Knowing When

Making this last decision for your dog or cat can be difficult. Help is here.

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Many pet owners have said they wish their ailing pet would pass peacefully in his or her sleep. But it is rare for a pet to pass in this way. Near the end of life, most dogs and cats will feel discomfort; they may experience weakness, lack of appetite, dehydration, nausea, difficulty breathing, immobility, disorientation, self-soiling, and even pain. Symptoms like these may be subtle at first and slowly increase over time. The natural dying process may last for many days.

 

When a pet’s quality of life is severely diminished, few pet owners want to watch their friend decline until the end comes unassisted. When a pet is suffering, the decision to end life may be clear, despite the sadness that goes with this decision. Often however, knowing when it is time to end a life is difficult. Many pets will experience good days (times of relative comfort and happiness) interspersed with bad days (times when the pet will not eat, seems painful, or is inactive or withdrawn).

 

Here are some things you may consider as you make this important decision. You may find yourself vacillating - this is normal, especially as your pet’s condition will change from day to day.  Please contact Dr. Ivey if you need help evaluating your pet’s quality of life or if you are having difficulty with a euthanasia decision. It is most important that you feel certain that any decision you make is best for your friend.

 

Is my pet suffering?

Suffering is caused by serious, often-present pain or discomfort. For example, a bone tumor or spinal disease can cause intense pain that cannot be relieved by medication. Other causes of severe discomfort include difficulty breathing, ongoing nausea, or disorientation due to cognitive changes. Many pets cope very well with minor disabilities, such as arthritis or weakness - these do not cause suffering if the condition is minor or can be helped with medication. Some problems, for example blindness, seem to be much less troubling to pets than to humans.

 

What is my pet’s Quality of Life?

  • Is my pet in pain? Sometimes, signs of pain are obvious, such as crying when touched or picked up. But many pets do their best to hide signs of pain. More subtle symptoms of pain include:

  • Mobility changes: limping, difficulty with stairs and/or jumping, decreased willingness to get up, stiff gait or weakness, difficulty settling down, pacing

  • A change in demeanor: dull or worried eyes, lowered or flattened ears, tucked tail, hunched body posture, increased aggression, increased muscle tension - especially when touched

  • General signs (these have other causes in addition to pain): Decreased appetite, decreased overall activity, increased breathing rate, house soiling (due to difficulty getting outside or into the litter box), sleep disturbances

  • In addition, for dogs: panting (when not hot), decreased social interest. For a more detailed description of signs & severity of pain in dogs, click HERE

  • For cats: Hiding, tail flicking (especially when touched), whiskers held forward, dilated pupils, decreased grooming. For a more detailed description of signs & severity of pain in cats, click HERE

  • Does my pet have a good appetite? Poor appetite often signals a decline in quality of life, because many pets will not eat if they feel poorly, are in pain, are nauseated, or overly anxious.

  • Does he or she have enough mobility to get around and to eliminate without soiling him/herself? If mobility is limited, does he or she cry to be moved or to be nearer the family? Are there any pressure sores? If there is soiling of the coat, does he or she mind being bathed frequently? To help your pet’s mobility, see tips at the bottom of this page.

  • Is my pet having labored breathing? This is very important. People with labored breathing describe this as being very uncomfortable.

  • Does my pet enjoy interacting with people and his/her surroundings? Many frail or ailing pets can still enjoy the company of others and passive activities such as looking out of a window or sunbathing. When a pet seems withdrawn and no longer enjoys any kind of socialization or stimulation, we feel that quality of life is diminished. Cats in particular tend to become less affectionate and they often hide when they are in pain or not feeling well.

  • Is my pet disoriented or afraid? As with humans, end of life changes can be mental as well as physical. Older pets may experience anxiety, disorientation, restlessness, and other forms of cognitive decline that prevent them from enjoying life. Some pets get trapped in furniture or have other problems navigating the home.

  • Can my pet’s quality of life be improved, even though an illness cannot be cured? For example, medications to increase appetite and control pain or anxiety can help give a good quality of life. Fluids may be given to help with hydration, and the environment may be modified to help your pet get around comfortably (see below for mobility aids).

  • Are treatments causing distress? Some pets are very tolerant of handling and medication; others experience emotional stress or unpleasant side effects. If your pet is experiencing distress from a treatment, an alternative may be available (e.g. injections rather than pills, a different type of medication, or a different diet).

 

What if my pet still has good days?

Many ailing pets still enjoy good days - this makes an end of life decision especially difficult. We don’t want to deprive our friend of joy in life, but we don’t want to prolong an uncomfortable decline. We often don’t know what the future will bring. Answering the following questions may help:

  • Right now, do the good days outnumber the bad?

  • Is my pet truly happy on his or her best days? Is he or she suffering on the bad days?

