How do I know when it is time?
As pet owners ourselves, we understand how difficult it is to decide what to do when your pet is coming towards the end of their life. Unfortunately, the vast majority of the time, our pets will not pass away peacefully on their own before going through a period of distress and/or pain. Euthanasia is therefore designed to intervene at a point in time which prevents your pet from going through undue suffering and to provide them with a dignified and peaceful end of life.
This then raises the difficult question of when is the right time. There are several ways to assess your pet's quality of life. It will always be your decision to make, as after all, you know your pet better than anyone but we will always help and guide you through this assessment.
In order to experience a good enough quality of life, our pets have rather similar needs to us when you break it down. We all have physical, emotional and social needs and it is no different for your pet. One useful tool to help us evaluate all of these different considerations, are quality of life questionnaires. It can still be difficult to fill these questionnaires out as for example, it is not always obvious how much pain your pet is in and as vets, we are often asked to help owners evaluate this. Therefore, we are able to help guide you through the questionnaire over the telephone if you need some help.
The HHHHHMM Questionnaire
This questionnaire focuses on 7 main factors which affect your pets quality of life and allows you to grade your pet on each of them. The questionnaire focuses on: pain, appetite, hydration, hygiene, happiness, mobility and the number of good days or bad days that your pet is currently having. Each section is graded on a scale of 1-10 where 10 is ideal and the best score (imagine your pet when they were young) with 1 being the worst. A total score of 35 or below is a cause for concern and we would encourage you to speak to us if your pet has a score in this region.
Is my pet under adequate pain control? How much pain is my pet in? Trouble breathing is a major concern. Can the pet breathe properly? Does my pet need Oxygen? (10 is ideal and 1 is worst)
Is your pet eating enough? Does hand feeding help? Does your pet need a feeding tube? (10 is ideal and 1 is worst)
Is your pet dehydrated? For patients not drinking enough water, subcutaneous fluids can be used once or twice daily to supplement fluid intake. (10 is ideal and 1 is worst)
Your pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores with soft bedding and keep all wounds clean. (10 is ideal and 1 is worst)
Does your pet express joy and interest? Is your pet responsive to family or toys? Is your pet depressed, anxious, lonely, afraid or bored? Can the pet's bed be moved to be close to family activities? (10 is ideal and 1 is worst)
Can your pet get up without assistance? Does your pet need human or mechanical help? Does your pet want to go for a walk? Is your pet stumbling or having seizures? (10 is ideal and 1 is worst)
More good days than bad days
When the bad days outnumber the good days, this may indicate your pets quality of life is compromised. When a healthy-human animal bond is no longer possible, the caregiver must be made aware that the end is near. (10 is ideal and 1 is worst)
Original concept, Oncology Outlook, by Dr. Alice Villalobos, Quality of Life Scale Helps Make Final Call, VPN, 09/2004; scale format created for author’s book, Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, Blackwell Publishing, 2007 and Second Edition 2018. Revised for the International Veterinary Association of Pain Management (IVAPM) 2011 Palliative Care and Hospice Guidelines. Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell.