College Connection | Page 6

college connection LEARNING IN PRACTICE Members of the veterinary profession have a responsibility to uphold standards to ensure the public has access to safe, quality veterinary care. When those standards are compromised, the College responds. Every veterinarian can learn from these situations and publishing the details of complaints received and resolved is intended to support that learning. The example below is taken from an actual case and is offered as a self-reflection tool to improve practice across the province. CONSENT MUST BE INFORMED AND DOCUMENTED BRIEF SUMMARY The client took her dog to an emergency clinic for treatment of a severely swollen hind leg. The previous day, the client had been referred to a specialist at the same facility. The specialist had performed several diagnostic tests but no definitive diagnosis was made. The dog’s condition continued to deteriorate despite treatment. The dog was examined and admitted for further observation and intravenous (IV) fluid therapy. Overnight, the dog had a seizure and his neurological status deteriorated. The member took over the dog’s case following a shift change. The admitting veterinarian and the member suggested the dog be referred to a neurologist. However, due to a possible poor prognosis, the client wanted to come in to the clinic to see the dog and make a decision. Later that morning, the member called the client to inform her the dog had suffered cardiopulmonary arrest. When the client arrived at the clinic, she was surprised the dog had been euthanized. REASONING Informed consent for euthanasia must be clearly documented and, if obtained over the phone, it is prudent to have a second person confirm the consent. In addition, in the event that a pet dies unexpectedly, the veterinarian has an obligation to inform the owner of the availability of an independent autopsy. In this situation, the member indicated she called the client while the veterinary technicians performed cardiopulmonary resuscitation (CPR) on the dog. The client was given the option of continuing CPR 6 / College Connection or euthanizing the dog. The client asked if euthanasia could be delayed until she arrived, but was told the dog would not survive the wait. The member asked again about euthanasia and the client said “go ahead, we are on our way.” The technicians stopped CPR and the dog was euthanized. The medical records noted the phone conversation and that the client gave permission for euthanasia over the phone. Upon arrival, the client asked the member why she performed euthanasia if the dog was arresting. The member said it quickens the animal’s passing so the pet does not suffer. The client said that none of the veterinarians she spoke to used the word “euthanasia”. The client said she told the member to “let him go” but never said to euthanize the dog. The member had written “authorized over the phone” on the euthanasia consent form but a second person did not confirm the authorization and the client did not see or sign the form. The panel agreed in some cases an arresting animal may experience changes that prevent a peaceful and pain-free death. Hastening a pet’s death by euthanasia to prevent suffering is acceptable and ethical. The medical record indicated the client consented to an autopsy if time permitted. Due to time constraints, an autopsy was not performed. When a patient has died unexpectedly, the client must be promptly informed about the availability of an autopsy through an independent veterinarian. At the client’s request, the attending veterinarian or their associate may perform the autopsy. Key Considerations Guidelines on Veterinary Euthanasia www.cvo.org/euthanasia The CVO Guidelines on Veterinary Euthanasia state the following: “It is best to obtain written informed owner consent at all times. For expediency in some situations, oral consent might be an appropriate course of action; this consent should be documented in the medical record. If oral consent is obtained over the telephone, it would be prudent to have it witnessed by a second person who asks it to be repeated to him/her and makes note of it in the medical record.” Sample Euthanasia consent form A sample Owner Consent and Request to Perform Euthanasia form is available in the College Guidelines Veterinary Euthanasia. Ontario Regulations 1093 One of the requirements of the legislation is that the client is offered an autopsy from an independent veterinarian in situations where the animal dies unexpectedly or from an anesthetic.