The Weight of the Needle

How repeated euthanasia affects the mental health of veterinary professionals

Introduction

Euthanasia is one of the most profound acts a veterinary professional can perform. Carried out with skill and compassion, it can end suffering and offer an animal a peaceful death. Yet for the person holding the syringe, the weight of that act performed again and again across a career rarely goes unacknowledged in private, even when it goes unspoken in the consulting room.

Over a 30-year career, a veterinary professional may perform euthanasia on an estimated 2,000 animals. For many, each procedure carries emotional complexity: grief, relief, doubt, connection with a grieving family, and sometimes a quiet, unresolved question of whether it was truly the right call. This article draws on current research to explore what repeated exposure to euthanasia does to us over time and why that matters for our profession’s most serious crisis: suicide.

The Caring–Killing Paradox

Veterinary professionals enter the profession out of a love for animals and a desire to protect their wellbeing. Euthanasia creates a fundamental tension within that identity: the very person responsible for an animal’s care is also the one who ends its life. This has been described in the literature as the “caring–killing paradox,” a term originally applied to animal shelter workers, now widely used in veterinary contexts (Reeve et al., 2005).

Research examining the emotional experience of euthanasia in veterinary professionals has found that 84% report sadness, 70% frustration, 67% experience doubt about the procedure, and 59% feel guilt (Cooney and Kipperman, 2023). These are not signs of weakness — they are natural responses from compassionate professionals repeatedly asked to make or carry out life-and-death decisions.

The paradox deepens when euthanasia is perceived as avoidable: when financial constraints, owner decisions that conflict with clinical judgement, or systemic limitations mean an animal is euthanised before the clinician feels it is truly the right time. In these circumstances, the emotional toll is considerably greater.

Moral Stress, Moral Distress, and Moral Injury

These three concepts are related but meaningfully distinct.

Moral distress arises in a specific situation: when you know the ethically correct course of action but are prevented from taking it, for example, by an owner’s decision, a financial barrier, or institutional constraints. Research compiled by the AVMA identified moral stress as the top trigger for compassion fatigue in veterinarians (AVMA, 2015).

Moral injury describes lasting psychological damage from acts that transgress deeply held moral beliefs such as being compelled to euthanise an animal you believe could be saved, or being party to decisions that conflict with your professional ethics. Unlike situational distress, moral injury leaves a residue that does not resolve when the moment passes (Durham University, n.d.).

Moral stress is the chronic, systemic version: a sustained background tension from working within a profession where these ethical conflicts are not occasional but routine. Rollin (2011) identified euthanasia, particularly when it felt coerced by financial or social pressures, as one of the primary drivers of chronic moral stress in veterinary medicine, contributing to what he described as a distinctive form of occupational suffering.

Together, these forms of moral burden accumulate. What begins as situational distress can, without adequate acknowledgement or support, harden into something more pervasive, shaping how professionals feel about themselves, their work, and their future.

Compassion Fatigue and Emotional Labour

Compassion fatigue is a state of exhaustion and dysfunction resulting from prolonged exposure to the suffering of others. It is not the same as burnout, though the two often co-occur. Where burnout stems from occupational overwhelm, compassion fatigue is specifically linked to sustained empathic engagement with suffering and distress.

Research suggests that between 50% and 67% of veterinarians experience compassion fatigue at clinically significant levels, notably higher than reported rates in human medicine (Nu Noe et al., 2024). Euthanasia is a consistent predictor. Studies examining cumulative exposure have found that performing euthanasia regularly, particularly under emotionally taxing circumstances, directly predicts compassion fatigue scores.

A systematic analysis by Cooney and Kipperman (2023) found that 40% of veterinary professionals reported their mental or physical health had been negatively affected by euthanasia, and 33.7% reported that personal distress had made it difficult to perform the procedure. These are not marginal findings; they reflect a widespread, largely private struggle playing out in practices every day.

There is also the underappreciated burden of emotional labour: the professional expectation that grief and doubt are suppressed in the clinical moment. Veterinary professionals are expected to manage client distress while containing their own. Serim-Yıldız, Onaylı and Ilgın (2026) found, using a trauma-informed framework, that this repeated emotional suppression constitutes cumulative occupational strain, substantially increasing risk of burnout, depression, and psychological harm.

The Cumulative Toll: Burnout and Beyond

Repeated euthanasia does not only affect us in the moments it happens. The evidence points to a cumulative process: each procedure, each grief-laden conversation with a client, each ethical conflict adds to a professional load that, without adequate support, eventually becomes unsustainable.

