Euthanasia | 227 capital punishment in the United States) The AVMA guidelines strongly discourage the use of neuromuscular blocking agents that paralyze respiration, except in some defined emergency situations Critics of human capital punishment by lethal injection have sought guidance from the AVMA guidelines, arguing that if the risk of pain and distress with these drugs is too great for animal use, it is too great for human use as well Some forms of lethal injection that have been used on humans would not meet the AVMA’s standards if performed on nonhumans Making the Euthanasia Decision One of the hardest decisions for an animal’s guardian is when and whether to euthanize an ill or aging animal How can we know when it is the right time? This author believes there is no such thing as the right time, given the range of factors at play The euthanasia decision is only partly a medical decision, but it should certainly be made with a veterinarian’s input The veterinarian can his or her best to provide a medical diagnosis of the animal’s condition But even a diagnosis of an incurable illness does not mean immediate euthanasia is warranted A combination of good medical and nursing care may keep animals with certain terminal illnesses comfortable for months or years Conversely, a diagnosis of some treatable injuries and illnesses may still result in the animal’s euthanasia This may be because of the cost of the treatments, since insurance coverage for payment of veterinary bills is not common, the time demands of some treatments, or the significant suffering that an animal would likely go through before starting to feel better Veterinarians can help animal guardians predict what the animal will experience with a particular illness Not all heart diseases, for instance, are equal Some heart disease may result in sudden death, some in decreased exercise tolerance, some in a distressful inability to breathe comfortably From the animal’s perspective, these are three very different heart conditions Sudden death is sad, but the animal does not suffer in the months leading up to it Decreased exercise tolerance means the animal will run and play less, but may be content to limit his or her activities without significant suffering The inability to breathe comfortably, however, may be severely distressing for weeks or months on end A veterinarian can help the guardian understand not just whether the condition is treatable, but how much suffering it causes As with heart disease, so with other life-limiting illnesses Some cancers may be excruciatingly painful, while others are barely noticed until they are very advanced Kidney disease can make animals feel extremely ill, but with dietary management and supplemental fluids, they may remain in relatively good health for several months There will be medical uncertainty Veterinarians can give parameters for how the average case progresses, but not how an individual patient will People want to know, “Is this animal suffering?” Like human patients, animals have better and worse days Veterinarians can help the caregiver learn how to recognize the major signs of an animal’s quality of life: interest in food, ability to eat and drink, the ability to move about or to sleep comfortably None are particularly mysterious, but they require careful observation