Ethics of Human Doctors Performing Feline Intracardiac Euthanasia During Hurricane Katrina

Five years have passed since Hurricane Katrina wreaked havoc on human and animal communities in the Gulf Coast. Recently, I wrote an article (Veterinarian Perspective on Human Euthanasia During Hurricane Katrina) based on Sheri Fink’s New York Times Magazine feature The Deadly Choices at Memorial. In my article, I lent my perspective on the ethical struggles Memorial Medical Center doctors and nurses faced regarding the elective euthanasia of their terminally ill human patients during the desperate aftermath of one of the worst natural disasters to affect the United States. As my clinical veterinary practice requires me to guide pet owners through the decision to continue or end their beloved pet’s life, I connected to the situations faced by Memorial’s medical staff. The decision to euthanize a pet is achieved based on the likelihood a pet may not survive illness, recover from trauma, or when the quality of life is considerably compromised. Along with the humans that were “put to sleep”, Fink mentions the euthanasia of two cats by John Theile, a Memorial pulmonologist. Evidently, the cats’ “owners brought them to the hospital and were forced to leave them behind.” Thiele reportedly “trained a needle toward the heart of a clawing cat”, meaning the euthanasia was performed via intracardiac (into the heart) injection. The drug given to the cats was not specified. Euthanasia by intracardiac injection of euthanasia solution (Sodium Pentobarbital, other) is rapid, yet painful and stressful to the patient. Intracardiac euthanasia is typically reserved for situations when other accepted means of injection are not permitted. It is exceedingly difficult to administer any form of injection (intramuscular, intravenous, other) to a fractious (behaviorally challenging) feline without physical restraint from at least one assistant. According to the AVMA (American Veterinary Medical Association) Guidelines on Euthanasia, “When intravenous administration is considered impractical or impossible, intraperitoneal administration of a nonirritating euthanasia agent is acceptable, provided the drug does not contain neuromuscular blocking agents. Intracardiac injection is acceptable only when performed on heavily sedated, anesthetized, or comatose animals. It is not considered acceptable in awake animals, owing to the difficulty and unpredictability of performing the injection accurately. Intramuscular, subcutaneous, intrathoracic, intrapulmonary, intrahepatic, intrarenal, intrasplenic, intrathecal, and other nonvascular injections are not acceptable methods of administering injectable euthanasia agents.” The majority of veterinarians performing euthanasia on animals give the life ending injection intravenously (into the vein). I always strive to minimize my patients discomfort during their final moments by administering an intramuscular combination of sedating and pain relieving medications before giving the final, intravenous euthanasia injection. Fink details Thiele’s struggle to inject the cats in a less than humane fashion in the midst of his ethical conflict over human euthanasia. Considering, Thiele’s expertise of the cardiovascular system as a pulmonologist, why did he not pursue a more humane option for the two cats? Thiele could have administered the injection into the cat’s peritoneal (abdominal) cavity. Intraperitoneal injection is a less painful alternative to intracardiac or intravenous route. The peritoneal cavity and abdominal organs are lined by a thin layer of cells called the peritoneum, which readily permits transfer of liquid medication into the bloodstream. Intraperitoneal euthanasia requires a longer time than intravenous or intracardiac route, yet permits the cat to slowly “go to sleep” instead of struggling with a needle stuck into the heart. Why could the cats not have been left to fend for themselves. Were the cats sick or injured? The cats must have been healthy enough to resist being handled or injected. The article claims that the cats were brought to the hospital by owners who “were forced to leave them behind”, but does not elucidate the cats’ medical need to be euthanized. I fully realize that Memorial’s doctors, nurses, and support staff were under extraordinary stress and forced to provide medical treatment in a less than ideal environment. Life altering decisions were being made based on the likelihood that human patients with terminal illness or severely compromised health would survive the evacuation process. As Memorial’s medical staff were trying to alleviate the suffering of their human patients during Hurricane Katrina, I wish they would have elected to set the two cats free or used a more humane method of euthanasia than intracardiac injection. Thank you for reading my article. To receive my next article via email, please press the “Don’t Miss a Blog Post” button on the right upper corner of this page. Copyright of this article is owned by Dr. Patrick Mahaney, Veterinarian and Certified Veterinary Acupuncturist. Republishing any portion of this article must first be authorized by Dr. Patrick Mahaney. Requests for republishing must be approved by Dr. Patrick Mahaney and received in written format. Photo Credit Flickr Editor B - The Rooftop Society of Cats have survived Hurricane Katrina and are seen happily basking in the Gulf Coast sun.