Take a lot of photos and spend as much time with your animal as you can. 7. When your animal is dying or has died, grief is normal and expected. It is okay to cry and experience all kinds of emotions. For veterinarians. I believe that this study generates information that will be important for veterinarians, as well. For example, talking about how unprepared many veterinarians feel when it comes to dealing with their human clients' emotions, one veterinarian concluded, "We have frequently overlooked the fact that there was an owner at the end of the leash who sometimes required more care than the pet" (Withrow as cited in  Euthanasia and Companion Animals  63  Lagoni et al., 1994, p.xv). This study should provide insight into what some clients are experiencing when making end-of-life treatment decisions, what veterinarians may encounter in terms of the range of emotions, thoughts and behaviors, as well as ways that the whole decision-making and euthanasia experience might be improved. One thing that was mentioned a number of times was that veterinarians need to listen to the animal owners and respect whatever decisions are made. Given all of the options and having had a veterinarian explain each thoroughly, owners need to feel supported in whatever decision they make. Tn support of this, participants in this study said, It was helpful that the vets showed me her x-rays and test results and explained everything like I was a human- not just a credit card . . . It is important to have a vet you can talk to and discuss options with . . . one who will listen and care and not rush you. Being compassionate makes a huge difference. It's like your own doctor- you want to be able to really communicate with them. (Mia) The vets never really listened to me. I remember feeling so helpless at the end . . . I wish the vets were more supportive and responsive and listened to the owners- we love these animals. We may be stumbling along trying tofigureout how to do best for our animals but we do want what is best for them. We may at times disagree with vets because we sense something because we really know our animal. (Joyce) A similar sentiment was expressed by a participant in an earlier study: We had a lot of guilt that we didn't go with our gut feeling and euthanize her when we thought she needed it. We were really resentful that the vet talked us out of it and treated us like we didn't know the pet. (cited in Thomas, 1996, p.53) Veterinarians might also want to consider the theme, "Could the vet come to me?" Considering 4 of the 8 participants in this study mentioned this, it seems that there may be a clientele who is not satisfied with the current way euthanasia is conducted. Even if home  Euthanasia and Companion Animals  64  visits are not feasible, it seems that the euthanasia procedure could be improved by making a treatment room more warm and inviting than the sterile, cold rooms that are typically found in vet clinics. Lagoni, Butler, and Hetts (1994) offer many practical suggestions for improving euthanasia procedures in the vet clinic and in clients' homes. For counsellors. Recognizing that end-of-life decision-making, grief, and anticipatory grief related to the deaths of companion animals as potential issues that may bring clients to counselling is a first step. Because of the disenfranchised nature of these losses, it may be important for counsellors to advertise that they are interested in this area to help give clients permission to ask for help. Also, like other traumatic experiences, remembering that what clients need the most is the opportunity, safety, and reassurance to share their story with a patient, supportive listener will be important. I think that offering to do consultations with veterinarians is another area that counsellors are especially well-suited for. For example, counsellors could explain the grief and loss process, offer to be a referral source that veterinarians could give clients, and could support veterinarians with their own grief around euthanasia. In addition, counsellors could develop loss support groups for animal owners and those who are making end-of-life decisions for their animals. A number of people in this study indicated that talking to people "who have been there" is most helpful. Generalizing to human end-of-life decision-making? This study may help people to understand what the process of end-of-life decision-making is like and it may help to make death and grief a little less mysterious or intimidating. "We see the inevitability of the impending loss of a loved one and it becomes crystallized in a moment in time. In these moments, we see the bedrock issues of our humanity laid