We all want to do well by our furry companions. We want to have as much time as possible with them, but also want to make sure that they do not suffer when they are older and ailing. For many of us, reading the signs to determine when the time has come for euthanasia can be a harrowing experience, with feelings of anxiety, guilt, fear, and grief.
When faced with this difficult decision, animal caregivers may wish to turn to a valuable resource designed to help us make the call: the Quality of Life Scale. The scale, developed by Dr. Alice Villalobos, a renowned veterinarian oncologist specializing in the care of terminally ill pets, was created in conjunction with an animal hospice program Villalobos developed called “Pawspice” that is based on the human hospice model of palliative care.
The Quality of Life Scale provides guidelines for the assessment of an aging, ailing, or terminally ill pet. The scale examines seven key quality of life factors: hurt, hunger, hydration, hygiene, happiness, mobility, and, finally, “more good days than bad.” The animal’s well-being in relation to each factor is rated on a scale of 0–10, with 10 being ideal. Under “hurt,” for example, a zero score would indicate the most extreme pain, while a score of 10 would indicate that the animal is, in essence, pain-free. Within the Pawspice program, a score of 35 (an average of 5 on each factor) is considered sufficient quality of life to justify continuing to provide hospice care to the animal.
While people with pets—as opposed to trained veterinarians—may not feel qualified to assign numerical scores, a familiarity with the factors can still provide some guidance during a traumatic, bewildering time. The seven factors are explained below.
Hurt: The first and perhaps most important consideration is how much pain the animal is in. Pain control must be effective and should be given preemptively. Also, an inability to breathe is rated at the top of the pain scale in human medicine. Caretakers, therefore, must be able to identify labored breathing in pets and provide timely relief when possible. If the pet cannot breathe properly, even with the help of oxygen therapy, nothing else matters.
Hunger: Malnutrition can develop quickly in animals who refuse to eat. Offering a variety of foods, hand feeding, and placing food in the pet’s mouth and rubbing the neck to encourage swallowing may be very helpful.
Hydration: Caretakers should learn how to assess for proper hydration in their pets using the pinch test. In general, animals should receive 10 mL of fluids per pound per day. An animal who isn’t getting enough fluids may benefit enormously from subcutaneous fluids, which can be administered via injection at home.
Hygiene: Pets should be kept clean and should not be left to lie in their own soil after elimination. Animals (in particular, cats) who are having difficulty grooming themselves can be brushed and stroked gently with a sponge dampened with a very diluted solution of lemon juice and hydrogen peroxide.
Happiness: Can the animal’s wants and needs still be met? Are they depressed, lonely, anxious, or bored? Pets can have scheduled fun time that they look forward to every day, such as petting sessions from family members or low-key play (e.g., cats batting at a toy or showing interest in a moving laser light). To avoid isolation, it may help to move the animal’s bed to where the humans are during the day.
Mobility: There are various options to compensate for reduced mobility. Cats can be helped into their litter box. Dogs who show interest in going outdoors can be assisted with a sling or a cart. Medication may help. Mainly, is the pet—independently or with assistance—able to get up and move around enough to satisfy normal desires?
More good days than bad: An animal’s quality of life is compromised when the number of “bad” days outnumbers the number of “good” days, or when there are too many bad days in a row. Bad days might be filled with unpleasant experiences such as nausea and vomiting, diarrhea, frustration, falling down, weakness, seizures, or physical discomfort.
AWI’s presentation of the Quality of Life Scale is intended only for information purposes, not as veterinary advice. As always, it is important to consult with your veterinarian on these matters. We also understand that there are no easy answers—each case is different and each individual human and companion animal relationship is different. But we have a responsibility to see that our pets don’t suffer unduly. With that in mind, the Quality of Life Scale provides insight into what our pets may be dealing with and what we can and should do to help them.
We all want to give our closest companions the highest quality of life in the time they have left. We also need to know when and if to make the heart-wrenching decision that euthanasia is the kindest option when life is no longer worth living for them. It is an admittedly hard thing to do when we don’t want to let go, when we want to hold tight and bargain for just a little more time.
||Adequate pain control; breathing ability is of top concern.|
||Is the pet eating enough? Does hand feeding help? Does the pet need a feeding tube?|
||Is the pet dehydrated? For patients not drinking enough, daily subcutaneous fluids can supplement fluid intake.|
||The pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores by providing soft bedding and turning the animal over often. Keep all wounds clean.|
||Does the pet express joy and interest? Is the pet responsive to family, toys, etc.? Is the pet depressed, lonely, anxious, bored, or afraid? Can the pet’s bed be moved to be close to family activities?|
||Can the pet get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the dog feel like going for a walk? Is the pet having seizures or stumbling?|
||When bad days outnumber good days, quality of life might be too compromised.|
Original concept, Villalobos, A. (2004). Quality of Life Scale Helps Make Final Call, Veterinary Practice News, September. Formatted as a scale for Villalobos A. and Kaplin L. (2007). Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond. Aimes, IA: Blackwell Publishing, revised for 2nd edition (2017), Hoboken, NJ: Wiley-Blackwell. Adapted with permission from Dr. Alice Villalobos.