How Will I Know When It's "Time"?
Have you thought about how you will know it's time to euthanize your dog or cat? The "time" can creep up on you or can happen all of a sudden. It is common and normal to struggle with the enormity and finality of this decision. You naturally desire to pick the exact right time - not "too early", not "too late." But how do you know?
The HHHHHMM Scale
Dr. Alice Villalobos, a veterinarian who started Pawspice, a hospice program for terminal pets in California, has published a scoring system for life quality called The HHHHHMM scale that many find helpful. Pet caregivers can use this Quality of Life Scale to determine how a pet is doing or how they are responding to any treatments focused at prolonging life.
Using a scale of 0 to 10 (0 = Unacceptable, 10 = Excellent), score each category and add up the point value
- HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen supplementation necessary for breathing issues?
- HUNGER - Is the pet eating enough? Does hand feeding help? Does the pet require a feeding tube?
- HYDRATION - Is the pet dehydrated? Can subcutaneous fluids be given once or twice daily to achieve good hydration? Can the fluids be given without causing pet undue stress?
- HYGIENE - The pet should be brushed and cleaned, particularly after elimination. Avoid pressure sores and keep all wounds clean.
- HAPPINESS - Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated?
- MOBILITY - Can the pet get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling?
- MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
A total over 35 points represents acceptable life quality
(Adapted from Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 09/2004, for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006)
Adaptation of The HHHHHMM Scale
The Ohio State University College of Veterinary Medicine has a slightly different adaption of Dr. Villalobos's scale that asks pet parents to respond to statements such as "My pet is sleeping more than normal" or "My pet is trembling/shaking" on a spectrum of strongly agree/always to strongly disagree/never, and then take a somewhat subjective average of all the points along that spectrum to arrive at a quality of life assessment.
The Ohio State adaptation can be found here.
The "Time" Is a Range
Another, fully subjective framework, that I find helpful, is thinking about the "time" as a range. When a pet is before the euthanasia range, they are healthy and happy, with a very high quality of life, and their families have the resources (time, financial, emotional, physical resources) to deal with any issues the pet may have.
At the beginning of the the euthanasia range, a pet has serious issues that are impacting quality of life and are getting to the point of being difficult to manage, but the pet may still be able to do many of it's normal activities and is generally comfortable and happy. Resources needed to deal with the pet's issues may be running thin. A serious decline is eminent, but hasn't taken over yet. Humane euthanasia is now in the picture as a reasonable option.
At the end of the euthanasia range, the pet is very clearly no longer comfortable and happy, there are no other treatment options to help pet with her or her issues. Resources (time, financial, emotional, or physical resources) are depleted. The quality of life of the pet, as well as it's family is really suffering. Humane euthanasia is the only remaining option.
Your veterinarian can help you decide if your pet is in this range, but where within the range you feel it's time to let go depends on you. Some pet parents tend to fall on the earlier side of this range and say goodbye at the first sign of terminal illness or decline in elderly pets, while others tend to wait until the very last minute. Both approaches and philosophies can be reasonable, humane, and loving.
Whatever approach you use, know that this is not black and white process. There is always room for subjectivity.
Finally, I find that it is rare for pet parents to wish they had waited longer before deciding to euthanize a pet. More commonly, once they get some perspective and process their grief, they wish they had been willing to let their pet go earlier. Our own feelings and our closeness to the situation can blind us to our pet's true needs. Don't be afraid to ask for help and second opinions from veterinarians, friends, and family who know you and your pet.