bare" (Shane, 1998, p.4). Because everyone has or will face the death of a loved one, I believe that there is a lot we can learn  Euthanasia and Companion Animals  65  investigating these crystallized moments in further detail. For example, in 1990, 66% of the participants in a United States Gallup Poll believed that someone in great pain, with no hope for improvement, had the moral right to commit suicide (Lagoni et al., 1994). If this trend continues, the experiences companion animal owners and veterinarians have with end-of-life decision making may provide important insights, cautions, and questions for anyone faced with similar decisions. For example, many of the regrets and suggestions for animal owners and veterinarians that emerged in this study may be interesting points for further discussion for anyone facing end-of-life decisions. Future Research. There are several areas that seem important and interesting to investigate in future research. 1. I think that an intervention outcome study on the effect of being able to share the experience of making end-of-life decisions and coping with the death of a companion animal will be important. For example, does having support and an opportunity to talk while making end-of-life decisions facilitate a less complicated or less painful grief process after an animal is euthanized? 2. I think that it will be important to try to gain access and talk with people who have never shared their experience, perhaps because they have been too embarrassed to show their grief. People who feel talking is too painful or uncomfortable seem important to recognize because I would guess that they are the least likely to seek help even though they may be the most in need of support. (For example, these are the people who are not able to acquire another animal because of the pain caused by the death of a pet). . 3 . 1 think that a study focusing on the experience of veterinarians and how they approach this topic would also be very informative. What challenges do they have? What do they believe helps pet owners make and cope with end-of-life decisions? How do they take care of themselves? For example, one veterinarian said, "Every animal I destroy leaves a little bit of me dying and I always feel a sense of failure, even though I know it was the right thing to do" (cited in Fogle & Abrahamson, 1990,  Euthanasia and Companion Animals  66  p. 146). Additionally, it seems likely that feeling uncomfortable with euthanasia will impact the quality of care offered to pet owners. For example. When euthanasia is performed well, it can soothe and reassure all involved that the decision to end the animal's life was correct. However, when the euthanasia is done poorly (that is thoughtlessly or without compassion and sensitivity), it can deepen, complicate, and prolong grief for everyone. (Lagoni et al., 1994, p. 169)  Final thoughts. "Without a doubt, some of the greatest, most enduring lessons I've learned about life I've learned from animals" (Milani, 1998, p.368). Though I agree with this statement, after completing this study, I have to add that talking about people's relationships with animals has been equally as illuminating for me. For example, because of having the privilege to speak with the 8 participants in this study, I am in a very different, more peaceful place cognitively and emotionally when I think about the losses I have had and the experience I had with Webster. It is difficult to capture on paper the powerful, emotional stories that were told and the impact that the "storytelling" and mutual understanding had for the participants and myself. I feel more motivated than ever to find ways to support companion animal owners through the end-of-life decision-making process and the death of their animals. For companion animal owners, veterinarians, and for the "helpers" and support networks, I hope this study has provided as many insights as questions to consider regarding the experience of making end-of-life decisions for companion animals.  Euthanasia and Companion Animals  67  REFERENCES Archer, J . , & Winchester, G . (1994). Bereavement following the death o f a pet. British Journal of Psychology, 85, 259-271. Bartholomew, K . (1993). From childhood to adult relationships: Attachment theory and research. In S. Duck (Ed.), Learning about relationships: Understanding relationship processes (pp.3062). Newbury Park: Sage Publications. Bowlby, .1. (1980). Attachment and loss. V o l . Ill: Loss, sadness and depression. New York: Basic Books. Brown, B . H . , Richards, H . C . , & Wilson, C A . (1996). Pet bonding and pet bereavement among adolescents. Journal of"Counseling and Development, 74, 505-509. Carmack, B . J . (1985). The effects on family members and functioning after the death o f a pet. Marriage and Family Review, 8, 149-161. Covvles, K . V . (1985). The death of a pet: Human responses to the breaking o f the bond. Marriage and Family Review, 8, 135-148. Creswell, J . W . (1994). Research design: Qualitative and quantitative approaches. Thousand Oaks: Sage Publications. Creswell, J . W . (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks: Sage Publications. Doka, K . J . (1989). Disenfranchised grief.  