Euthanasia in Animals and Humans: Distinctions to Consider

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COMMENTARY

Euthanasia is regularly practiced on animals in veterinary medicine. In fact, the American Veterinary Medicine Association (AVMA) states that euthanasia may be warranted in situations where a pet is “vicious, dangerous, or unmanageable.”¹ More commonly, euthanasia in animals has generally been used to relieve animal “pain and suffering.”² Quite frankly, euthanasia in animals is not much of a debated topic. The human euthanasia and physician-assisted suicide debate, on the other hand, is growing worldwide.

Two recently published articles provide an example of the recent human euthanasia debate. In 2024, Fowler et al conclude, “Inflicting death by any means is not professional or proper and is not trustworthy medicine.”³ In contrast Scopetti et al wrote in 2023 that there are cases where euthanasia is “probably mandatory.”⁴

The authors of this article have frequently heard discussion regarding animal euthanasia versus human euthanasia and physician-assisted suicide. A commonquestion is, “If we allow euthanasia for animals, why not for humans?” This article’s purpose is to outline certain distinctions between humans and animals relating to the debate on euthanasia. Such distinctions should be the basis for any discussion comparing the practice of euthanasia in humans versus animals.

Case Example

“Helen,” a 59-year-old widowed female patient with chronic depression feels that her symptoms have not satisfactorily improved over 5 years of psychiatric treatment. She has concluded that her suffering is unbearable and she is done trying different treatments. Helen wants to go to the Dignitas Clinic in Switzerland, which accepts people with psychiatric disorders from abroad for physician-assisted suicide, if they are cleared by a psychiatrist for meeting the criteria in their home country. Helen approaches her psychiatrist with this request arguing, “We allow our pets to be euthanized when they are suffering unbearably, I should be afforded the same compassion and dignity.” In fact, that was the argument which convinced her family to support her in this request.

The Hierarchy of Life Value

Humans and animals are not equivalent, though both deserve respect, and of course, both suffer. The inherent disjunction in the value of these lives is demonstrated throughout all societies and civilizations in which the penalty and consequences for taking the life of a human are dire, whereas the consequences for taking the life of an animal, if any, are at the level of property disruption. So, if someone kills your beloved child, society recognizes a different order of magnitude in ethical significance and legal consequence than if your beloved dog is killed—either deliberately or accidentally. This contrasting sanctity of life of humans and animals is universal and archetypal, both ancient and contemporary, inherent in religious and secular law. It is arguably one of the most enduring and widespread ethical distinctions in Western civilization’s history. Though the death of a loved pet is very sad, sometimes profoundly so, the loss of a loved human is tragic.

The Importance of Sentience

Just as there is a spectrum of value in mere life itself, there is also a spectrum in sentience. Western religious and secular paradigms have long held that the value of human sentience exceeds that of other lifeforms. Aristotle noted that, unlike plants and animals, human sentience is the only form that comes with responsibility.⁵ Accumulated experience, knowledge, and meaning is also part of sentience and creates a hierarchy of difference between people and animals.⁶ This argument is the starting point of distinguishing between abortion of a human fetus versus physician-assisted suicide and euthanasia, which is beyond the scope of this article. However, this idea highlights why euthanasia and physician-assisted suicide of patients for psychiatric illnesses may particularly be ethically problematic.

The Difference Between the Doctor/Human Relationship and Veterinarian/Animal Relationship

Physicians are human beings treating human beings. Therefore, though the doctor-patient relationship is analogous to the relationship between vet and animal, it is not identical nor comparable. The long and venerable history of medical ethics is built around the therapeutic encounter of human equals in the therapeutic relationship. In this way, empathy, identification, expectation, and agency are quite different in the treatment relationship with human patients compared with animal patients. We can have empathy for other human beings through the shared experience of human lives. At best, we can have sympathy for animals. That is a particularly important difference. Treating patients is a human endeavor; treating animals is a humane endeavor.

Humans Are Capable of Creating Elaborate and Sophisticated Meaning

Physicians can minister to suffering patients not just with somatic interventions and medicaments, but also invoking meaning, symbolism, interpretation, reflection on relationships, contemplation of the past and the future, and the consequences of their suffering or dying on others. Karl Jaspers distinguished the tool of vershtehen or “understanding” in clinical medicine that is only possible due to the domain of human mental life.”⁷

“This mode of evaluation [vershtehen] is that of empathy; of perceiving the meaning of psychic connections and the emergence of one psychic phenomenon from another... This method of understanding is only possible with psychic events. In this way we can be said to understand the anger of someone attacked, the jealousy of the man made cuckold, the acts and decisions that spring from motive...the understanding of psychic events seen from within.”⁸

Human medicine can deploy vershtehen, whereas veterinary medicine is confined to compassion and sympathy. The tool kit to address suffering is vastly more elaborate for treating humans than for treating animals. Even if human patients are unconscious or comatose, their world of meaning can be deeply conjured via loved ones, biographical information, and so on. This ability to connect meaningfully, and to imagine the mind of another, enables palliative care to be deployed for suffering humans in a far more elaborate and effective way than for animals. With humans, palliative clinicians have various ways of ascertaining the patient’s values; For example, the value of continuing life in the context of a terminal illness versus valuing an escape from anticipated or actual suffering. Spiritual and religious beliefs can be explored. Clearly, we cannot gain access to our pets’ “values” because—presumably—they are not creatures that embody or espouse values. We cannot have a dialogue with our dying golden retriever regarding how much he wants to live.