Steffey et al. (2023) documented the physiological and psychological consequences of burnout in veterinary professionals, noting that sustained occupational stressors, with euthanasia among the most significant, activate chronic stress pathways that affect sleep, immune function, cognitive performance, and emotional regulation.

The development and validation of the Veterinary Stressors Questionnaire (Vet-SQ) by Mudry, Truchot and Andela (2025), a longitudinal study drawing on 3,244 respondents, confirmed that euthanasia-related strain is one of the most robustly identified occupational stressors in the profession, persisting across settings, career stages, and national contexts.

Left unaddressed, this cumulative strain creates pathways toward clinical depression, anxiety disorders, substance use, and, at the extreme, suicidal ideation and suicide.

When Death Becomes Familiar: Euthanasia and the Psychological Relationship with Suicide

One of the most clinically significant and least openly discussed questions in veterinary mental health research is whether repeated, professional exposure to euthanasia shapes how veterinary professionals relate to the idea of their own death. The evidence here is complex, contested, and important.

Acquired capability and fearlessness about death

Thomas Joiner’s influential interpersonal theory of suicide (Joiner, 2005) proposes that to move from thinking about suicide to acting on it, a person must acquire the capability to do so; specifically, a reduced fear of pain and death, built through habituation to painful or death-adjacent experiences. For veterinary professionals, who routinely administer death in a calm, controlled, professional context, this framework has clear relevance.

Witte, Correia and Angarano (2013) found that veterinary students’ experience of performing euthanasia was significantly associated with greater fearlessness about death, one of the key components of acquired capability in Joiner’s model. The more euthanasias a student had performed, the lower their measured fear of death. This was not a finding about intention or distress: it was about the psychological effect of normalised, repeated exposure to dying.

Glaesmer, Bahramsoltani, Schwerdtfeger and Spangenberg (2021) extended this to practising German veterinarians, finding that lower euthanasia distress (a marker of habituation) was significantly associated with higher fearlessness about death. Veterinarians who had become more emotionally desensitised to euthanasia were more fearless about death overall. The authors noted, however, that fearlessness about death did not itself differ significantly between veterinarians and the general population, suggesting this is a subgroup rather than a universal profession-wide effect.

Frequency of euthanasia and suicidal ideation

A key finding from the NORVET study, a nationwide cross-sectional survey of Norwegian veterinarians (Dalum et al., 2024), was that performing euthanasia five or more times per week was significantly associated with serious suicidal thoughts. This association held even when accounting for other occupational and psychological risk factors, pointing specifically to the volume of euthanasia as a meaningful variable.

Tran, Crane and Phillips (2014) similarly identified a distinct and specific role of performing euthanasia, separate from general occupational stress or depression, in predicting suicidal ideation in veterinarians. Euthanasia was not merely a proxy for distress in general: it carried independent psychological weight.

Does euthanasia change how vets think about their own death?

Perhaps the most direct question is whether veterinary professionals, through their professional experience of euthanasia as a valid, compassionate, and clinically appropriate response to suffering, come to view voluntary death differently for themselves.

Bartram and Baldwin (2010) noted in their structured review that “the veterinary profession’s role in providing animal euthanasia and so facilitating a ‘good death’, may normalise suicide, with death perceived as a rational solution to intractable problems,” one of several mechanisms proposed to explain the elevated suicide risk in the profession. The concern is not that veterinary professionals consciously decide that their own death would be equivalent to clinical euthanasia, but that repeated professional exposure to a framed, medicalised, and normalised form of death may gradually erode the psychological barriers that protect against suicidal behaviour.

The NORVET study (Dalum et al., 2024) found that 55% of surveyed veterinarians agreed that euthanasia should be permitted for humans with a fatal disease and a short life expectancy, a rate somewhat higher than general population averages. Notably, however, the frequency with which a vet performed animal euthanasia was not significantly associated with more permissive attitudes toward human assisted dying. The relationship between euthanasia and suicidal thoughts appears to operate psychologically, through habituation and fearlessness, rather than through a deliberate philosophical equivalence between animal euthanasia and human self-inflicted death.

In other words, the risk may not be that vets think “this is a good death and I deserve one too.” It may be more subtle: that repeated, normalised exposure to controlled dying gradually reduces the instinctive resistance to the idea of one’s own death — a resistance that, in most people, serves as a powerful protective factor.

A note of caution

Researchers in this area are careful to note that these findings should not pathologise routine euthanasia practice, nor suggest that all veterinarians who perform frequent euthanasia are at elevated risk. Glass (2025) has highlighted the danger of “taken-for-granted truths” in veterinary suicide research — narratives that become accepted without sufficient evidence to support them. The field is still developing robust, standardised measurement tools, and causal claims remain premature.

What the evidence does suggest, with increasing clarity, is that the combination of professional familiarity with death, chronic moral burden, emotional suppression, and access to lethal means creates a risk profile that is specific to veterinary professionals — and one that warrants serious, targeted attention.

Suicide in the Veterinary Profession: The Data

The statistics are stark and they demand our attention.

A landmark 2018 CDC study found that female veterinarians were 3.5 times more likely and male veterinarians were 2.1 times more likely to die by suicide than members of the general population (CDC, 2018).

A CDC NIOSH bulletin further found that veterinary technicians face rates 5.0 times higher (men) and 2.3 times higher (women) than the general population (CDC NIOSH, 2019) — confirming that the crisis extends well beyond those with a degree.

Tomasi et al. (2019) analysed US veterinarian suicides from 1979 to 2015 in the Journal of the American Veterinary Medical Association, finding that veterinarians were 5.5 times as likely to have suicidal ideation compared to the general population, with 17–25% reporting having considered suicide, and in some study populations 17.3% having done so within the past 12 months.

A 2025 cross-national study spanning multiple European countries confirmed elevated psychological distress and suicidal ideation across different veterinary institutions, indicating “a worrying pattern of emotional distress in the veterinary field.”

The Role of Access to Lethal Means

One factor that makes this crisis particularly acute is access to the pharmacological agents used in euthanasia. Platt, Hawton, Simkin and colleagues (2012), in a systematic review that remains one of the most cited analyses in this field, found that 37% of suicide deaths among veterinarians involved pharmaceutical poisoning, a rate 2.5 times higher than in the general population. Crucially, the same research found that if pentobarbital-associated suicides were excluded from the data, veterinarian suicide rates would approach those of the general population. This is a finding with major implications for any discussion of means restriction.

Rymaszewska et al. (2026) explored this further using network analysis, finding that the combination of chronic moral stress and proximity to euthanasia drugs creates a distinctly elevated risk pathway. Access to means does not cause suicide, but in the presence of other risk factors it dramatically increases the lethality of any attempt.

What Can We Do?

The same body of research that documents this crisis also points toward what helps.

Acknowledge rather than normalise

The culture in many practices is to treat euthanasia as “just part of the job,” a coping strategy that, over time, can prevent genuine processing and compound the psychological burden. Creating space, however briefly, to acknowledge the emotional weight of difficult cases and complex euthanasias matters.

Seek and offer peer support

Veterinary professionals are notably reluctant to seek help, partly due to stigma, partly due to an entrenched culture of stoicism. Peer support schemes, such as those run by Not One More Vet (NOMV), provide meaningful connection without the barrier of a formal clinical pathway.

Recognise compassion fatigue as an occupational injury

Serim-Yıldız et al. (2026) situate compassion fatigue explicitly within a trauma-informed framework, an occupational injury arising from systemic exposure to emotionally demanding work. Framing it this way shifts the responsibility from the individual to the system, and opens the door to institutional responses.

Know where to turn

If you are struggling, please reach out. The following offer confidential support for veterinary professionals:

Not One More Vet (NOMV) — peer support network for the global veterinary community

Vetlife Health Support (UK) — free, confidential mental health support for all those in the UK veterinary community

AVMA Wellbeing Resources — wellbeing resources from the American Veterinary Medical Association

A Final Word

If you have read this far, it is likely because some part of this resonates with your own experience. That experience is valid, and it is shared, not by a few at the edges of the profession, but by the majority of people who chose this work because they cared.

The weight of the needle is real. The research now confirms what many have felt privately for years: that performing euthanasia leaves a mark, that the mark accumulates, and that left unacknowledged it can become dangerous. Acknowledging that weight rather than carrying it in silence is not weakness. It is, in fact, the beginning of resilience.

If you are in crisis or having thoughts of suicide, please do not wait. Speak to a trusted colleague, your GP, or a crisis line. You matter far beyond what you are able to do for your patients.

References

AVMA (2015) ‘Moral stress the top trigger in veterinarians’ compassion fatigue’, JAVMA News. Available at: avma.org (Accessed: 12 July 2026).

Bartram, D.J. and Baldwin, D.S. (2010) ‘Veterinary surgeons and suicide: a structured review of possible influences on increased risk’, Veterinary Record, 166(13), pp. 388–397.

CDC (2018) New Study Finds Higher than Expected Number of Suicide Deaths among U.S. Veterinarians. Available at: archive.cdc.gov (Accessed: 12 July 2026).

