One of the most difficult decisions to make is when it is time to put a beloved pet to sleep as they reach the end stages of their life with you. As upsetting as the loss of your pet may be, sometimes the complication and stress of having to make the decision of when to euthanize can be even more distressing. The decision is much easier to make with a sudden unexpected decline in the pet’s wellbeing, but if they develop a more chronic illness, then you should consider the question of when and how sooner in the process rather than later. It can help to have preset in your mind the boundaries that your pet can be expected to endure.

Briefly, the purpose of this article is not to discuss ‘hospice’ care for pets. There are a great many options for handling the nursing care, medication, nutritional needs, mobility and pain management options for elderly and ill pets. With so many care choices available now, simply allowing them to suffer to death in ‘benign’ neglect is never a reasonable or humane option any longer. We as their caretakers need to do everything possible to keep them comfortable and well cared for until such time as we lose them. The scope of this current article is purely how to evaluate their quality of life properly

There is nothing easy about having to make the decision about bringing your beloved pet’s life to an end, but, though we may wish otherwise, they cannot live forever. We as their caretakers can make a rational, thoughtful choice on how much they will or will not have to suffer through until that end. It is a very difficult choice, but they have relied on us their entire lives to make decisions regarding their welfare and care, and this is no different or less important to them.

First, be sure that you properly educate yourself on what to expect with the progression of your pet’s disease or terminal condition. Ask questions of your veterinarian as to what to expect in the course of disease, what signs and symptoms you can expect to see, what signs and symptoms you can expect to alleviate with medication, what side effects you can expect from medication, etc.

The answer as to when to euthanize a pet is often one only the owner can answer best because it can be a combination of factors that contribute to the ‘quality of life’ overall. Sometimes there are set points that are red flag moments – they no longer enjoy their most favorite activity, or they no longer will eat, or they can no longer get up and down on their own when they are a large dog. Other times you will need to evaluate their situation overall and decide when the bad days are consistently outweighing the good ones.

Factors to Consider When Gauging Your Pet’s Quality of Life:

Pain

This can ruin a pet’s quality of life all alone if not managed properly or if the condition progresses to the point that the pain simply cannot be controlled. However, we have to be able to recognize that pain exists in order to attempt to control it. First, if you are not sure, then bring them in so that we can assess them fully and advise you as to the level of pain and our ability to control it or not.

Unfortunately, dogs and cats do not always vocalize or show obvious signs when they are in pain. Signs of pain externally on the body or limbs are:

• Limping
• Shifting weight off a limb consistently while standing (just barely leaving a toe touching the ground for balance)
• Turning to look at you, yelping, or biting when an area is palpated or manipulated
• Panting  and trembling
• Pacing and reluctant to settle and rest as if cannot get comfortable
• Stiffening or bracing against your attempts to manipulate or palpate an area. If their belly is uncomfortable then often when you try and feel or palpate it they will stiffen their belly muscles tight against your hands

If you are unsure if the response you see is pain then check again and see if the response is repeatable. You can also check their heart rate before and after testing an area for pain, if the heart rate is higher after you palpate an area then likely it was painful for the animal. In cats especially it can be difficult to assess pain as often they simply withdraw from their usual activities and do not choose to move if it can be avoided.

If pain cannot be controlled adequately, so that your pet can be comfortable then this factor alone may be the one that determines the lack of quality of life that signals it is time for a decision to be made. Pain is the most often thought of factor, but absence of pain alone
does not necessarily imply a good quality of life.

Breathing

Not being able to breathe ranks extremely high on the pain scale for humans actually. Few things upset an animal more than being unable to breathe properly. Evaluate them for labored breathing if they have a condition that may be affecting their heart or lungs. They should not be struggling or making obvious effort to pull a breath in. Do they seem generally tired, easily fatigued, or low on energy? Does the slightest exertion seem to take them a long time to settle down and catch their breath? Are they coughing constantly or uncontrollably? Trouble breathing can easily outweigh all other concerns just as easily as severe pain.

