How do I know when it is time?

Is my pet's quality of life accpetable?

When a pet becomes sick or old, there comes a time when you will ask yourself the question “How do I know when the time has come?” or “How do I know if I am keeping him or her alive for selfish reasons?” or “Am I being selfish?” or “He is suffering more than enjoying life?” Those are all valid questions that most pet owners ask themselves sooner or later. Most pet owners outlive many pets in a lifetime and each time, it is heartbreaking to see them getting old, sick and have to make the decision to let them go.

I hope that this article will help you decide for yourself when the time is right without robbing yourself of a few good months, weeks or days and without extending your pet's life beyond a point where he or she no longer experience an acceptable quality of life.

It probably is the most difficult decision that you will ever have to make as a pet owner. It is probably the most heartbreaking but also the most humane and selfless decision.

There are several points that you will have to consider.

First of all, have you consulted with your veterinarian? From my experience as a veterinarian, I have seen people come to my office to have their pet euthanized, thinking that nothing could be done when the pet actually had a simple treatable disease.

Make sure you feel comfortable with your veterinarian and that you communicate to him or her the limits of what you personally consider ethical to do for your pet according to your own integrity and also what is financially possible for you. Do not let yourself be talked into some treatment that you do not want to carry out. However, listen to what your veterinarian has to say and to what the options are.

Some people want to do everything humanly possible for their pet and will go to any extent of available medical technology to save their pet. Some people do not believe that it is right to go to such an extent. Some people would love to do everything possible but simply cannot do so financially. You may be somewhere in the middle. It is a highly personal subject. Whatever your viewpoint is, it may or may not seem correct to another person, but the important thing is that you choose what is right from your own personal viewpoint. Your veterinarian's role is to give you the options and tell you what can and cannot be done. The final decision is yours.

Here are some guidelines that may help you make the right decision.

1. Is your pet eating? Usually, a pet who has enough life energy will be interested in his or her food. They may need some help, but will be interested in some food if only their favorite one.

2. Is your pet relatively comfortable? Pain medication may be needed to achieve a decent quality of life, but when pain medication no longer helps and pain goes beyond what is humanely acceptable, it may be time to think about euthanasia.

3. Does your pet still enjoy his or her favorite activities? As a pet gets older, the definition of favorite activities may change. As a puppy he might have enjoyed chasing a frisbee for hours. As a senior pet, he may simply enjoy going for a 2 minutes walk around the block or sit next to you by the fireplace.

4. Do you still enjoy your pet's company or do you feel bad all the time, having to clean up after your pet, getting frequently frustrated or sad at the sight of his debilitation? Your pet may know how you feel at some level and this is a point to consider. If you don't enjoy more good times than bad times with your pet, chances are that he or she doesn't either.

Dr Alice Villalobos, a renowned veterinary oncologist has not only started “Pawspice”, a quality of life program for terminally ill pets, but has published a scoring system for life quality called the HHHHHMM Scale. The letters stand for: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More Good Days than Bad.

Aside from consulting your own knowingness on the matter, this is the most analytical way of assessing the situation.

Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 09/2004, for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006.

Pain

One of the most common concerns and one of the big decisive factors regarding euthanasia is pain.  The amount and degree of pain and discomfort is a big factor in the quality of life of a pet and no loving pet owner wants his pet to suffer.  However, we can easily be blind to our pet’s suffering.  The reason is that pets are experts at hiding their pain for 2 main reasons:  Instinctively, they know that, in the wild, if they show any sign of weakness or pain, they will be killed either by a pack leader or by a predator.  The other reason is particularly true for dogs since they are pack animals.  They consider us part of their pack and they love us.  They do not want to weaken us and therefore will do everything they can to hide their pain and weakness in order to protect us.  

Very rarely will a pet whimper or cry in pain.  When he or she does, the degree of pain is considerable.  Therefore, we must be alert to indicators of pain because they can be quite subtle.  Many misguided pet owners tell me that they don’t think that their pet is in pain, yet the pet is showing many symptoms that the owners are not aware are pain indicators.  

Therefore, I have put together a list of pain indicators that will help you to decide whether or not your pet is in pain.  The list must be evaluated as a whole and of course there is a gradient of severity of each symptom.  I do hope this will be a helpful guiding tool.  

1. Crying in pain
2. Crying when a particular area is touched
3. Whimpering
4. Moaning
5. Lack of appetite
6. Hunched back
7. Excessive panting (particularly when it is not hot)
8. Subtle lack of alertness gradually increasing to a deep apathy
9. Flinching when touched in a certain area
10. Shivering/trembling
11. Aggressive behavior to protect a particular area
12. Growls when a certain body part is touched or approached
13. Reluctance to be picked up
14. Compulsive licking or rubbing of a certain body part
15. Body tension
16. Reluctance to be touched in a certain area
17. Disinterested in surroundings
18. Unsettled
19. Pacing
20. Limping
21. Wakes up at night
22. Does not sleep well
23. Shifts frequently when resting
24. Doesn't rest easily when lying down
25. Difficulty getting up
26. Difficulty lying down
27. Uncomfortable when resting
28. "Worried" facial expression
29. Difficulty moving after a long rest
30. "Guards" a particular body part
31. Doesn't respond when called
32. Sleeps in a position that avoids a certain body part from touching the ground or bed
33. Lack of social interaction
34. Droopy head
35. Droopy ears
36. Tail is tucked
37. Does not want to play
38. Does not enjoy games
39. Lack of interest in walks
40. Refusal to go on walks
41. Can't jump on couch or bed
42. Pressing head against wall
43. Looking at sides or other body part suddenly and/or worriedly
44. Lying down at a distance from everybody and somewhat isolated
45. Accepting treats or food gingerly (particularly if pet used to accept them enthusiastically)

Please remember that a single yes answer does not mean that your pet’s quality of life is poor.  It depends on the degree to which the pet exhibits the symptom and it depends on the symptom.  For example, if a pet cries, it is a more severe symptom than if the pet’s head or ears droop.  However, subtle symptoms should not be ignored especially if several of those symptoms are present.  

Pain killers can be quite effective at handling pain and can restore your pet’s quality of life, at least temporarily.  If you notice one or more pain indicator listed above in your pet, please discuss this with your primary veterinarian to see if a simple pain killer would be appropriate to try on your pet.  However, there will come a time when even the strongest pain killers will be ineffective and you will have to consider the option of euthanasia.

I hope that the above has been helpful to you and will help you make the right decision at the right time.