Quality of Life and When to Say Goodbye
As a veterinarian, I often encounter friends or clients who remark, “I could never do it” (the “it” refers to euthanasia). Although I don’t know any veterinarian who enjoys this particular duty, it is one of the most important services we provide for a suffering animal and its owner(s).
As a dedicated vet student, I spent four years learning normal and abnormal anatomy and physiology, how to diagnose and treat numerous diseases and injuries, and even how to humanely end an animal’s life. There was never any formal training on how to council overwhelmed owners through the decision of when to euthanize their beloved pet, nor any discussions about how I would feel about it.
My first year in practice was a steep learning curve in many ways and it didn’t take long before I was reeling from the effects of compassion fatigue. I spent many shifts sobbing in the staff bathroom, trying to pull myself together between appointments. I had been absorbing my clients’ grief and adding in some of my own, for having failed to save another patient. After a particularly devastating patient loss, I finally realized that I needed to make some professional and personal changes. I reduced my working hours, and eventually relocated back to my hometown to surround myself with a greater support system. I had a baby, and eventually another. These intermittent breaks from my profession forced me to pause, reflect, and gain a new perspective on life and death.
Over the years, I have learned that death is not the worst outcome. Allowing for a peaceful and painless death can be the most beautiful last act of love that a pet owner can give to their companion. Knowing when to let go is not easy and it is such a personal decision. Although I hope that this article arms owners with some insights into understanding quality of life and acceptable end-points when making such a heavy decision, nothing can replace an honest conversation about your pet’s quality of life with your veterinarian.
What is quality of life?
Most veterinarians and pet owners I talk to agree that an animal’s quality of life is more important than its quantity of life. Although we all have a broad idea of what quality of life means, I find it helpful to break the concept down into more quantifiable factors that summarize an animal's physical and mental well-being. The following is a scoring scale for quality of life that pet owners can use regularly to help visualize the general well-being of their pet.
Quality of Life Scale: The HHHHHMM Scale
Score patients using a scale of 1 to 10 for each catagory.
HURT - Adequate pain control, including breathing ability. Is the pet's pain successfully managed? Is he/she running/playing as often and vigorously as usual? Does he/she pant or groom excessively?
Pain control can be improved with oral, injectable or transdermal medications.
HUNGER - Is the pet eating enough? Is the pet willing to eat his/her normal dog food, or is only enticed to eat “treats” or “junk food?” Does hand-feeding help?
Blended/liquid diets and feeding tubes can be used to facilitate appropriate caloric intake.
HYDRATION - Is the patient dehydrated? If you pull up a small “tent” of skin on the pet’s head, does it snap back into place as yours does? If you touch the pet’s gums, are they moist or dry/sticky?
Subcutaneous fluids and electrolyte gel packs can supplement fluid intake for some pets.
HYGIENE – What does the pet’s coat look like? Does he/she have the same luster and shine to the coat that was present as a younger animal?
Frequent sponge baths can help keep a pet clean after elimination in addition to providing tactile stimulation. Barrier ointments (Vaseline) can reduce fecal/urine scald, and sometimes antibiotics are required to fight secondary infections.
HAPPINESS - Does the pet express joy and mental stimulation? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid?
Moving a pet’s bed closer to family members can reduce isolation and neglect.
MOBILITY - Can the patient get up without assistance? Does the pet need human or mechanical help (e.g., difficulty rising on a tile floor)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling?
A harness or sling can facilitate a pet’s mobility, although cats and small dogs can still enjoy life with less mobility than their large dog counterparts. Providing soft and clean bedding, in addition to frequent repositioning of a larger pet is imperative in order to prevent bed sores. Mobility carts can help pets with paralyzed or extremely weak hind legs. Yoga mats and carpet runners provide traction, allowing weaker pets to get up and walk around a house with slippery flooring.
MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be compromised. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
*TOTAL *A total over 35 points represents acceptable life quality
Perhaps the greatest burden of pet ownership is deciding when to let our companions go. We all wish that our pets could die peacefully in their sleep but in reality, this rarely happens. Most natural deaths involve slow, sustained periods of suffering. I truly believe that we should always aim to prevent suffering in our pets and if this is not possible, we must not allow the suffering to continue.
This post is dedicated to my late loves: Ralphie (the best-worst Boxer there ever was), Buster (my favorite lapdog) and Luna (my crochety old kitty)
Sources:
Villalobos, Alice. The HHHHHMM quality of life scale.