Quality of Life
This is one of the most difficult, and most important, questions to answer when making a decision about end-of-life care. When we discuss quality of life, we want to take into account physical and cognitive/emotional realms. These can be difficult to assess because what we see depends on the individual, and every pet's context is different. Unfortunately we are also subject to biases, particularly when it comes to our loved ones and the pain, guilt and shame associated with loss.
As a general rule, veterinarians in the field strive to "be a little early rather than a second too late."
The Human Element
This requires some introspection. What are our thoughts/beliefs around death and euthanasia? What ties do our pets have to our lives and memories?
Some conditions develop slowly (e.g., arthritis, hip dysplasia, Cushing's disease, stable diabetes mellitus), but some happen suddenly (e.g., pathologic fractures, tumor ruptures, internal bleeding) or may accelerate (e.g., immune-mediated disease, lymphoma). Pets are often more painful than families know.
Are you able to handle declines in mobility or function? Some pets are too big or too painful to transport. Consider sanitation, secondary issues (e.g., matted fur, skin infections) and exposure (particularly families with elderly or children who could slip or be exposed to feces, blood or vomitus).
What is your plan if pet declines after normal working hours? What limitations or boundaries do we have? Finances realistically play a role in treatment options. Sometimes we're emotionally or physically exhausted.
Accepting you may not get a choice, what would you want for your loved one?
The Time Capsule
Review photos/videos of your pet as they have aged or as conditions have been diagnosed or progressed.
Throughout your time with your pet, what were their 5 favorite things to do? Are they still able to do them? Some of them? None of them?
How have your pets changed? How have you changed behaviors, routines or schedules to accommodate your pet?
Have interactions with other pets or family members changed over time?
A good general way to assess changes over time is with a +/- calendar. Simply get or print a calendar and track your pet's days with a "+" (good day) or a "-" (not so good day). Separate family members can track their input with different colors. It helps us stay accountable to changes over time and trends.
Take a scoring of your pet's activities and attitude. Dr. Charlie recommends can be done daily or weekly and separately by multiple owners or family members to give the best overall idea of your pet's score.
Take a look at OSU's Quality-of-Life Assessment (PDF Page 2). Simply circle your score and total up the selected numbers. Dr. Charlie considers scores averaging 75 or less of concern. The lower the more worried we become about a pet's suffering and poor quality-of-life.
Compare assessments among family and over time.
Many owners value Dr. Charlie's experience, philosophy and pragmatic advice. If you have questions or concerns, consider consultation options.
If you are unsure what to expect or how your pet's condition may progress or decline, please contact your veterinarian or consider consultation with Dr. Charlie.