In K . J . Doka (Ed.), Disenfranchised grief:  Recognizing hidden sorrow (pp.3-1 1). Lexington: Lexington Books. Endenburg, N . (1995). The attachment o f people to companion animals. Anthrozoos, 8, 83-89. Fogle, B. (1981). Attachment-euthanasia-grieving.  In B . Fogle (Ed.), Interrelations between  people and pets (pp.33 1-343). Springfield: Charles C . Thomas. Fogle, B., & Abrahamson, D. (1990). Pet loss: A survey o f the attitudes and feelings o f practicing veterinarians. Anthrozoos, 3, 143-150. Friedmann, E . , & Thomas, S.A. (1985). Health benefits o f pets for families.  Marriage and  Family Review, 8, 191-203. Gage, G . , & Holcomb, R. (1991). Couples' perceptions o f the stressfulness o f the death o f the family pet. Family Relations, 40, 103-105. Gerwolls, M . K . , & Labott, S . M . (1994). Adjustment to the death o f a companion animal. Anthrozoos, 7, 172-186. Gosse, G . H . , & Barnes, M . J . (1994). Human grief resulting from the death o f a pet. Anthrozoos, 7, 103-11 1.  Euthanasia and Companion Animals  68  Kay, W., Fudin, C , & Cohen, S. (1987). Thanatology: Death of a pet. In P. Arkow (Ed.), The loving bond: Companion animals in the helping professions (pp. 107-122). Saratoga: R & E Publishers. Kotch, C , & Quackenbush, J. (1988). The bereaved pet owner and social work service referral. In W.J. Kay, S.P. Cohen, H.A. Nieburg, R.E. Grey, A . H . Kutscher, & M . M . Osman (Eds.), Euthanasia of the companion animal: The impact on pet owners, veterinarians, and society (pp. 164-180). Philadelphia: The Charles Press. Kvale, S. (1996). Interviews: An introduction to qualitative research interviewing. Thousand Oaks: Sage Publications. Lagoni, L., Butler, C , & Hetts, S. (1994). The human-animal bond and grief. Philadelphia: W.B. Saunders Company. Levinson, B . M . (1984). Grief at the loss of a pet. In W.J. Kay, H.A. Nieburg, A . H . Kutscher, R.M. Grey, & C E . Fudin (Eds.), Pet loss and human bereavement (pp.5 1-64). Ames: The Iowa University Press. MacEwen, E.G. (1988). The pet with cancer: Impact on the family. In W.J. Kay, S.P. Cohen, H.A. Nieburg, R.E. Grey, A . H . Kutscher, & M . M . Osman (Eds.), Euthanasia of the companion animal: The impact on pet owners, veterinarians, and society (pp.97-100). Philadelphia: The Charles Press. McMahon, S. (1988). Euthanasia and bereavement: A study of clients and veterinarians. In W.J. Kay, S.P.Cohen, H.A. Nieburg, R.E. Grey, A . H . Kutscher, & M . M . Osman (Eds.), Euthanasia of the companion animal: The impact on pet owners, veterinarians, and society (pp. 186-193). Philadelphia: The Charles Press. Milani, M . (1998). Preparing for the loss of your pet: Saying goodbye with love, dignity, and peace of mind. Rocklin: Prima Publishing. Montgomery, M . , & Montgomery, H. (1993). A final act of caring: Ending the life of an animal friend. Minneapolis: Montgomery Press. Nebbe, L.L. (1991). The human-animal bond and the elementary school counselor. The School Counselor, 38, 362-372. Neimeyer, R.A. (1998). Lessons of loss: A guide to coping. New York: McGraw Hill. Planchon, L., & Templer, D. (1996). The correlates of grief after death of pet. Anthrozoos, 9, 107-113. Quackenbush, J.E., & Glickman, L. (1984). Helping people adjust to the death of a pet. Health and Social Work, 9, 42-48. Rando, T. A. (1986). A comprehensive analysis of anticipatory grief: Perspectives, processes,  Euthanasia and Companion Animals  69  promises, and problems. In T.A. Rando (Ed.), Loss and anticipatory grief (pp.3-37). Lexington: Lexington Books. Riches, G., & Dawson, P. (1996). Making stories and taking stories: Methodological reflections on researching grief and marital tension following the death of a child. British Journal of Guidance and Counselling, 24, 357-365. Rosen, E.J. (1990). Families facing death: Family dynamics of terminal illness. Lexington: Lexington Books. Savishinsky, J. (1988). Common fate, difficult decision: A comparison of euthanasia in people and in animals. In W.J. Kay, S.P. Cohen, H.A. Nieburg, R.E. Grey, A . H . Kutscher, & M . M . Osman (Eds.), Euthanasia of the companion animal: The impact on pet owners, veterinarians, and