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Quality of Life Issues

By

Manuals Staff

Last full review/revision May 2020 | Content last modified May 2020
Topic Resources

At some point in a pet’s life, the owner will be faced with this difficult question. The information below is provided as a guide to help you make the decisions you will need to make.

The quality of life for your pet should be the first priority during any treatment program. This is true for both pet owners and veterinary staff. When treating cancer, or any other disease, the goal should be to increase the pet’s quality of life. Throughout the treatment program, the animal’s quality of life needs to be assessed and adjustments made to support that goal as you move from diagnosis, through treatment, and to the end of the pet’s life.

Short-term problems—such as pain or temporary debility—can often be addressed with medications and changes to the living area to improve the pet’s ability to move around a home. Eventually, however, there may come a time when it is impossible to control the effects of cancer and the animal may be in great pain, unable to control its bodily functions, or unable to eat or respond to others in its environment. At this point, comfort care may not control the animal’s distress, and quality of life is lacking.

A humane and peaceful death is the best option in these situations. In making these decisions, having a set of guidelines or life quality standards is very helpful. Such criteria can help a pet owner decide when prolonging an animal’s life is worse than providing a peaceful end. Your veterinarian and other veterinary staff will provide information you need to understand euthanasia and a medical assessment of your pet’s condition and recovery prospects. In many cases, as the time for such a decision arrives, you and your family have already realized that the time for euthanasia has arrived.

Euthanasia

When an animal’s life becomes intolerably painful and distressing, the act of humanely ending that life is called euthanasia. The word comes from the Greek language and, literally, means “good death.” Veterinarians are trained to provide an easy and painless death when that decision has been made. In many cases, deciding on euthanasia is an owner’s final act of kindness and caring.

There are 3 goals when providing euthanasia. The first goal is to relieve pain and suffering. Second, there is a need to minimize any pain, anxiety, distress, and fear that the animal may have before consciousness is lost. The third goal is to provide a painless and distress-free death. The most common method of euthanasia is the injection of a high dose of anesthetic. This allows an animal to go to sleep, lose consciousness, and die peacefully.

During euthanasia, your veterinarian will monitor your pet, observing the animal’s behavior and bodily responses to be sure the goals of euthanasia are being met. Just as humans have individual responses to events, so do animals. Monitoring euthanasia allows your veterinarian to provide the highest level of comfort for both you and your pet.

The process of euthanasia has been developed so that the loss of bodily functions does not cause your pet fear and distress. The first step is a rapid loss of consciousness, which eliminates fear and distress. Next, the ability to move is lost. Then, the animal’s breathing and heart stop. Finally, permanent loss of brain function occurs. Throughout this process, the humane treatment of your pet is the primary concern.

Every pet has needs that should be recognized and respected. Pet owners often have feelings of guilt about making a euthanasia decision. These feelings can often be addressed through the use of a quality of life scale. Such a scale can also provide needed help in making the decisions about the care of animals with incurable diseases other than cancer. Some veterinarians have developed their own quality of life scales for use in pets (see The HHHHHMM Scale). Scales such as these provide a starting point for thought, discussion, and decision making. This is of course not the only way to make a quality of life decision.

No matter what decision is ultimately reached, every animal needs to be considered as an individual and receive kind and supportive care.

The HHHHHMM Scale

One quality of life scale, developed by a veterinarian, is known as the HHHHHMM scale. The letters stand for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and “More good days than bad days.” Some of the issues raised in this scale are discussed in the text. They provide a starting point for thought, discussion, and decision making.

HURT: Adequate pain control, including the ability to breathe, is the most important aspect of quality of life and it is first and foremost on the scale. Many pet owners may not realize that not being able to breathe easily can be one of the most painful experiences for an animal.

HUNGER: Can your animal eat on its own? Has it lost interest in food? If your pet is not receiving adequate nutrition, by hand or force feeding, then a feeding tube should be considered, especially for cats. Malnutrition develops quickly in sick animals if the care giver is not knowledgeable about pet nutrition.

HYDRATION: Is your animal hydrated? Fluids that are injected beneath the animal’s skin are a very effective method to supplement the water intake of ailing pets. You can learn from your veterinarian how to perform this procedure on your own.

HYGIENE: Some questions to consider include: Can your pet be kept brushed and cleaned? Is the coat matted? Is your pet situated properly so that it will not have to lie in its own waste after elimination? Can your pet control its waste output?

HAPPINESS: One important question to consider when contemplating euthanasia is: “Is your pet able to experience any joy or mental stimulation?” Pets often communicate their thoughts and emotions with their eyes. You should try to answer questions such as: Is your pet responsive and willing to interact with the family? If the animal is a cat, is it able to purr and enjoy being on the bed or in your lap? Is there a response to a bit of catnip or a favorite toy? Can your pet’s bed be moved close to the family’s activities and not left in an isolated or neglected area? Is your pet depressed, lonely, anxious, bored, or afraid?

MOBILITY: You should determine whether your pet is able to move around on its own or with help in order to satisfy its needs. Does your pet feel like going out for a walk? Does your pet have central nervous system problems, such as seizures or stumbling? Can your pet be taken outdoors or helped into the litter box to eliminate with assistance? Will a harness, sling or cart be helpful? Is medication helping?

The need for mobility seems dependent on the species and breed. You should bear in mind that cats and small lap dogs can and do seem to enjoy life with much less mobility than large and giant-breed dogs.

MORE GOOD DAYS THAN BAD: When there are too many bad days in a row or if your pet seems to be “turned off” to life, quality of life is compromised. Bad days are filled with undesirable experiences such as vomiting, nausea, diarrhea, frustration, and seizures. Bad days could be from profound weakness caused by anemia or from the discomfort caused by an obstruction or a large, inoperable tumor in the abdomen. When a healthy human-animal bond is no longer possible, the caregiver should be aware that the end is near. Making the decision for euthanasia is a kindness to pets that are suffering.

Adapted from Villalobos, A.E., Quality of life scale helps make final call, Veterinary Practice News, September 2004.

Saying Goodbye

Pets are a part of the family. When they die, it is expected and natural for owners and family members to grieve and feel sorrow, anger, and stress. In some cases, the loss is felt not only in the animal’s immediate family but also by neighbors and by the veterinary team that has provided care. And, given the relatively short lifetime of most pets, it means that owners can face the loss of several loved pets during a lifetime.

When a pet is to be euthanized, the decision can generate overwhelming feelings of guilt and the idea that there has to be one more step that could have been taken. Even with the support of family and your veterinarian, the guilt may not be reduced.

In some cases, owners decide to have the euthanasia take place at home, not only to create a private experience, but also because the pet will be in familiar and comfortable surroundings. Other individuals and families decide to have the euthanasia performed at a veterinary clinic, some of which offer a “comfort room” with surroundings that look more like a home than an examination room. Some people may find the euthanasia process so upsetting that they elect to say goodbye to their pet prior to the procedure, by spending time alone with the animal.

During the euthanasia procedure, some owners stay by their pet’s side up to the moment of death. They may take a piece of the pet’s hair as a keepsake, sing a song, or stroke the animal’s body. It is perfectly natural for owners and family members to take time to say goodbye and stay by the animal for a period of time to achieve a closure. Veterinarians who treat cancer are familiar with these processes and have experience with owners who are going through the sorrow and grieving that accompany a pet’s death.

In some communities and at some veterinary colleges, there are counseling services and pet loss hotlines. Grieving owners can get support through these programs. Just as it takes time to recover from the loss of a human member of the family, so it takes time for people to recover from the loss of a pet. Some owners require a full year to achieve real closure and accept the loss of their pet.

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