When a young lady told Coleen Ellis, the founder of the International Association for Animal Hospice and Palliative Care (IAAHPC), that she knew “it” was coming, she wanted to ensure she did everything possible at the end. She spent the next four days painting pictures of her dog. She checked items off her bucket list. She painted a rainbow in her driveway with sidewalk chalk and invited neighbors to come and say their goodbyes. 

When the veterinarian arrived, she took her dog out into the rainbow and put him to sleep there. 

And they walked across the Rainbow Bridge, which, according to the Ark-Valley Human Society, is a metaphorical bridge that pets are said to cross once they die, so that they can wait for their owners in a beautiful meadow.

“She kept telling me that the end was perfect. What a lovely, lovely thing to say,” Ellis said.

At the end of their dog’s life, pet parents may be faced with the decision and potential emotional turmoil of euthanasia. According to Science Direct, owners who euthanized their pets felt less guilt but more grief than those whose pets died of other causes. 

Financial accessibility concerns add another layer to this decision. According to the Face Foundation, some pets experience economic euthanasia when they are euthanized for a treatable medical condition because their owners can’t afford necessary medical treatment.

Regardless of the cause of pet euthanasia, it can be a very painful experience for owners. Ellis experienced this grief firsthand 22 years ago.

“My dog died, and I decided then that I was not finding the pet funeral homes that I thought she deserved, and I deserved to have the services that I wanted for her, which included respectful treatment of her body, grief support, the opportunity to have a funeral, and memorialization products,” Ellis said.

Ellis created IAAHPC to provide these services for other families.

“We live in this death-avoidant society that struggles to have those conversations. And I’m very okay to have those conversations,” Ellis said.

Ellis focuses on educating families about euthanasia and reframing how they think about it.

“Death isn’t a failure. Euthanasia isn’t a failure. Euthanasia is an option,” Ellis said. 

She described euthanasia as a beautiful option, especially when contrasted with letting animals suffer.

“The beauty of euthanasia is that I will be there. I will be holding him,” Ellis said.

Ellis emotionally supports families during their pets’ final moments. She said she learned some of her techniques from animals.

“There’s a beautiful thing about dogs in particular, they just sit by you, and they don’t have to speak. They can just be. And when I’m sitting with a family, that’s the first thing I think of. ‘I need to be like a dog right now,’” Ellis said.

Ellis also said that individuals may experience different reactions to pet loss. She believes that allowing people to feel their varied emotions is the core of her work.

“Permission. Permission to grieve, permission to mourn, permission to honor, permission to do a ritual, permission to buy a memorialization. Permission for all of that,” Ellis said.

Sometimes, families struggle to determine when the right time is to euthanize their pet. 

Sylvia Wenning, a licensed therapist specializing in pet loss support, understands the guilt many people feel when making this decision.

“Pet loss can tap into deep-seated fears of guilt because our animals look to us for care and to make the best possible decisions for them. It can be especially hard when we can’t ask our animals, ‘Are you wanting to let go now, or do you want to hold on?’” Wenning said.

Ellis addresses such concerns by emphasizing that any time is the right time.

“If the veterinarian has said that he’s there and there’s nothing more we can do than what I know is then I’m in the window of time. And any time in the window of time is the right time because he’s ready,” Ellis said.

Colleen Crowley is the communications manager at Peninsula Humane Society (PHS) & Society for Prevention of Cruelty to Animals (SPCA). The PHS & SPCA is a local charitable organization that provides many animal welfare services, including animal adoption, supportive care for those in need, and euthanasia for pets.

“Mostly this hard decision is made when a family does not want to see their pet suffer, and there is no other viable option,” Crowley said.

Regardless of the timing, many families may still feel guilty for putting down their pet.

“People who put down their pets feel a lot more responsible. They blame themselves if they feel like they didn’t handle things in the best way possible,” Wenning said.

According to Ellis, the best way to handle what she calls the “final walk” of an animal is to keep them comfortable and help them enjoy bucket-list items.

Jenn Winnick, a hospice and palliative care veterinarian and peaceful euthanasia veterinarian, visits people in their homes to administer euthanasia, making sure their pets are comfortable in their final moments.

“A sedative is administered for their pet to comfortably fall asleep first, and then the last injection is given about five to ten minutes later,” Winnick said.

Winnick gives the family time – time to adjust to her presence, to administer the injection, and to be alone with their pet one last time.

“When they’re ready, small pets are swaddled in a blanket, and the family or I would carry it to the car. If their pet is heavier, they assist me in moving their pet onto the stretcher and take it out to the car,” Winnick said.

Who cares?

People who aren’t pet owners may not understand the pain of losing an animal, according to Wenning and Ellis. 

“It’s a disenfranchised grief where, in our society, there’s a lot more understanding if someone loses a human or a family member. But if it’s an animal, sometimes it can feel like people don’t really get it,” Wenning said.

Ellis provides education on reframing the typical perception of pet loss.

“You’re not crazy if you feel this way about this little pup, or this little kitty, or this little bunny, or this little snake. You’re not crazy and have permission to feel the way that you want to feel, even though others may be telling you ‘it’s just a dog, and you should be over this,’” Ellis said.