society (pp.3-8). Philadelphia: The Charles Press. Shane, T.W. (1998). When life meets death: Stories of death and dying, truth and courage. New York: The Haworth Press. Sharkin, B.S., & Bahrick, A.S. (1990). Pet loss: Implications for counselors. Journal of Counseling and Development, 68, 306-308. Stake, R. (1995). The art of case study research. Thousand Oaks: Sage Publications. Stallones, L. (1994). Pet loss and mental health. Anthrozoos, 7, 43-54. Steinberg, M.D., & Youngner, S.J. (1998). End of life decisions: A psychosocial perspective. Stern, M . , & Cropper, S. (1998). Loving and losing a pet: A psychologist and a veterinarian share their wisdom. Northvale: Jason Aronson. Stewart, C.S., Thrush, J . C , & Paulus, G. (1989). Disenfranchised bereavement and loss of a companion animal: Implications for caring communities. In K.J. Doka (Ed.), Disenfranchised grief: Recognizing hidden sorrow (pp. 147-159). Lexington Books. Thomas, J.K. (1996). The human-animal bond and grief: A phenomenological perspective (Doctoral Dissertation, Mississippi State University). Dissertation Abstracts International, 1996, 57 (4A) 1507. Turner, W.G. (1997). Evaluation of a pet loss support hotline. Anthrozoos, 10, 225-230. Van Lloutte, B.A., & Jarvis, P. A. (1995). The role of pets in preadolescent psychosocial development. Journal of Applied Developmental Psychology, 16, 463-479. Weirich, W. (1988). Client grief following pet loss: Implications for veterinary school education. In W.J. Kay, et al. (Eds.), Euthanasia of the companion animal: The impact on pet owners, veterinarians, and society (pp.208-212). Philadelphia: The Charles Press. Weisman, A . D . (1991). Bereavement and companion animals. Omega- The Journal of Death and Dying, 22, 241 -248.  Euthanasia and C o m p a n i o n A n i m a l s  75  APPENDIX F INTERVIEW PROTOCOL  -777e purpose of this interview is to explore the relationship you and (your animal) shared, right through the last moments you had with him/her. -I hope you will feel comfortable lo share your story openly and without omissions. Identifying info will be disguised or deletedfrom the final write-up lo maintain confidentiality. -There are no right or wrong answers and you do not have to answer any question you do not feel comfortable with. —Any questions? 1. Could you tell me a little about ? What was he/she like? Favorite memories? When (and how) did you know that 's health was deteriorating? —Could you share your experience from that point on? What happened? (remember empalhic responses, give lots of time)  2.  (If needed): 3. How did other people respond (in general) when was sick/dying? After he/she died? —How did they respond to you and what you were going through? (level of support)  4. What was it like to make life-and-death decisions for ? —How did you decide what was best? How did you make these decisions? —What parts of this experience were especially difficult for you? 5. If anything, what do you wish could have been different? (during decisions and/or in general) -Have there been things that you have not been able to share with other people? 6. What (if anything) helped you through this experience? -What advice might you give someone who is facing a similar situation or is making treatment decisions for their companion animal? 7. What experience did you have with loss before Was 's death different for you? How? 8.  died?  Had you ever thought about euthanasia before this experience? How would you describe your beliefs about euthanasia? Did these change at all as a result of this experience?  9. Is there anything else that you would like to add?  10. Do you have any questions/comments?  Anything that we have missed?  —What was this like for you?  Euthanasia and Companion Animals  77  APPENDIX H A TRANSCRIPT OF AN INTERVIEW / chose this interview to include as a complete transcript because il had the most dialogue of all of the interviews. A number of the other interviews were characterized by long monologues from participants, where empathic responses and follow-up questions were rarely used because I had few opportunities to speak! This was the third interview and it lasted about 1 'A hours. We reviewed the informed consent form that had been mailed to "Susan " and looked through photographs of Tootsie before the tape recording began. Susan's current cat entertained us throughout the interview by pouncing on my pen, crawling over us and being quite playful. "S" indicates Susan's responses, "L " (for Laurel) indicates the interviewer's responses and questions. L: Maybe you could start and say a little about Tootsie and how you came to get him. S: 1 got him from my sister. 