  • What does my pet have to look forward to? If an activity can be planned that would give your pet joy, that can be a very meaningful part of saying goodbye. If on the other hand, you feel that your pet is getting worse every day, you might not want to wait until there is no joy left at all.

 

Other ways to think about Quality of Life

If you feel your pet is slowly approaching the end of his or her life, but your heart is still troubled in making a euthanasia decision, try asking yourself these questions:

  • Is there something I am waiting for? Is there something your pet must do (or not be able to do), that would tell you that the time has arrived - and what would this look like? For example, if an owner is waiting until a dog cannot wag his tail anymore, that may mean waiting until the dog is nearly comatose - this owner might have regrets if he or she waits this long. Similarly, cats often purr at the end of life, even if they are uncomfortable. Waiting until a cat can no longer purr might mean making things harder for the cat and the family.

  • If there were a treatment that would keep my pet in the exact same condition (no improvement or worsening of symptoms) for an entire year, would I give it? If the answer is yes, then your pet must have a good quality of life that you wish you could maintain. If the answer is no, then this is an indication that the current situation is not something that should continue for very long.

  • Will euthanasia prevent suffering? For example, if you feel your pet seems to have increasing discomfort, it may be a kindness to prevent this decline from becoming unbearable. If your pet is having problems with disorientation and getting trapped under furniture, you may be worried that this will happen when you are not home.

  • Is there a chance for a rapid decline? Some illnesses (for example, heart disease and internally bleeding tumors) can lead to a precipitous decline in comfort. If this becomes an emergency, in-home euthanasia may not be an option.

  • Are we at a turning point? Once a pet has not eaten for several days, or becomes very weak, things are probably not going to get better, only worse. Discussing the situation with a veterinarian (your regular vet or Dr. Ivey) can help.

  • Should I use a Quality of Life (QOL) Scale? There are point systems designed to quantify QOL. While some people find these scales helpful, QOL can be difficult to measure with a number. Please click HERE for more information on QOL scales.

 

What if some family members are not ready? Difficult decisions are even harder when family members don’t agree on what’s best. Most people, especially children, remember these hard decisions for a very long time. For this reason, it is important that all family members can discuss their feelings. Ideally, the decisions made for a family pet are made together, and everyone is ready when a euthanasia decision is made. Sometimes it helps to remember that euthanasia is not about ending a pet’s life - the pet’s disease is ending his or her life. Euthanasia is a loving gift to prevent suffering, and allows a beloved pet to end life with dignity and comfort. Please remember that the timing of euthanasia is an emotional as well as a medical decision. Feelings of guilt or not being ready to let go are issues that can last for a very long time, even years, after a pet has passed.

 

Is recovery possible?

If you are having trouble with a euthanasia decision because you are not sure what your pet’s prognosis is, please contact Dr. Ivey to discuss this. She will discuss your pet’s individual situation with you; this includes not only a discussion of the medical aspects, but also a discussion of what types of treatment both you and your pet are comfortable with.

 

Tips for pets with decreased mobility

Mobility is a significant end of life concern for many pets, especially large dogs. Limited mobility may be due to arthritis, neurological disease, or muscular weakness. Treatments to help mobility and comfort may include:

  • Prescription treatments: this may include medications, such as anti-inflammatory drugs, analgesics, and medications that support joint health. Non-pharmaceutical treatments include acupuncture, laser therapy, and chiropractic care.

  • Environmental modifications: rugs or non-skid mats on slippery floors, ramps over stairs, and ramps/stairs to places like beds can be a big help.

  • Other physical aids: a harness such as the Help ‘Em Up can provide much needed assistance with stairs, walking, and getting into the car. Boots can help provide traction.

  • Help with toileting: ailing or weakened pets may have trouble with house soiling. For dogs, helping them out frequently (especially before bedtime) and/or puppy pads can make a big difference. For cats, a low sided litter box (such as a lid to a Rubbermaid container, or a regular box with the side cut out) can help access. Having litter boxes in every room, or at least on every level of the home, can help.

 

Other concerns Many other factors can make a euthanasia decision especially hard. Children’s feelings, feelings of guilt, and questions regarding the ethics of euthanasia are examples of other issues your family may be dealing with. Don’t forget to consider your own quality of life also: pets that are incontinent, need continuous care, or are up all night can create real problems for their beloved humans. With human hospice, several nurses provide care in shifts; 24 hour care does not fall on one person’s shoulders.

 

Many people experience strong feelings of grief at the time a final diagnosis is given, when the pet is still alive. This is anticipatory grief, and it can be just as painful as when a beloved pet dies. This period is especially hard when many big decisions must be made regarding treatment and euthanasia. The Association for Pet Loss and Bereavement has special resources for people with anticipatory grief, including an online discussion room, at the APLB web site.

 

Other Euthanasia Topics:

What to Expect, How to Prepare

Aftercare