Project Work of the 17th Edition of the Master’s Program in Applied Narrative Medicine by Laura Sinigoi
Within the caring professions, there remains even today a shadowed area that rarely finds space in public or scientific discourse: the suffering of the caregiver. In veterinary medicine, this dimension emerges with particular intensity in end-of-life procedures, where the clinical act of euthanasia is configured not only as a technical intervention, but as a relational, ethical, and existential experience. Narratives collected from veterinary professionals during the development of the project work for the Master’s degree in Applied Narrative Health and Medicine reveal a complex picture in which compassion fatigue, burnout, and moral injury intertwine, outlining a silent crisis that deeply questions the very meaning of caregiving.
This crisis finds particularly alarming confirmation in official epidemiological data. The veterinary profession shows a significantly higher suicide rate compared to the general population and other healthcare professions: the risk is up to four times higher and about double that of physicians and dentists. European data indicate that the risk is already elevated during university training, with approximately one in five students having contemplated suicide.
Alongside these data, there is a widespread picture of psychological distress: about 9% of veterinarians experience severe mental health issues, 31% have experienced depressive episodes, and up to 17–21% report suicidal thoughts during their professional life. These figures cannot be considered marginal; rather, they represent the most extreme expression of a structural malaise rooted in continuous exposure to suffering, compassion fatigue, grief management, and the ethical conflicts that daily permeate clinical practice.
Compassion fatigue manifests as a progressive emotional exhaustion resulting from constant exposure to the suffering of others. In the veterinary context, it takes on a unique form: the professional is simultaneously managing the pain of the animal and that of the human caregiver, within a triadic dynamic that amplifies the empathic burden. The collected testimonies highlight how the veterinarian is never merely the executor of a procedure, but an emotional mediator, a guide, and often a container for others’ grief.
In this scenario, language becomes a privileged indicator of internal experience. On one hand, a technical register emerges, composed of clinical terminology and codified procedures, functioning as a protective barrier. On the other, when this barrier cracks, powerful metaphors surface: the veterinarian is described as an “angel,” a “ferryman,” sometimes even an “executioner.” This oscillation between the symbolic and the factual is not incidental but reflects an attempt to make sense of an act that challenges traditional medical categories.
Burnout represents the more structured evolution of this exhaustion. It is not merely fatigue, but a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. In the narratives analyzed, it manifests through automatism: the professional describes themselves as an “automaton,” capable of performing the procedure perfectly, yet progressively disconnected from their own feelings. This detachment, initially functional for emotional survival, risks over time transforming into a loss of meaning and disengagement from work.
Even deeper is the dimension of moral injury, the “moral wound” that occurs when professionals perceive a fracture between their ethical values and the actions they are required to perform. In veterinary end-of-life care, this fracture emerges when faced with requests for euthanasia lacking clinical necessity. Italian legislation does not allow euthanasia for purely managerial reasons: an animal’s old age, the increased time required for its care, or a burdensome daily routine are not legitimate medical indications to end a life. In such cases, the veterinarian finds themselves trapped between regulatory rigor, the client’s wishes, and their own ethical sense. Questioning the legitimacy of ending a life that is no longer “desired” by the human opens a space of crisis that can leave deep marks; the professional feels pushed toward a boundary that challenges their identity as a caregiver.
A crucial element emerging from the narratives is the centrality of the relationship with the caregiver. Paradoxically, the veterinarian’s emotional focus often shifts more toward the human than the animal. The caregiver’s grief becomes an amplifying mirror in which the professional reflects and empathizes. This intersubjectivity, while foundational to authentic care, also represents one of the main risk factors for compassion fatigue. The veterinarian does not merely witness pain but absorbs it, moves through it, and sometimes retains it.
Further exacerbating this condition is what can be defined as “slow violence,” a slow and invisible form of violence operating at a structural level. Work rhythms often impose a rapid transition from one euthanasia to the next appointment: “take a breath and move on” becomes an implicit norm. This denied time for processing prevents the transformation of experience into meaning, instead fostering the accumulation of emotional residue.
Isolation represents another aggravating factor. Death, despite being intrinsic to veterinary practice, remains a taboo even within professional communities. There is a lack of structured spaces for sharing, moments of collective reflection, and training tools dedicated to managing emotional experiences. The result is a professional loneliness that amplifies the risk of burnout and, in the most extreme cases, tragic outcomes such as suicide.
In this context, narrative medicine emerges as a possible path for transformation. Through the collection and sharing of stories, it allows voice to be given to what often remains unspoken, fostering processes of awareness and elaboration. Narration is not merely a descriptive tool but a therapeutic device: it enables the integration of experience, the recognition of emotions, and the reconstruction of a sense of internal coherence.
Narrative classifications, such as those proposed by Launer and Robinson or by Michael Bury, offer further interpretative frameworks. “Progressive” narratives show how some professionals manage to transform pain into growth, reinterpreting euthanasia as an act of compassion. “Stable” narratives highlight a precarious balance, while “regressive” ones signal a loss of meaning and a high risk of burnout.
Integrating narrative medicine into training pathways and clinical practice represents a fundamental step. It means recognizing that technical competence, while essential, is not sufficient. It is also necessary to develop narrative and emotional competence capable of supporting professionals in moments of greatest vulnerability.
Ultimately, speaking about compassion fatigue, burnout, and moral injury in veterinary medicine means questioning the human cost of care. It means recognizing that behind every clinical act there is a story, and that caregivers themselves also need to be heard. Giving space to these narratives is not only an act of justice toward professionals, but an essential condition for a more conscious, sustainable, and authentically humane veterinary medicine.