1 had him for 15 years. He was like my child- he lived with me from when 1 lived at home and then he went with me when I moved out. He acted more like a person- he was allowed to do whatever he wanted. He had the run of the house. He used to walk up our driveway on Halloween and he'd wait for the kids. When the kids came, he'd walk them down to our door and then when they were finished, he'd walk them back up the driveway and wait for the next set of kids.  L: Oh, that is cute! (both laugh) S: Christmas time was great. He'd climb the Christmas tree- I think all kittens do that. He used to sleep in the presents which was funny because when it was dark, you'd see these glowing green eyes peeking out from under the tree. He loved to be in small, confined boxes. We'd bring boxes home from the grocery store for a treat for him. (both laugh) When I was upset or depressed he knew and he'd always come and cuddle and that always made me feel better. It's hard to explain- he knew that I was upset and he tried to comfort me.  L: He was very keyed in to your emotions and what was important for you. S: He was. If I cried, he was right there for me and he slept with me every night and he was like a little person. He was exactly what I wanted in a cat- very affectionate.  L: You were 13 when you got him? S: Yes.  L: He seems like quite a character from the photos we looked at, especially him silling in the cactus pot. It kind of shows he had the run of the house when you see that. S: He did, and he knew if he did something wrong that he had better run because he'd get an earful. Though, most times he'd get away with it.  L: For sure. What did you like about him the most? S: That he comforted me and was affectionate and he was funny. He did his own thing. He wasn't playful, though. He preferred to just sit.  Euthanasia and Companion Animals  78  L: The calm, comforting type, (pause) What was different about your relationship with Tootsie compared to maybe other people and their cats? S: U m . . . I can't think of the words, but we were more in tune to each other of each other's needs. He had treats and special times of the week where he got little snacks. He was spoiled. L: So it sounds like he was fully incorporated into your lifestyle. S: Yah. Whenever 1 moved he was incorporated. "Is he allowed to come?" He was always my priority. L: Il seems like he really gave you a neat sense of support and companionship that way, he paid attention to what was going on for you. He tried to be reciprocal it.seems, (pause) So how did you know when his health started lo deteriorate? S: I guess it took about a year for me to really click in. He lost a lot of weight but it was kind of hard to tell unless you touched him. You could feel his back and he didn't have a round tummy. That was the first sign and I thought, "It's just old age." People when they get older lose weight. L: For sure. S: And then he started going to the washroom in the house and he had never done that before and I started to worry. Then I thought, "Maybe he's just mad at me or something," because they do strange things when they're mad at you. L: They can make a bit of a statement. S: Yah, but it went on for about 5 months and then he started turning on the kids and attacking them and 1 thought, "There's something really wrong." L: Yes. Do you have kids? S: No. My sister and I lived together. And the fmal straw, we had my sister's granddaughter's Christening and we had the big tea at our house and he attacked one of the little girls and he bit her and he scratched all up her arms, i thought, "Oh, this is not him." He used to greet the kids when they came at Halloween! L: It was really out of character for him. S: Way out of character. And he bit my mom and he had always had a good connection with her. So we took him into the vet for a check-up and they couldn't really give us a diagnosis. They said his temperament had changed. They couldn't really tell me what was wrong except that he is 15 years old and they said it was up to me to decide what to do with him- whether to put him down or decide how much farther he'd progress. I had always agreed with my mom that if he got to a state where he was not healthy and not the same that I would put him down- though it ended up taking me a long time to do it. I ended up deciding to do it and then they judged me. L: I think that you told me a little about that over the phone. S: It was the hardest thing I've ever done. My dad's been through triple bypass and that was a breeze compared to putting him down cause I did it all by myself and went in with him cause I always wanted to be there if he had to be put to sleep. I wanted him to know that I still cared. L: Yah, you weren't going to leave him at that point. So, fi'om when his weight started to drop, how long was that?  