Quality, Not Quantity

October 29, 2013

If you’ve shared your home and your heart with cats and dogs over the years, inevitably you’ve been faced with making a decision about whether your beloved, infirm pet needs to be euthanized. Most veterinarians are strong advocates for euthanasia, in lieu of protracted suffering at home with a terminal illness. We are fortunate with our domestic pets to be able to say “I love you so much, I’m not going to allow you to suffer.” That is a noble and selfless decision, but sometimes an excruciatingly difficult one. Since dogs, and especially cats, are often capable of hiding symptoms of serious illness, it can be hard to determine when the time has come to say goodbye.

Recently, a Quality of Life (QOL) scale has been developed by a veterinarian who provides hospice care to geriatric and terminally ill pets. This QOL scale formalizes the criteria that veterinarians have been using for years to help clients establish whether Fido is living the kind of life we want for him, or whether he is suffering. The QOL scale includes seven criteria, which are detailed here. It is important that all family members review the criteria on an ongoing basis to establish whether Fido is suffering, or whether he is still maintaining a good quality of life.

I often advise owners to think about the following few things when assessing Fido’s life quality, most of which are echoed in the Pawspice QOL chart.

1.) Appetite- To most veterinarians, this is the strongest indicator of quality of life. A pet that eats regularly is a pet that feels well. It’s that simple. Older cats don’t become “picky eaters” for no reason; they stop eating because they feel sick, or are in pain. Sometimes we can diagnose and treat the underlying problem, but sometimes we cannot. If Fluffy or Fido goes days without eating, despite your best efforts to tempt with every tasty morsel in the fridge, it may be time to consider euthanasia.

2.) Mobility- This is especially relevant for our geriatric, larger breed dogs who become weak and debilitated in the hind legs. For a lot of these dogs, it’s a struggle simply to stand, and they can be too weak to posture to urinate and/or defecate. Dogs in this situation often develop incontinence, and sometimes decubitus (bed) sores. Dogs and cats that are too weak to walk have a very poor quality of life. (Some smaller breed dogs can be managed even with full paralysis of the hind legs, but they are the exception to this conversation. It is much easier to carry an 8 pound Chihuahua outside than it is to carry an 80-pound Labrador.)

3.) Social interaction- Most of our pet dogs and cats seek out interaction with family members. When Fluffy is consistently hiding under a bed, in a closet or in the basement, she is telling you she feels poorly enough to “opt out” of family life. If Fido doesn’t get off his bed to greet you when you walk in the door, or doesn’t wag his tail at the sight of his leash or favorite toy, he’s telling you he feels really poorly. Dogs and cats that don’t engage with the family as they used to do not have the quality of life we wish for them.

4.) Intractable pain/vomiting/diarrhea/other uncontrolled symptoms of illness- These obvious symptoms happen much less commonly than owners think. (Often indications of sickness in our pets are more subtle, as outlined in the first three points here.) Rarely, we will see a patient with horrific pain that cannot be controlled, or with profuse vomiting that cannot be managed. In these patients, it’s more evident that euthanasia is necessary.

I’m often asked the question: “Should I allow Fluffy to just pass away in her sleep at home, naturally?” I wish I could say that Fluffy would just peacefully go to sleep one night, and not wake up. And it’s possible she might. Unfortunately, the reality is that death is often a lengthy process, and can sometimes take many weeks or even months. During that time, your pet is likely slowly starving and/or dehydrating to death; that is a terribly unpleasant way to go. Humans with end-stage terminal illness are often kept on morphine drips, so at least they are sedated, pain-free and unaware of what’s happening to them. We do not yet have the ability to offer this type of care for Fluffy; to avoid the lengthy suffering commonly associated with a “natural death”, we very strongly advocate euthanasia instead.

Certainly, there are a number of pet owners that for moral or religious reasons do not feel comfortable making the decision to euthanize a pet. I am very respectful of clients’ wishes when it comes to end-of-life care. A veterinarian’s primary responsibility is to be an advocate for your pet; if I feel your pet is suffering, it my obligation to tell you that, and then we can formulate a plan about what’s best for you and for her. It is incredibly important to me that clients are as comfortable with their choices as they possibly can be. It is not my place to force anyone’s hand or coerce them into making decisions; instead, it is my privilege to hold your hand, serve as a guide through a difficult, emotional, mournful process and sometimes share a tissue or two, as we fondly remember Fido together.