CDC NIOSH (2019) Suicide Risk for Veterinarians and Veterinary Technicians. Available at: cdc.gov/niosh (Accessed: 12 July 2026).

Cooney, K. and Kipperman, B. (2023) ‘Ethical and practical considerations associated with companion animal euthanasia’, Animals, 13(3), p. 430. doi: 10.3390/ani13030430.

Dalum, H.S., Tyssen, R., Moum, T. et al. (2024) ‘Euthanasia of animals — association with veterinarians’ suicidal thoughts and attitudes towards assisted dying in humans: a nationwide cross-sectional survey (the NORVET study)’, BMC Psychiatry, 24, p. 2. doi: 10.1186/s12888–023–05402–7.

Durham University (n.d.) Moral Injury in Veterinary Professions. Available at: durham.ac.uk (Accessed: 12 July 2026).

Glaesmer, H., Bahramsoltani, M., Schwerdtfeger, K. and Spangenberg, L. (2021) ‘Euthanasia distress and fearlessness about death in German veterinarians’, Crisis, 42(1), pp. 71–77. doi: 10.1027/0227–5910/a000689.

Glass, J. (2025) ‘Moving away from “taken-for-granted truths” in veterinary suicide research’, Suicidal Behaviour Research Laboratory blog. Available at: suicideresearch.info (Accessed: 12 July 2026).

Joiner, T.E. (2005) Why People Die by Suicide. Cambridge, MA: Harvard University Press.

Mudry, A., Truchot, D. and Andela, M. (2025) ‘Development and longitudinal validation of the Veterinary Stressors Questionnaire’, Scientific Reports. doi: 10.1038/s41598–025–05965–3.

Nu Noe, M.T., Baysal, Y., Masserey, A., Hartnack, S. and Guseva Canu, I. (2024) ‘Measurement of compassion fatigue in animal health care professionals: a systematic review of available instruments and their content validity’, Frontiers in Veterinary Science, 11, p. 1425741. doi: 10.3389/fvets.2024.1425741.

Platt, B., Hawton, K., Simkin, S. et al. (2012) ‘Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review’, Social Psychiatry and Psychiatric Epidemiology, 47(2), pp. 223–240. doi: 10.1007/s00127–010–0328–6.

Reeve, C.L., Rogelberg, S.G., Spitzmüller, C. and di Norcia, V. (2005) ‘The caring–killing paradox: euthanasia-related strain among animal-shelter workers’, Journal of Applied Social Psychology, 35(1), pp. 119–143.

Rollin, B.E. (2011) ‘Euthanasia, moral stress, and chronic illness in veterinary medicine’, Veterinary Clinics of North America: Small Animal Practice, 41(3), pp. 651–659.

Rymaszewska, J., Fila-Pawłowska, K., Szcześniak, D., Hildebrand, W., Pawłowska, E. and Magdziarz, M. (2026) ‘Is access to euthanasia drugs and moral stress linked to suicide rates in veterinarians? A cross-sectional national survey and network analysis’, Frontiers in Psychiatry, 17. doi: 10.3389/fpsyt.2026.1795845.

Serim-Yıldız, B., Onaylı, S. and Ilgın, H.E. (2026) ‘Trauma-informed veterinary practice: linking emotional labor, moral distress, and occupational well-being’, Frontiers in Veterinary Science. doi: 10.3389/fvets.2026.1746939.

Steffey, M.A., Griffon, D.J., Risselada, M., Buote, N.J., Scharf, V.F., Zamprogno, H. and Winter, A.L. (2023) ‘A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors’, Frontiers in Veterinary Science. doi: 10.3389/fvets.2023.1184525.

Tomasi, S.E., Fechter-Leggett, E.D., Edwards, N.T., Reddish, A.D., Crosby, A.E. and Nett, R.J. (2019) ‘Suicide among veterinarians in the United States from 1979 through 2015’, Journal of the American Veterinary Medical Association, 254(1), pp. 104–112. doi: 10.2460/javma.254.1.104.

Tran, L., Crane, M.F. and Phillips, J.K. (2014) ‘The distinct role of performing euthanasia on depression and suicide in veterinarians’, Journal of Occupational Health Psychology, 19(2), pp. 123–132. doi: 10.1037/a0035837.

Witte, T.K., Correia, C.J. and Angarano, D. (2013) ‘Experience with euthanasia is associated with fearlessness about death in veterinary students’, Suicide and Life-Threatening Behavior, 43(2), pp. 125–138. doi: 10.1111/sltb.12000.