Euthanasia and Companion Animals  79  S: It was about a year of weight loss, and then the last 4 to 5 months having accidents in the househe stopped using his litter box altogether and attacking... L: So the vet the first time when you went in said, "This is kind of old age "? S: Yah. There was one thing, one treatment option had been discussed- I can't really remember-1 wish I had written it down. Tests would have cost $500-$600 to do the tests. I guess 1 didn't want to put him on drugs for the rest of his life if that was what the choice was. I wanted him to be better, but also he was 15 and I thought here I'll put all of this money into it and then I'll have to turn around and put him to sleep anyway. M y mom reminded me of these things and supported me. She said, "Take your time. Think about it and make your decision." There was a combination of things. If it had only been one, I probably could have held off. L: It wasnj; just one thing- there were a lot of things going on. Right after (hat first vet appointment, what was it like for you? S: After the first vet appointment, I put it out of my mind for about a month, thinking, "He's fine," and then I couldn't take the accidents and the attacking anymore. The weight loss I could deal with-1 mean if I had to feed him steak and lobster for a month I would have- but being dirty and attacking me got to be too much. So after about 3 months, I called the vet up and said, "I'm coming in to put him to sleep," and we made an arrangement to do it the next day. M y boyfriend at the time met me there the next day, though he was late. So, when I got there, they took me in the room and let me play with him. Then the girl came in and took him to go put a catheter in and brought him back a few minutes after and she asked, "Why do you want to do this?" She said, "He's healthy and there's nothing wrong with him." I explained to her, "It's like you guys told me (in the vet appointment 3 months ago), he's 15, there's his temperament-he's biting people and attacking, he's lost weight, he's dirty (having accidents) in the house..." He just wasn't himself. She said again that "there doesn't seem to be anything wrong with him," and so many things are running through my mind at this point. She told me it would be really fast, that he'd take a deep breath and it would be over, so I said "okay." As she put the needle in the catheter, she said, "Are you sure?" Then she did it anyway and 1 was shocked- why would she do that? L: (pause) They made something that was already very difficult even worse. S: Very much so. L: Was this the vet who was doing ail of the questioning or an assistant? S: I think she was a vet assistant- there was no vet in there and she just kept questioning me. I stayed with him for about 10 to 15 minutes alone, then I went out hysterical, crying, paid my bill and I've never been back there. L: No. That wasn i a good experience. S: The vet had been great all the years 1 had him but this was awful. L: They blew it big time. S: Yah, they blew it because I would have come back. It took 2 years for me to get another cat because I was doubting myself- maybe it was just me who saw all of his problems, maybe I had made a mistake and did something wrong- 1 really questioned myself. My family's been very supportive, they knew they had to be there for me. L: They knew what Tools ie meant lo you. It sounds like you went through a period of questioning what you had done and questioning ifyou had misread the signs.  Euthanasia and Companion Animals  80  S: Yah, I thought that 1 had made a big mistake. There were so many questions after I did it that made me doubt what 1 had done but 1 didn't want him to get to the point where he was suffering and get really sick cause I know people who have been selfish and kept the pet because they couldn't deal with letting him go, that they've kept him suffering for their benefit. I didn't want to do that to him.  L: So, pari of what helped you with your decision was thai prior knowledge and talks you had and your own principles around- it's better to have a quality life than a longer life. S: Yah. If I really think about it I know he had a good life cause I have a lot of good memories.  L: For sure. (Animals) add to your life and you add to theirs. Bui even knowing (euthanasia) is the best thing, it's still difficult. S: Yah. It was very hard. I've lost grandparents where I was upset and sad, but not for this long.  L: Yes, this is still fresh. How long has it been? S: He died almost 2 years ago.  