The right time? Measuring your dying pet’s quality of life

As pet carers, the decision about whether or not to have a precious animal companion euthanised (or ‘put to sleep’) is one that many of us will have to face. If you have a pet that’s terminally ill or very old, the chances are that the topic of euthanasia will be on your mind.

You may have a lot of questions.

Should you let nature take its course? Is euthanasia preferable to a ‘natural’ death? Will you know when it’s the right time?

The question of timing can be one of the most daunting – we don’t want to let go too soon but what if we leave it too late?

People will often tell you that you’ll know when it’s the ‘right’ time to euthanise a pet but the reality is that it isn’t always obvious, especially if your pet is experiencing a slow decline.

Quality of Life

The concept of a ‘quality of life’ recognises that life is made up of good and bad experiences but that there must be a balance between the two. This is particularly discussed in the context of animal welfare.

We all know that poorly animals can have good and bad days, just like humans, but many feel that when a tipping point has been reached and an animal has more bad experiences than good because of their health – and if there is no reasonable hope of recovery – then we have to ask whether there is still an acceptable quality of life.

Knowing this, experts have devised a number of different systems for measuring an animal’s quality of life.

It may sound dispassionate but some people find that these systems can help you to review whether or not your pet is suffering at a time when it’s hard to see clearly.

The right to five freedoms

One such system is the ‘Five Freedoms’. According to the Animal Humane Society, these are internationally accepted standards of care that affirm every living being’s right to humane treatment. These standards were developed by Britain’s Farm Animal Welfare Council in 1965 and adapted by the Association of Shelter Veterinarians for companion animals in shelters. 

Although the Five Freedoms initially related to husbandry practices when keeping farm animals, they are a good starting point for assessing your pet’s quality of life.

1.      Freedom from hunger and thirst

Every animal should have access to species-appropriate food as well as fresh water.

We can use this freedom as a measure for quality of life.

Is your pet able to eat and drink? A good quality of life is often still possible with a change of diet, hand feeding and other adaptations. However, if your pet is no longer physically able to eat or drink, it may be a sign that their body is shutting down.

2.      Freedom from discomfort

Animals should have the right type of environment, including shelter and somewhere comfortable to rest.

If your pet is no longer able to rest without discomfort or move easily within their environment then this can be another sign that their quality of life is decreasing.

3.      Freedom from pain, injury or disease

The Five Freedoms state that animals should have freedom from pain, injury or disease, either by prevention or by rapid diagnosis and treatment.

But what happens when you can’t cure an animal because they are hurt beyond repair or terminally ill?

In most cases, it will mean looking at the other four freedoms. Is your pet still able to eat and drink? Can they sleep without being in pain or move around? Are they calm and relaxed?

4.      Freedom to express normal behaviour

Freedom Four says that an animal should be able to stand up, lie down, turn round, stretch their limbs and groom all parts of the body.

You may feel that ‘normal behaviour’ covers other things that your pet enjoys or needs, like being able to go to the toilet or showing interest in their surroundings.

If your pet is no longer able to express their usual behaviour then it’s important to discuss this with your vet, as well as your pet’s immediate family.

5.      Freedom from fear and distress

Freedom Five is about your pet’s state of mind as well as their physical state. Of course, it’s hard for an animal to tell us if they feel frightened or afraid but you know them better than anyone. If you feel that your pet is distressed and that their condition is unlikely to improve, you might want to consider euthanasia.

‘Quality of life’ questionnaire

Even with the Five Freedoms, it can be difficult to determine your pet’s quality of life. What if they’re struggling with one of the five freedoms but seem okay in the other four areas so far?

Another challenge that many of us face is when the animal’s quality of life deteriorates slowly or you’re presented with a diagnosis that tells you they will decline rapidly over a short period of time in the near future.

In all of these scenarios, when is the right time to consider euthanasia?

One helpful tool is a quality of life (QOL) questionnaire. This can help you to define your pet’s quality of life today and then monitor how it progresses.

A good example is on the Cinque Port Vets website.

As you can see, this questionnaire asks you to score your pet’s wellbeing in six key areas (score 2 for normal/good, 1 for poor/reduced or 0 for none):

  1. Mobility (Good/poor/bare minimum)
  2. Appetite (Good/poor/none – vomiting/nausea)
  3. Hydration/thirst (Good/poor/requires oral or intravenous (i.e. a drip) fluids)
  4. Interaction/attitude (Normal/reduced/none – only contact is when you instigate it)
  5. Toilet habits (Normal/reduced/little to no output)
  6. Favourite things (Normal/reduced/no interest)

You could also add categories for your pet’s heart rate, blood sugar or other measurable factors and score in quarter and half points if you notice a slight increase or decrease in any of the categories.

There are, of course, various other QOL scales/scoring systems. An online search will lead you to others to consider until you find one that works for you and your pet.

What the Quality of Life (QOL) score means

When using a questionnaire like this, it’s advised that you think about what the different overall scores mean to you.

For example, you could decide that a score of:

  • 12-9 means everything is OK for now – your pet is still enjoying their life
  • 8-6 means that your pet may need support from you or the vet – this could mean that their treatment needs adjusting to increase the score
  • 5-0 means that your pet’s quality of life is significantly lower than you would want it to be and it might be time to consider euthanasia

It can be helpful to have this sort of baseline in your head. That way, you can remind yourself that “Today’s QOL score is eight. It’s not time yet” or “His score is just four now, which means he’s got little to no normality in most aspects of his life”.

If you don’t have to make an immediate decision, you will probably find it helpful to track your pet’s QOL score on a daily basis.

With an elderly or terminally ill pet, it can be hard to pinpoint a clear downward turn in your pet’s quality of life as there is often a mixture of good and bad days.

You may find, however, that when you track the QOL score every day, you suddenly notice that you’ve hit a week when there were more fours and fives than sixes. Knowing this, you might feel that a tipping point has been reached.

Trust your instincts and intentions

In many ways, euthanasia as an option for our pets is both a gift and a curse. The ability to prevent unnecessary suffering when there is no hope for recovery is often described as the ‘last kindness’ that we can give our pets. Understandably though, it’s a decision that weighs heavy on pet carers.

Trust that your vet will advocate for your pet and will only suggest euthanasia when all other reasonable options have been exhausted.

While finding ways to measure your pet’s quality of life can be useful, knowing the ‘right’ time usually comes down to trusting your instincts and good intentions towards your pet. You know them better than anyone and you only want what’s best for them.

Different people make different decisions for their pets but that doesn’t make either person wrong.

Whatever you face right now, know that you’re not alone.

Until next time, very best wishes from Shailen and The Ralph Site team
The Ralph Site, non-profit pet loss support

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