In Part 2 of this series on The New AVMA Companion Animal Aftercare Policy, I discussed the importance of encouraging pre-planning for pet parents, as it can lessen the stress of making a number of decisions (e.g. aftercare, etc.) on the day of their euthanasia appointment. They are trusting us to not only guide them to make the best possible decisions, but they are also trusting us with their beloved companion during aftercare as well. Let’s talk about respectful and dignified containment of the remains as pointed out in the new AVMA policy.    3. Companion animal veterinarians should provide adequate containment of the remains.”  Keeping with the theme of this new policy, which is that of dignity and respect, we are to provide adequate containment of the remains. What exactly does this mean? This can be interpreted in a variety of ways, but it’s safe to say we are phasing out the use of plastic bags for the storing of remains. As anyone who works in a medical field knows, we have all witnessed our fair share of less-than-pleasant sights. The status quo cannot be the definition of “adequate.” Pet parents are trusting us to protect their furry companions and dignity should be something we strive for. The use of an appropriate body bag is not only dignified but symbolic. Think of all the extra effort we put in for our patients, but when it comes to how the body is handled after death, the same standards do not apply. According to a survey conducted of pet owners in July of 2019, 86% of pet owners consider proper containment important. A medical-grade bag making insertion of the body easier is - so far - the best bet with regard to body bags. They are more efficient to store than boxes and look respectful when organized in the freezer. Ones made from recycled material are better in terms of environmental impact. Euthabag was designed by a Canadian veterinarian, Dr. Celine Leheurteux. She could not stomach placing pets in trash bags as this was a major conflict to her practice standard and values, so much so she created a solution to this problem. Overall, something comprised of quality and respect is in order. Imagine if we put humans in garbage bags. There is a reason it is not the standard. Why do we continue to do this with our beloved pets and patients? There are plenty of options available to provide adequate containment of the remains, and the AVMA is encouraging us to take notice. This can be particularly important whenever an owner decides to come back after euthanasia and wishes to see their pet one last time. What do you do in this event? Most often we will ask the owners to wait in a room while we locate the remains. We poise and place them neatly on a blanket or something more aesthetically pleasing. Are we being dishonest if we are not showing the owners what the real containment looks like? It’s worth giving this some thought.More specifically, this section in the AVMA policy states: “ veterinarian should handle animal remains in a sensitive manner, such that it is not unnecessarily disturbing to the owner or any other person with a valid reason to see the remains.” They go on to say “Deceased pets, whenever possible, should be maintained in a condition suitable for return to the owner or to the aftercare providers such that families may witness their pet’s aftercare.” Lastly, in this section they point out, “the sensitive handling of pet remains is an important aspect of veterinary practice.” This adds to our code of ethics as well as professionalism as a whole. It’s certainly encouraging that the AVMA sheds light on this and shifts our focus to what the pet owners will feel like if it’s the last time they saw their pet. Have we as a veterinary industry asked the public what they want? Like our friend Dr. Rollin, another veterinarian was curious and actually asked people what their preferences and expectations were on aftercare of pets. In a very recent study conducted by Dr. Kathy Cooney on the preferences of pet owners she showed that the majority of people found it unacceptable that animals were placed in garbage bags. Much like Dr. Rollin thought, it begs the question: “the majority of the public does not like this … so why are we giving it to them?” The perception of the human-animal bond is evolving, and decisions to adhere to these higher-order guidelines help us to create a world that treats all life with respect and protects its dignity. It is something we all intuitively know, yet we must work hard to achieve. We already know what the right thing to do is and the AVMA is helping us get there. To paraphrase a concept by the philosopher Plato6: we do not teach, simply, we remind.    https://www.sciencedirect.com/science/article/pii/S193897362030101X  https://iep.utm.edu/meno-2/ 

