This article is dedicated Maggie Bennett, our beautiful 17 year old Australian Shepherd. She was laid to rest peacefully in the loving arms of her parents, Michelle and William on Saturday, September 5th, 2015.
The sad reality is that most likely, we will outlive our pets. In my middle age, I’ve outlived too many. Two decades into this career, I’ve observed countless clients make this very difficult decision of when to say goodbye. Many say, “When it’s time to say goodbye, you’ll know”. You don’t.
You don’t, because euthanasia is a mind boggling decision which challenges you to delve into your heart and soul. When we decide to have a pet, we take on a complex responsibility and covenant to protect and be there– in every way, and the best way possible. It pushes you find equilibrium within logic and intellect with complex paradigms of love: attachment, sentiment, tenderness and compassion. It’s incredibly complicated, because we love. These amazing creatures brought us unconditional love for years in the form of companionship, partnership, loyalty and dedication. To let go, is not a simple decision because our pets are our anchor in this crazy world.
Some dogs pass peacefully on their own, but in many cases, the will to survive keeps a dog going long past the point of experiencing good quality of life. While recent advances in veterinary medicine are nothing short of amazing, just because we can prolong his life, we must consider whether it’s in his best interest to do so. In my twenties, I was adamantly against euthanasia. I felt it was murderous and immoral– who am I to play God?
I was incredibly naive. Two decades later, after mistakes I’ve made and learning to accept circumstances beyond my control, I came to the conclusion that euthanasia is the most humane decision we human caretakers can ever make. In making this incredibly difficult moral decision, we must step beyond our own feelings and attachment. If used appropriately and in good timing, it prevents suffering. If we have the power to prevent suffering, administering that power is the ultimate gift of love. But when?
Prepare in Advance
The best thing you can do for you and your dog is advance planning. Let’s face the bittersweet reality. The probability of you having to make this crucial decision is very high– at best, within a decade or two. Planning helps to think about what your beliefs are concerning your dog. Are there certain treatments you’re not willing to pursue? If quality of life are important to you, how will you measure it? Most importantly, based on your dog’s personality, what would he prefer? Once you have made a decision, remind yourself of it regularly– because when that time comes, no matter how stoic and firm the preliminary decision, it’ll be one of the toughest you’ll ever make.
At Dog City, we had an awesome Newfoundland named Kiko. We gave him the name, “Chief Kiko” because he was our police chief who helped us raise countless puppies with his fair and loving style of discipline. Two years ago, the amazing alpha dog collapsed. The owners, Shawn and Anthony made an expeditious decision within hours. When I told them how I respect them for their ability to be so decisive, they said “This is something we have discussed. That we would never allow him to suffer”. It was clear to me that this was not a decision they made in a few hours. It was a choice they deliberated throughout 12 years of his life. It was a decision that was put into action in a few hours.
How to Know When it’s Time
Dogs do not speak, complain, nor offer their opinion about their mortality. It’s up to us to ascertain whether continued treatment is prudent, or euthanasia is humane. There are no scientific methods or medical protocols that’ll be satisfactory enough to make the correct decision because it’s also a moral and spiritual decision. But the main determinant should be whether or not they are suffering.
Here are three methods developed by Eric L. Nelson, MS, MA and Sharon Zito, DVM that might help in determining when the time is right: Quality of Life, Pain Assessment, and Insight.
All three should be used in order to fully evaluate the pet’s circumstance. Two methods (Quality of Life and Pain Assessment) ask questions which correspond to numerical values. In this article we present three methods for making a euthanasia decision. All three should be used in order to fully evaluate the pet’s circumstances. Two of the methods (Quality Of Life and Pain Assessment) ask questions which correspond to numerical values. The numbers are added, and the Recommendation Table is consulted to determine if euthanasia is indicated. The third method, Insight, uses a thought experiment to look into the companion animal’s mind, in order to find out what she wants done.
The Quality of Life Assessment
This section is divided into seven categories of life experience such as walking and affection. As an animal ages, or as the course of a disease progresses, the quality of an animal’s life experience will deteriorate. It evaluates a companion animal’s decreasing quality of life. Some characteristics are, by themselves, indicators for prompt euthanasia. For example, a pet who can no longer arise without assistance, or an animal that has lost bladder or bowel control, and who urinates or defecates on herself.
| Quality Of Life Assessment | |
| Walking | |
| 8 | No longer can walk |
| 3 | Walks to eat, drink, or toilet only |
| 1 | Stiff, cannot run |
| Arising | |
| 8 | Cannot get up without help |
| 3 | Arises slowly, is stiff |
| Eating & Drinking | |
| 8 | Is not eating &/or drinking |
| 5 | Losing weight &/or dehydrated |
| Playfulness | |
| 3 | Does not play anymore |
| 1 | Limited playfulness, reduced play interest |
| Toileting | |
| 8 | Urinates or defecates on self |
| 8 | Painful urination or defecation on a chronic basis |
| 3 | Cannot hold urine or feces indoors / has accidents |
| Affection | |
| 5 | Shows aggression when approached (fangs, growling) |
| 3 | No longer shows affection even when petted or rubbed |
| 1 | Only shows affection when laying down |
| Artificial Life Prolongation (ALP) | |
| 8 | Is on 3+ ALP measures |
| 5 | Is on 2 ALP measures |
| 3 | Is on 1 ALP measure |
| ____ | |
| <== Total Points | |
| Recommendation Table | |
| Total Points Action | |
| 1-3 | Re-assess every 90 days |
| 4-7 | Re-assess every 30 days |
| 8+ | Euthanasia recommended |
Many characteristics are not, by themselves, an indication for euthanasia. For example, stiffness and reduced interest in play have small numerical values. Adding the smaller values together may generate a score which is high enough to indicate the time has come to euthanize, or the score may only indicate that the pet should be re-evaluated periodically.
