Euthanasia: The Good Death

Ending it is not giving up. When that is done, ending it is the last kindness you have to give, and it is yours to give.”

People ask me if euthanasia is the hardest thing I do.  The honest answer is yes and no.

It is hard because there are two losses in that room, and I feel both of them.  I lose the patient, an animal I have often known for years.  A sentient creature who knows my smell and my voice, and sometimes one I have grown close enough to, that I press my nose against its nose, because over the years we built that kind of intimacy.  And I stand beside a person I have come to know just as well, someone whose family I have watched grow, the two of us taking an honest interest in each other's lives as members of the same community, a community built around one simple thing, the love we share for the animals.  When that bond ends, the person loses a member of their family, and I lose a patient who knew my hands.  You do not get used to that.  If you ever do, you should hang up your stethoscope.

I have a great deal of confidence in my ability to diagnose disease and perform surgery, but this is  the most important thing I do, and in its own way the most rewarding. The word tells you why. Euthanasia is Greek.  “Eu” means good.  “Thanatos” means death.  A good death.

The Greeks made Thanatos a god, but a gentle one, the twin brother of Hypnos, who was sleep.  They put death and sleep next to each other and called them brothers.  After all these years, I have not found a better way to think about it.

Saying good-bye

Where it happens matters.  The location is of the utmost importance and the choice belongs to the client.  Some prefer the exam room, where I keep the lighting muted on purpose and the table cushioned with padding and blankets.  Others prefer the animal's own home.  It becomes a visit to the pet’s own sanctuary.  For the animal too large to lift to any convenient level, that is the time to get down on the floor and give the drugs there, at its level, where it is comfortable.  Some I have performed in a familiar backyard, on the grass the animal knew.

Here is the actual act, sharing it because people are afraid of the unknown.  The sedative always comes first.  A simple painless intramuscular injection. It is given while the owner is holding them, while the beloved companion grows heavy and calm and free of pain, and almost always the person leans down close in those last waking seconds and whispers to them.  

“Good boy. I love you.”  

And finally, “thank you.”

Usually it’s a whisper, the animal hears that voice, the one voice it has trusted it’s whole life, and slips away under it.  Only when they are fully asleep, hearing nothing, feeling nothing, do I give the second injection, the one inserted in a vein, the one that stops the heart.  Then I step back again, and I let the person hold their dog or their cat for as long as they need.  That part is not medicine.  That part is just letting someone say goodbye.  And when they are ready, if it feels appropriate, a gentle hug. In that moment I am not their veterinarian.  I am just another person who knew the animal and loved it too, standing in a room where something has ended.

The last kindness

I tell every client the same thing before we start, because every one of them feels the same insecurity in making such a profound decision.  They wonder if they are doing the right thing, if it is too soon, if they are giving up.  I tell them that when the only thing left is pain, or no real quality of life, ending it is not giving up.  When that is done, ending it is the last kindness you have to give, and it is yours to give.

I lost my best friend, a white, 14-year-old standard poodle named Colin.  I had to put him to sleep, and it is enough to say that loss taught me what no amount of clinical training ever could, and that everything I have just described, I have come to understand from both sides of the table.

Being in Greece actually played a part in this story.  I learned something on a piece of land on the island of Thassos.  My wife Jacqueline and I came to Thassos because it was the closest island to the mainland and still relatively undiscovered by tourists.  We chose it for a practical reason.  We were traveling with our eight-month-old son, and we wanted to be somewhere we could reach a hospital quickly if he needed any kind of medical care.  

Little did we realize that the island held such significance in the history of medicine itself.  There is a headland on Thassos that we came to call “Hippocrates Point.”  Hippocrates himself, the father of medicine, once stood there.  We call him that for a reason.  Before him, sickness was the work of the gods, something you prayed away.  He was the first to say disease had natural causes a person could observe and treat, and the first to bind a physician by an oath.  

The principle everyone still remembers from that oath comes down to four words.  First, do no harm.  Over the centuries the same ground bore a Roman temple, and later a small Christian church.  By the time of our visit it had come down to almost nothing, a single broken section of a Roman column, a drum of white marble lying on its side in the grass, and the spirit of Hippocrates, that was enough.  Legend says this was where he wrote the The Epidemics, looking out on that same sea.  

We stood on the point and read it aloud, and we set our son, Alexander, on the remnants of that marble column, propped upright on two thousand years of stone.  We did not read the oath as a set of rules for a trade.  We took it as something sacred, a way to practice a profession and a way to live.

An oath to end the harm …

And here is the contradiction any honest reader will see.  The same oath that says do no harm also says to give no deadly drug.  For 30 years I gave the deadly drug.  I gave it on purpose, with my own hand, and not once did I think I was breaking faith with him.  Because when the loss is total quality of life, or pain, the deadly drug is not the harm.  It is the end of the harm.  The man who forbade the act is the one who taught me what it was for.

And the boy who was eight months old on that headland grew up to be true to the man who wrote those words.  

I did not set out to make him that way.  He does not recite the oath, but I am sure he knows it.  He simply lives it.  He treats the man who can do something for him and the man who can do nothing for him exactly the same.  I spent a whole career trying to put into words what it costs to stand close to suffering and not turn away from it.  Alexander never had to write any of it down.  He just is it.

I often wonder about that contact.  An eight-month-old child set upon two thousand years of marble, his skin on the same stone where the oath was written.  I wonder whether something passed between them that I have no name for, or whether it was only Jacqueline and me.  

I know for sure Jacqueline did.  And I hope I had something to do with it too.

Dr. Lamb is a veterinarian who lives in Manchester.