Grief during decision-making can occur at any level. Decision-making about treatment or euthanasia might occur acutely (trauma, toxicity or acute illness), during surgery (an exploratory for vomiting revealing metastatic neoplasia), or following a failure of treatment for a pre-existing problem (eg CHF). Some owners do not feel grief at the diagnosis, but show classic signs during the decision making process. Bargaining (as above) may occur; ‘will you promise me he will get better if I do the chemotherapy’ or ‘Fluffy if you get better I will walk you every day’, as may guilt and anger, at themselves, and at the veterinary staff for ‘forcing’ a decision. This can be particularly evident when an animal is under anaesthesia, and a decision is required ‘on the spot’.  Blame and pain can be focussed on the vet team involved. Bargaining might also take the following form: ‘If we let her wake up, can she come home to die if we give her lots of drugs?’ Sorrow and acceptance are self explanatory. All of these stages may occur in the space of one phone call. But remember that the stages will likely be felt again, upon actual loss of the pet. Decision-making creates grief in anticipation of the loss, and grief at having to be the one to choose.

Grief at the actual time of death can manifest variably depending on the cause of death, the suddenness and the role of the owner in that loss. A sudden death from a chronic illness may be a shock to an owner in the short term, but because they have ‘known it was coming’, they may move very swiftly into sadness without showing any signs of the earlier phases. Likewise, with some owners, even with ample time and warning of the imminence of death, the actual passing may plunge them into despair, and have them display anger and bargaining (’come back, don’t leave me, I promise to look after you better’).