In Part I of this series, we ended with the importance of validating the cremation services offered by your chosen facility, and also looked over some investigations into various crematory companies. Now, we will turn the page and look to ways in which we can benefit pet parents by offering them pre-planning solutions to lessen the burden on the day of their appointment.    2. “Encourage prior planning so that owners are aware of their options and can easily communicate their preferences. Pre-planning can be offered by the veterinarian or delegated to the aftercare facility*.”   The power of pre-planning for euthanasia is exceptional in that it gives the owners a chance to both prepare and begin to cope with the loss of their companion. It often empowers owners as they face the circumstance of loss. Opening up dialogue about this also gives them the time to think about what they want in terms of the appointment itself, when it should occur, and aftercare options.   While the veterinarian helps pet owners in making the right decision about when to euthanize their pet, there are many tools for pet owners to take home with them to assist in evaluating their pet’s quality of life. The Ohio State University Veterinary Medical Center has a wonderful Quality of Life Assessment Tool for pet parents where they can assess QOL at home. A printable pdf can be found here.   The Companion Animal Euthanasia Training Academy suggests a few points to consider for the appointment. Where to gather (Home, hospital, favorite place)  When it should take place (Before a crisis, when loved ones will be able to attend)  Who should be there (family and friends, children, other pets)  What special touches to include (Music, photos, ceremonies)  How the aftercare will be managed (personal preference of crematorium, cemetery, or memorialization).    The AVMA also discusses in their policy: “Providers should allow clients to be well informed about pet aftercare options.” It gives them time to think about what they want and avoid feeling pressured to make a decision on the day of the appointment. Many people do not know what to expect with regard to the euthanasia appointment. It is often their first experience or a previous one has occurred so long ago that they forget the details. A pre-euthanasia appointment is a useful tool where we can map out the experience and what to expect on the day of their appointment, as well as time to discuss preplanning for aftercare options.   There is a great resource for a pre-planning tool developed by the Pet Loss Professionals Alliance that makes a wonderful addition to a pre-planning consultation. A printable version can be found here. Other resources for euthanasia pre-planning and tips for the practice can be found here.    https://caetainternational.com/making-pre-euthanasia-arrangements/ 

This post is the first of a 3-part series that I want to share with VetVine - focused on the new AVMA Aftercare Policy and why it's important for you and for veterinary clinics. We all want to see the progression of animal welfare and to increase the standard of our veterinary practice. Our daily choices can affect this in ways we may not intuitively consider. As we progress as a culture, we gather more information on what the people want in a broader sense and how we can better serve our clients and patients. Taking this cultural progression into account, the AVMA created a new policy on aftercare that affects us all. We can now be held accountable for the aftercare providers we choose. The AVMA has adapted their guidelines to the evolution of the human-animal bond. It starts out by small actions that can have a ripple effect even larger than we can imagine. In 2008, Dr. Bernard Rollin, a professor of biomedical sciences and philosophy of animal welfare, set out to eliminate the sow stalls that were being used as breeding factories for pigs. The first time he had ever encountered one, he was shocked. He was taken aback by the utter lack of moral treatment of animals, and right then and there he made a promise to himself that he would do whatever was in his power to eliminate that style of farming. Instead of going through legislative power, his strategy was to show big-businesses that their customers despised that style of practice. He marched into Smithfield, the largest pork producer at the time, and challenged them to poll their customers. “What will we find?” They asked. “You will find 75% rejection” of this style of farming. They called him back 6 months later to inform him, “actually, it was 78%”.   “78% of the public does not like this. Why do we keep giving it to them?”   The genius in the way Dr. Rollin strategized this was that he simply asked people for their opinions. He pleasantly discovered that people attribute more empathy to animals than once thought. Smithfield stopped using that style of sow stalls. Actions like this have a large effect on the industry as a whole. We are progressing culturally. The relevance of public opinion is something we will come back to when we look at the third point in the policy.   Our perception of the human-animal bond worldwide has strongly evolved in the last decade, and the AVMA took the lead in bringing a policy to frame our practice of aftercare. This is relevant and important in two ways:   Our standards of care are increasing, and this is a win for animal welfare  Veterinarians can be held accountable not only during the pet’s life but after death as well.   The 3 main policy points and some examples of how they work are detailed here.      1. “Veterinarians must understand that they may be responsible and may be held accountable, for the aftercare provider they recommend*i.”  