Appetite and Body Weight

Is your pet consistently eating? Can they maintain adequate body weight? Are they constantly nauseated or vomiting? There are numerous things to try depending on the cause of the loss of appetite or weight loss, but if your pet is no longer eating consistently and/or continuously losing weight despite a normal appetite, then this factor must be considered as an important quality of life factor as well. Slowly wasting away due to malnutrition and hunger are not pleasant things to endure.

Hydration

Sometimes illness and mobility issues can keep your pet from being able to maintain a normal hydration status. Serious dehydration can result in nausea, weakness, lethargy, and lack of appetite, even progressing to organ failure and death. Certainly, there are numerous ways to supplement hydration and correct dehydration, but if your pet routinely becomes dehydrated and you are not able to provide enough fluid supplement to them, then this is a serious negative quality of life issue.

Grooming and Elimination

Animals do not like to lay in their own urine and feces any more than we do. Being unable to control bodily functions due to illness or mobility compounded with being unable to move themselves away from their own eliminations can be extremely distressing to some animals. Your own stress levels as well as your ability to handle the cleaning and nursing needs of the ill pet must also be considered. If you are not able to keep them brushed, clean, dry, and rotated if they are lacking that level of mobility then bedsores and infection will quickly drag down their quality of life even further.

Mobility

Can your pet get up and down without assistance? Can they walk without assistance or do they stumble and fall? Can they get to and from food and water on their own without assistance? Mobility issues are often very relative to the size of the dog. There is a world of difference in caring for a large dog that is unable to move on its own versus caring for a small dog or cat that is easily moved from one place to another. Each animal is an individual regarding how important its mobility is to its overall quality of life. If the dog lives to play ball and can no longer get up, well that may be a defining moment versus for a small lap dog that seldom ever left its owner’s arms when it was still mobile.

Behavior and Enjoyment

Has your pet’s behavior changed significantly? Does it still express interest and enjoyment in the people and things surrounding it? Are they responsive to their usual positive stimuli like toys, other pets, treats? Has it become unusually irritable about being disturbed or touched? Changes in your pet’s normal daily routines are almost always significant and may indicate an unaddressed problem with one of the other factors discussed above. Are they bright-eyed and attentive when awake or have they become dull, reluctant to pay any attention to anything around them and barely responsive to routine interaction? If their days have lost any ‘happy’ defining moments, then this is a significant negative quality of life factor.

Summary

There are always fluctuations in the days of an aged or chronically ill pet, some good and some worse than others. It is important to keep the overall picture in mind. Are there still many more good than bad? Or is the scale tipping toward more bad than good? Bad days are filled with all the unpleasant things – pain, vomiting, nausea, difficulty breathing, diarrhea, frustration, falling down, seizures, etc. When the majority of your pet’s days are no longer good then that is an important quality of life consideration.

All these factors are important to consider. Sometimes the sum of them all equate to a poor quality of life even though there are only moderate changes in each of the areas mentioned. Sometimes a single factor is so severely compromised that it overshadows all else to result in a negative quality of life.

Talk to others that know you and your pet. Bring the pet into the office and we will be happy to help you evaluate where they are in the spectrum and offer what we can to improve the comfort and quality of life for your pet as long as is reasonable to do so. It is a hard decision to be faced with, but you do not have to make it alone because we are always available to help guide your decision.

Our pets have depended on us to make the best decisions on their behalf for their entire lives, and they always deserve our most careful consideration when it comes time to make a final decision for them.

A common guilt-fueled worry is that one has been selfish or premature in the decision to euthanize a pet. Very seldom is that ever the case, more often those that worry the most about not having done enough for the pet are the ones that have gone far above and beyond anyone’s expectations in caring for their beloved animal. It is far more selfish to prolong a pet’s suffering needlessly purely to postpone your own loss and grief. We can help you make that decision calmly, rationally, without judgment and with only the best interests of your pet in mind.