The Pain Assessment
The Pain Assessment allows the human companion to estimate the amount of pain which a pet is experiencing. Unfortunately animals do not speak in human languages, so they cannot tell us in our language what amount of pain they are experiencing. As a result, the human companion must look for behavioral signs which are then interpreted as indicators of pain.
| Pain Assessment | |
| 8 | Cries or moans when moving or re-positioning |
| 4 | Avoids all but necessary activity such as eating or toileting |
| 2 | Cannot climb stairs or inclines |
| 1 | Stiffness |
| ____ <== Total Points | |
Consider the example of a 14 year old German Shepherd, named Corrie. Her Quality of Life Assessment numbers were: Stiff (1), Arises slowly (3), Limited playfulness (1), for a score of 5. A score of five is not an indication for euthanasia; rather, it simply calls for re-evaluation every 30 days.
One day Corrie began to cry when she arose from lying down. This continued for two days, so this new behavior was not a transient symptom. Using the Pain Assessment method, Corrie’s score was found to be an 8. Though her score on the Quality Of Life Assessment was still a 5, the Pain Assessment score indicated that Corrie had reached the stage where euthanasia was the humane action to take.
The Insight Method
The third method is subjective and does not generate scores which can be checked on a recommendation table. Using the Insight method the human companion answers three questions in the way the pet would respond. Doing so illuminates the pet’s wishes. When we put ourselves into our animal companion’s mind, we may find that they want to be released, even though we – their human companions – are not ready to let go. The desires of the pet should be honored as a final act of love and respect for them.
Ask the following questions. Think like you are your dog, because you know him best.
- Do I want to be alive any longer?
- Do I still enjoy life?
- Am I ready to go?
Saying Goodbye
Once you have made this difficult decision, plan when, where and how. Knowing in advance allows you to arrange a situation that’s peaceful and most acceptable to you. Recently, I euthanized Tama, my eighteen years old cat. My husband and I made plans to spend her final week in preparation: abundance of roast chicken, bowls of milk to her heart’s content, sitting in the sun at Riverside park. By the sixth day, she was at peace. And so were we.
Dog City’s Assistant Spencer the Weimaraner had an amazing brother named Tyler. He was loving Golden Retriever who touched the hearts of many. His days were numbered due to cancer, and the owner kindly gave me forewarning. Their plan was to euthanize him in a week. And so each day, I brought him something special or took him to a place he loved. One day, a whole baguette. Another day, a hot dog at the park. A banana from the fruit vendor. I brought his favorite female dog, Hannah the Chesapeake because he was a stud who loved to flirt. I set his weary body free to roam at Riverside Park because he loved to blaze off in his younger days. Park rangers gave me a ticket and a lecture, but I mouthed them off. I’m glad I did, because Tyler’s condition worsened the following day. His owners, Brian and Tige made the decision to say goodbye that day– three days before he was scheduled to be euthanized. For Tama, Tyler, and countless other wonderful friends, I was grateful to have the time to display intentional, ceremonial gratitude and be fully present with them. These acts are not to force yourself to come to terms with it. It simply allows you to say thank you– which assists you in the deep grieving process that will follow. If you are fortunate enough to know the day of departure, make every remaining day special. Impermanence is inevitable, but because of of it, it’s beautiful. Their life deserves to be celebrated with the one they love the most. You.
Despite it all, it’s not going to be easy. It’s supposed to be hard because we are saying goodbye. Pets give us nothing but unconditional love during their tenure. But because they gave us unconditional love, the removal of their suffering is the ultimate act of love without conditions. The owners of Storm and Rebel, our German Shepherds at Dog City once said to me in discussing the loss of their previous dog: “It was a molecular connection.” Yes. Hence the hardest decision we will ever make.
When we raise them, we are to be their pack leader– their Alpha. To lead and protect them with love and discipline. To make them feel safe, to maintain their health and spiritual well being no matter what– that’s the covenant of dog ownership. We just want to make sure they are happy. And so at the very end, we make painful decisions because we are their Alpha.
That frigid day in January 2012, I’ll never forget what Chief Kiko the great Newfoundland’s loving owners said to me with tears in their eyes at Blue Pearl Hospital. “He makes it easy for us. Because we love him so much, it’s easy to make this decision”. At that moment, it hit me. Kiko was the alpha male at Dog City, but Anthony and Shawn were his ultimate guardians– his Chiefs.
| Recommendation Table | |
| Total Points Action | |
| 1-3 | Re-assess every 90 days |
| 4-7 | Re-assess every 30 days |
| 8+ | Euthanasia recommended |
QoL Scale Introduction/Summary
Alice Villalobos, DVM, DPNAP, a renowned veterinary oncologist, introduced “Pawspice”, a quality of life program for terminally ill pets. Pawspice starts at diagnosis and includes symptom management, gentle standard care and transitions into hospice as the pet nears death. Dr. Villalobos developed a scoring system to help family members and veterinary teams assess a pet’s life quality, The HHHHHMM Quality of Life Scale. The five H’s stand for: Hurt, Hunger, Hydration, Hygiene and Happiness. The two M’s stand for Mobility and More good days than bad. The QoL scale is also a helpful decision making tool to assist pet lovers in the difficult process of making the final call for the gift of euthanasia to provide a peaceful and painless passing for their beloved pet. Available for download at www.pawspice.com.
QoL Scale Caption
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. Revised for International Veterinary Association of Pain Management (IVAPM) 2011 Hospice Statement. Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell.
If there is ever a time to put your dog’s welfare over your own needs, this is it. The prospect of living without him is indeed devastating. But the thought of him suffering will feel worse.