The International Association of Pet Cemeteries and Crematories (IAOPCC) told Stephen Dubner of the Freakonomics podcast that 10 years ago, only a handful of facilities specialized in pet aftercare. There is now a vast increase in number of pet aftercare facilities to complement the ever-increasing number of pet owners. However, there is limited legislation in this industry and it varies from place to place.    With so much emotion surrounding death and aftercare along with the increase in number and size of aftercare providers, it makes us wonder what the margins of error are? Are these places respectful and diligent in their process? Have you, yourself, ever visited a pet cremation facility?   Freakonomics hosts investigated this issue. They wanted to know, are we indeed getting the appropriate ashes back when we take our beloved pets to the crematorium?   To investigate this, they created a fake cat. They took fur from a rabbit, stuffed it with hamburger meat, and named it Stevie. As there were no bones in Stevie the amount of ashes returned to them should be minimal compared to normal cremains. Crematoriums should likely flag this as the second step in cremation is to crush the bones, a process called cremulation.   They sent a version of Stevie to three crematoriums to see what they would get back … For each one, they received bone ash in the cremains. How is this possible? None of the crematoriums gave an explanation of how there could be bone fragments in the ashes. The Freakonomics team sent all of their data to the attorney general’s office and will update the viewers in the event this is pursued.   For more detailed information about this, you can listen to the excellent Podcast here. There was a similar Canadian-run experiment in 2012 in which investigators gave 12 crematoriums in the Vancouver area plush toy cats to find that 6 of the 12 returned ashes with bone fragments in them. You can find more detailed information about the Canadian version here. In line with an increasing number of pet parents and their concern, along with whispers of human crematory corruption (see this bone-chilling case in Noble, Georgia). It is clear there are issues in the Aftercare industry. The AVMA Policy is there to guide us and help prevent such traumatizing events.   One reason there will be more accountability on the part of the veterinarian: The IAOPCC decided to conduct a mock trial in the event of cremation fraud to see what the peoples’ perspectives are and how they would be judged in a court setting.  They invited the community to participate. In the trial, the prosecution sued both the crematorium and the veterinary facility for outsourcing cremation to the cheapest company.   In the trial, jurors ruled in favor of the prosecution in all counts, with a total of $3.5 million dollars in punitive damages. The jurors charged the veterinary clinic damages for not going out to check on the crematorium.   Our pets mean the world to us, and it’s clear that jurors do not take lightly the idea of having our pet families subjected to fraud. The public is clear on this.   If that doesn’t want to make you re-think checking out your crematorium, what will? It’s important that the crematorium you choose be open and available to the public and to the veterinary facilities to visit and see how they work. It is important we hold them to a high standard. The AVMA goes on to say “Aftercare providers you work with or refer clients to should be seen to always handle pets with dignity and respect.”  The interesting part about the mock trial is that it shows veterinarian facilities will likely be held accountable for any indiscretion on their part. To this point, the AVMA took the lead again in pointing it out in their policy that it is a very real possibility the facilities can face damages, something to keep in mind the next time you name your crematorium. It is also notable to mention that in many cases, crematory providers are sometimes chosen on the price of their service. Many veterinarians and vet teams likely have not visited a crematorium, though we send deceased pets to them every week … Either way, this is certainly food for thought. See you in Part 2.      https://www.youtube.com/watch?v=HzOH_Mm7hEM Public Responsibility in Medicine and Research Interview with Dr. Rollins, Oct 20, 2014.    https://www.iaopc.com/default.aspx and https://freakonomics.com/podcast/the-troubled-cremation-of-steviethe-cat-a-new-freakonomics-radio-podcast/  https://freakonomics.com/podcast/the-troubled-cremation-of-stevie-the-cat-a-new-freakonomics-radiopodcast/ (Dubner, 2013)  

We have a rich and colorful history with our companion animals. They bring so much to our lives. That said, the majority of us are unfortunately sure to outlive our furry companions. Once they do pass on, how do we treat them in this next stage? Can we commemorate them and all the joy they have brought us adequately? What does history tell us about our special human-animal bond, how have we treated our deceased pets in the past, and how can the veterinary industry help? 