Walking to the next exam room

Euthanasia is not just a stressful experience for patients, but also for veterinary employees. Cristina Soresca is a social worker at SAGE Veterinary Centers in Redwood City. SAGE is a 24-hour emergency hospital with specialties in oncology, neurology, internal medicine, surgery, anesthesia, and more. Soresca offers services including emotional support, grief counseling, guidance through end-of-life decisions, and anticipatory grief support.

The social work team at SAGE builds trusting relationships with its clients from the beginning. Each department at SAGE supports patients through the entire veterinary process.

The process is painful for patients, but it can also impact the employees in each department with whom they work.

“We call it moral injury, where you’re constantly seeing other people suffering from trauma and having to move on to the next exam room,” Soresca said.

On the other hand, Ellis said her work does not take an emotional toll on her.

“It is a subject that I honor that I get to be the person who walks with a family through this final day, and to be able to really, truly, make a difference with a subject that is very difficult to talk about,” Ellis said.

The constant need to see new patients still takes an emotional toll on many veterinary staff members.

“You walk into an exam room, there’s a puppy in there, you get elated and happy and excited. But then you walk into another exam room, and there’s a pet that’s been hit by a car, and you have to try and support that family. And then you go on to the next one. And our team constantly has to do that,” Soresca said.

The team at SAGE benefits from support groups, organizations dedicated to supporting veterinarians, and social workers who help with compassion fatigue. They also often share their experiences and emotions with each other.

“We talk about the hard cases and challenging interactions. We also do team-building activities with our group,” Soresca said.

Additionally, each department has a supervisor available to support these emotions through professional consultation. They often discuss maintaining a balance with their caseload, supplementing high-intensity cases with lower-stress tasks.

“If we go and support with euthanasia, the next hour or so we will work on just doing phone calls that are follow-ups and things that are less stressful,” Soresca said.

Employees have many responsibilities. They use the Professional Quality of Life Scale to assess compassion fatigue, burnout, and compassion satisfaction. The social work team administers the tool to their team members to assess their quality of life. They implement interventions to support the team and frequently discuss boundaries.

“‘What is mine to hold and what is theirs?’ is a grounding question. When you come into a room, this is the family’s experience. It’s not for us to experience with them,” Soresca said.

Despite any emotions that may arise from working with animals in their final days, staff members are motivated to continue their work.

“I get to be the one who sits there and gives them permission to have those emotions and permission to do whatever we need to do to honor a sweet little kitty or a precious little pup,” Ellis said.

Both Ellis and Soresca are passionate about animals and their care.

“The things that keep me going are definitely my two dogs and my two cats,” Soresca said.

Soaring vet bills

Staff at veterinary offices dedicate their time, effort, and expertise to keeping animals safe and ensuring the satisfaction of the families they serve. However, they are still businesses, which means they must generate a profit.

Bills at veterinary offices and organizations that offer extensive end-of-life support can be extremely expensive. According to Gallup, 52% of American families report skipping veterinary care due to its high costs. Euthanasia on its own can cost hundreds of dollars, and specialized veterinarians who do at-home services or workers who offer grief support may charge thousands.

These price tags are out of reach for most people. Thus, uninsured dogs with a life-threatening emergency condition were 7.4 times more likely to be euthanized than insured dogs, adjusted for age and other health factors, according to the University of Melbourne. So what do you do when you can’t afford to keep your pet alive? Or when their final minutes must be in a cold, stuffy clinic rather than on a hand-drawn rainbow in your driveway?

“It can be especially hard because they don’t want to see their pet suffering, so they put it off or don’t get the kind of care at the end, whether it is actual treatment or hospice care for pets that can be costly, but can help the animal be more comfortable. It can be a really tough place,” Wenning said.

Ellis points out that euthanasia can help owners who are struggling with affordability reframe their perspective, once again.

“Euthanasia isn’t a failure. Euthanasia is an option. And if I, at this particular juncture, cannot afford $5,000, $2,500, or $1,000, I have an option to not have him in pain anymore,” Ellis said.

SAGE veterinary clinics ensure that patients have as many options as possible.

“We support them by giving them different resources. There are grants, financial resource pamphlets, but knowing the different organizations in the community is one of the best ways to help families with accessing care,” Soresca said.

These grant programs include SAGE Compassion for All and PetSmart Charities. The Bay Area mobile veterinary clinic, Vets in Vans, also provides low-cost services to families in need.

“We offer low-cost pet euthanasia services when the time is right for owners to make this decision,” Crowley said.

Additionally, various veterinary organizations may have internal support mechanisms in place for families struggling financially.

“I maintain an angel fund, which families have either specifically donated into or I have applied overpayments on checks to that fund so that I can help some families with a portion of their bill,” Winnick said.

Veterinary staff remain dedicated to helping their patients, regardless of the circumstances.

“If folks can’t access the care at our hospital, we do our best to make sure that we can give them other options. This isn’t just, ‘Oh, sorry, we can’t help you,’” Soresca said.

Regardless of how a dog passes away, Ellis says that their final walk, from the diagnosis to the injection, is very special.

“When we honor death, we honor life,” Ellis said.