Awareness of the Dual Nature of Medicine's Power to Heal and Harm

The staff of Asklepius is a double snake, signifying the power of Medicine to either heal or harm. Humans are cognizant of both potentials in health care in a way that animals are not (indeed veterinary clinicians often observe that the first instinct of the animal in the clinic is to expect harm). Preserving the zone of safety that patients expect in medicine by removing the power to deliberately kill from the treatment space, produces an opportunity for the most comfortable deployment of vulnerability by a sick patient and the responsive compassion of a physician. Doctors producing death (not merely getting out of the way of death) has profound implications for the human healing profession.⁹ Animals do not need to know that the doctor will not kill them. Human beings do. Unlike humans, an animal’s trust and willingness to be vulnerable to the healer will not be affected by knowing that there is killing and healing in the same practice. Indeed, the Asklepion of Hippocrates was distinguished as the only one in Ancient Greece where euthanasia was not practiced¹⁰ and its adherents even swore an oath to that effect: “I will give no man a poison, nor advise anyone how to do so.”¹¹ This is the Hippocratic root of the mighty tree of medicine that grew over the next 2 millennia; It is an aboriginal ethos that suffuses its history and is a throughline as societies and nations have come and gone.

The Problem of Suicide

There is no clearly recognized animal suicide because of their lesser sentience and a minimal existential awareness regarding death (beyond awareness of an immediate threat). But there is human suicide and the medical profession, psychiatry in particular, is charged with attending to that pathology, preventing the behavior, and mitigating the intention. To that end, creating a zone of acceptable suicide (by renaming the act as something other than suicide, like “aid in dying”) grossly interferes with that effort. This effect is on both the level of the individual and public health. Confusing the cultural taboo against suicide is a serious concern when aiding and abetting suicide through medically assisted means. There is no such impact in veterinary euthanasia. In the human clinic, to allow acceptable and unacceptable forms of suicide to coexist within the same profession is like trying to perform surgery without a sterile field; it really interferes with the therapeutic activity, while also creating deep moral confusion. Veterinarians are not analogously at risk of this message confusion for their patients by offering euthanasia.

Psychosocial Considerations

The reasons why human beings choose euthanasia and physician-assisted suicide are extraordinarily complex.¹² There are many psychosocial factors underlying human suffering and the desire to end that suffering by death. The option of physician-assisted suicide and euthanasia short circuits many of the potential fortifications, ministrations, and solutions that we owe one another as reflective social creatures. The impact of euthanasia on the social ethos of the "common good," is broad and deep. In Canada, individuals are driven to physician-assisted suicide because of psychosocial deprivations—poverty and lack of access to prompt or expensive care. Societies can be let off the hook of solving problems like inequity and other values of the social contract, by permitting human beings to choose euthanasia rather than fixing social injustice and inequity. Euthanizing animals has negligible impact on the social contract that humans understand and expect of one another.

The Slippery Slope

The inevitable slippery slopes that we actually see in the living laboratories where human euthanasia and assisted suicide are practiced, show how the criteria for eligibility over time loosen.¹³ As examples—progressing to euthanasia from the terminal to the non-terminally disabled, telegraphing that some lives are not worth living. Or, as is being proposed in the Netherlands, progressing to euthanasia for those just "tired of living” or who cannot get the care they need.¹⁴ Or, speaking sweetly of the virtue opportunity of organ donation by euthanasia to make the lives of others worth living.¹⁵ Or the impetus to save health care costs (for the state, for the family) by offering the option of euthanasia. In a human euthanasia regime, choosing to be killed by your doctor can become the virtuous choice, for your family or society. Not choosing euthanasia, when your illness burdens loved ones and society, can start to be seen as selfish. Killing a suffering animal has never produced a comparable slippery slope.

Concluding Thoughts

We humans can bring some of the same sentiments, intentions, and postures towards animals that we have towards each other: compassion, pity, tenderness, nonmaleficence, even love. Yet, the way love and compassion justify killing in the veterinary setting, cannot be translated to the human clinic. Moreover, the state of the art of palliative care (often underutilized and underfunded¹⁶) gives us markedly effective tools for mitigating suffering and can even help to find meaning in suffering for ill or dying individuals. The focus on accompanying a single patient in human medicine has profound meaning and consequences for other patients who are in line for healing, and for the way societies treat the ill, disabled, vulnerable, and unfortunate. The presence of assisted suicide and euthanasia in the house of medicine creates ethical, clinical, and societal perils that are profoundly different than deploying these procedures in the veterinary clinic.

Dr Komrad is a psychiatrist on the teaching staff of Johns Hopkins Hospital in Baltimore, Maryland. He is also a clinical assistant professor of psychiatry at the University of Maryland in Baltimore and on the teaching faculty of psychiatry at Tulane University in New Orleans, Louisiana. Dr Glass is a provider at Northeast Georgia Medical Center, Northeast Georgia Health System. He is also a clinical associate professor at the Medical College of Georgia, Augusta University, and University of Georgia Medical Partnership.

Acknowledgements: Thanks to Drs Ronald Pies and Christopher Dreisbach for reviewing the manuscript and providing valuable feedback.

References

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