 The loss of an animal companion is as heartbreaking as the loss of a family member. They are our family. They bring us so much positivity and joy it’s hard to articulate in words, this special human-animal bond. Our experience with our pets is very tactile in nature, and this missing touch is often the first thing that is noticed when they depart. There is countless information on just how much impact our pets have on our emotional well-being; tactile sensing being one of the top factors in how our pets influence us. We know that humans have an innate need for touch. There have been studies that show human babies have extreme developmental delays if they are deprived of touch in the first few weeks of life . Touch is not only vital in our development, it also builds trust as well as reduces our stress and increases our overall immune response. Our pets help us here. More than we often realize.    Our companions help to keep us social: playing and bonding with animals increases our levels of serotonin and dopamine, the feel-good neurotransmitters in our brains. We’ve heard countless times they help stave off depression. They are great companions for those living alone. Sometimes we can’t help but to smile by simply looking at them. We get to know them and their habits very well. I know my cat likes to eat his portion of pate before his crunchy meal. I know he likes to bathe in one particular area in the house, the spot with the best sunlight. I know he likes this one particular chair to sleep on after bathing, provided he has his blanket to perform the infamous ‘happy paws’ (i.e., kneading). We are all so intimately familiar with our routines as a human-animal family, and these are just a few of many ways our fur family helps us.   There is something deeper than simply making us feel good. They are part of our tribe. We know them well, and we would do anything for them.   Interestingly, our culture is beginning to adapt to the research and incorporate animal therapy into a variety of practices from hospitals and schools to rehabilitation centers. There is a non-profit group called Gabriel’s Angels that introduces pets to help abused and neglected children and they believe animals will help them develop trust, learn empathy skills, respect, and other life skills that are important for children to learn.   They do so much for us. They are such an integral part to our lives. Their unconditional love is so genuine that when it is their time to depart, our grief matches the love they brought to us. Often, we are surprised by this feeling. The question is, how can we pay respects, mourn them, and do them justice for their departure? Do we have any precedents on which to guide us in this next step? This gets interesting ... As early as the ancient Egyptians, archaeologists have found enormous evidence that not only were animals treated well, there were harsh punishments for those that disrespected animals. Egyptians believed that animals were a major source of physical and spiritual survival. Often, pets who have passed were mummified and placed next to their human companions to be together in the afterlife. Almost all pets were mummified at this time.   In other areas of the world, archeologists have discovered pet burial sites that date back as early as 14,000 years! There is a very large gravesite in Russia that dates back to around 7,000 years ago. These people gave the same respects in the afterlife to dogs as they did to humans. “It’s my hypothesis that people really saw those particular dogs as being spiritually the same as themselves. That they were an animal with a soul, an animal with an afterlife,” says Losey, a professor at the University of Alberta, Canada who researches ancient human-dog relationships.   In another area in Egypt, some animals were not mummified but buried in a cemetery - one area having a count of 86 cats, 9 dogs, and 4 monkeys. A few had iron collars, and some animals were buried together, one gravesite containing a cat and kitten. Israel has a pet cemetery dating back about 2,500 years with an estimated 1000-1500 dogs!   Those are but a few examples of the burials and rituals dating back to the beginning of animal domestication. We have a long history of human-animal partnership, and a long history of commemorating them respectfully. There now exists several pet cemeteries as well as cremation services. There are many more unique options for pet remains and paying respects to our beloved furry companions. There are artists who can embed ashes into jewelry, there are places that will plant a tree in memory of the pet, memorial artwork can be made. Those are among some of the creative ways we have developed to pay respects to our companions.   But how are the remains transported after the last visit to the vet clinic? Unfortunately, in most cases they are transported in a garbage bag. Yes, a garbage bag. It’s quite unsightly, and certainly something one would never presume given how much history we have and how much our animals do for us.   Dr. Celine Leheurteux, a practicing veterinarian, saw this a huge gap between what the pet owner sees and what actually happens, and decided to make a change. Something that has surprisingly not been done in the veterinary community until now. She has created a pet body bag called Euthabag that will allow the appropriate and respectful transfer of remains from clinic or home to their ultimate destination, be it a burial or cremation. The bag is eco-friendly and contains no harsh chemicals that emit to the environment. But importantly, it is a symbol. It’s a symbol of our respect. If the ancient Egyptians and other very old cultures around the world treated remains with high regard, it would do our evolved and contemporary culture well to have our beloved companions depart with dignity. We can give them this respect, since they indeed give us so much.    Another wonderful service she offers is help with grieving our animals and how to adapt to this new loss. The Euthabag website provides practical advice, information, counselling, and information about why the bag is so relevant to us and our furry family.   Let’s pave the way for better treatment of our companions. After all, they really are our guardian angels.