Making the decision to let your pet pass can be one of the most difficult decisions that you face.
It is a decision that should be shared between yourself, your pet’s clinician and, with their consent, myself. Your veterinarian is well placed to guide you and ease the burden. It should never feel like it is your responsibility ‘to know’ and yours alone. Remember-if you don’t have medical training yourself (and perhaps even if you do), how are you supposed to make this decision alone? Well meaning friends may say, ‘Better a day too early than a day too late’. I particularly dislike that phrase. Instead I tell our families that, unless you are faced with a more acute situation, there is a window of time where the decision can be made and it is neither too early nor too late. Neither is the suggestion as to whether your pet still likes to do what they liked to do back in their prime particularly helpful. Personally I don’t want to do all the things I used to do in my 20s now I’m in my 50s. Your pet’s preferences when health concerns are present are likely also altered. You need support in making this decision, a shared load, so don’t be afraid to ask for it. And in more complicated situations, where not all family members are on the same page, perhaps even consider reaching out to a pet bereavement counsellor. They are there to support you at every step.
To help you it can be useful to start considering your companion’s quality of life at this moment in time. Your family unit needs to be considered too. Your quality of life and that of your family is equally important as you care for your friend. Affordability, time available to dedicate to, physical ability of carers and their emotional reserves all need to be factored in. Caregiver burden can be immense.
We are seeing an increasing number of Quality of Life assessment tools becoming available to us. Some are still heavily biased towards your pet’s physical wellbeing with little attention paid to patient preference or weighting of parameters, an example being the widely used Dr. Alice Villalobos seven parameter HHHHHMM scale, which I do not recommend for this reason. GUVQuest, a 109 item questionnaire developed at the University of Glasgow, has proven far more statistically sound but its use in practice depends on the services of a proprietary vendor VetMetrica health-related quality of life
Your pet can still have a good quality of life even with ongoing health issues, however hard this can sometimes be for owners to see as they struggle with the anticipatory grief of a bombshell diagnosis for their pet or worsening signs of chronic disease. Please don’t let fear of the future rob you of the present. Quality of life should not be purely focussed on the physical aspect but should also take in to account your pet’s emotional happiness and social health (the ‘balanced triangle’ or ‘pyramid’ approach). And sequential Quality of Life assessments (along with the use of pain scales, which I personally favour over all other approaches) may yet have another role in assessing efficacy and clinical progress when treatments and palliation are implemented.
Pain scales or pain scores have better scientific validation than quality of life tools. There are several available to your pet’s primary care clinician for dogs to help them assess your companion’s comfort alongside your feedback. For home use for dogs the BEAP pain scale is user friendly-but perhaps a little too basic. As said, your vet may be able to provide you with a better pain scale for your dog that they can oversee. For cats, we are very fortunate to be able to use the brilliant Feline Grimace Scale and this is something you can easily use yourself at home. A free Feline Grimace Scale app is now also available.
Below I have listed some useful resources that are considerate of the overall picture and that you may wish to use. Sometimes it can be as simple as marking good days and bad days on a calendar.
I have also included some articles by the very wonderful Drs. Cherie T. Buisson and Andy Roark-proving that what you are feeling is normal and even veterinary professionals are not immune.
Finally, a poem, ‘If it should be’ that still says it all better than checklists and tick boxes ever could ❤️
How Will I Know? Assessing Quality of Life and Making Difficult Decisions for Your Pet Ohio State University. Please note: this resource has a habit of changing its URL frequently. If I have yet to update on this page and you cannot locate the article, please contact me for the current link. Part of the Honouring the Bond programme run out of Ohio State University, please take a look at their other resources available at Honouring the Bond
Argus Institute, Colorado State University
Quality of life scale and family concerns Lap of Love
Pet quality of life daily diary Lap of Love
The quality of life question we all should be asking Dr Cherie T. Buisson
How to say goodbye Dr Andy Roark