L: Do you have a sense of why that might be? Can you put words on it, what makes this different? S: It feels like I have lost a child. I was responsible for him. He was my child.  L: Yes. Near the end, where you were able to call the vet (to schedule his last appointment), what brought you to that place? To say, "Today is the day? " S: Everyone had kept asking me what I was going to do with him and I wanted to just keep putting it off. My boyfriend eventually said, "You need to do this- you can't just keep putting it off. If you were suffering, wouldn't you want that to stop, someone to help you out?" And that helped me make the call to the vet.  L: So other people in your life were supportive but also pushed you a little? S: Yes. So I decided to do it and get it over with.  L: (pause) Have you ever done any thinking about why the vet. assistant might have reacted the way she did? S: The only thing I can think of is that Tootsie was being so feisty when they were putting the catheter in- I guess they couldn't see what I saw. They didn't know him. They didn't live with him. I really knew him, the weight changes and the attacking...  L: Yes. I guess I was wondering if her hesitation and unsupportive questioning had more to do with her discomfort with euthanasia and had nothing to do with you. S: Oh. I never would have thought of that.  L: In talking with people who work in the vet hospitals and the veterinarians, (euthanasia) can be just awful for them and it can be hard to justify to themselves why they have to do that as a regular part of their job. S: I would never have thought of that but that kind of makes sense.  L: Those questions she asked were probably her questions and not yours, but that was very inappropriate what she did. S: Yah. 1 never thought of it that way.  L: Have you approached them at all since then? S: I never wanted to go back in there. I've even stayed away from the area.  Euthanasia and Companion Animals  81  L: Do you have a sense of anything that might help you come to terms with what happened? S: No, I try not to think about it and try to believe that I've made the right decision. I mean, I couldn't keep him around forever. It's just too bad they don't get to live as long as we do. L: For sure. Was there anything that would have helped you during the year that he was sick and you were deciding what to do? S: It would have been better (in that first vet appointment) if they would have explained my options better- not just say I could put him down or wait and see if he improves. The vet could let you know you're making the right decision or say if you're having doubts to postpone it. I felt I was sent off alone and unsupported after both appointments. It would help to make a treatment plan- not just choose to treat him or put him down. It was not enough to go on. L: When you 're really worried about your animal, you need someone to go slowly through your options. S: It also would have been nice to have someone follow-up and show they're here for you. L: Yah. With euthanasia, the vets need to remember to care for the humans, as well. You're the one who has to decide, (pause) So what would you say was the most difficult part? S: 1 think the hardest part was walking out and having to leave him there and coming come and seeing all of his stuff. And knowing he was gone. He was just gone. L: S: do be  Yes. (pause) Is there anything you fell you could have done differently? I don't think so. I think I've made peace with judging myself and second-guessing myself. I can't that anymore and I just have to live with my decision. I know eventually the pain will ease and f Ml left with a fond memory.  L: Have you been able to talk about what's going on for you? S: Yah. We've always talked about it. Being able to talk about him has helped me a lot, to just get it out. I cried a lot for awhile and all I talked about was Tootsie. I never held anything back about him. Holding things in just makes it worse. For awhile, I remember still hearing him meow or- I probably sound crazy- even seeing him dart across the room. L: What would you say you've learnedfrom your experience, if anything? S: I learned to make sure I have a supportive vet. I would ask him to talk me through it and be supportive and not to doubt me. L: Definitely. Well, I've asked all of my questions. Is there anything we've missed? S: No. L: What was this like for you, talking about Tootsie and your experience? S: It felt very good. I'm even remembering more things about him, talking this length of time. It was very good talking about him. L: Thank you very much for sharing your experience with me.  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0089433/manifest

Comment

Related Items