Are You Ready for These Seven Key End-of-Life Choices?
How do you know when it's time to say goodbye? As pets get older, the human-animal bond gets stronger, so it only becomes more difficult to make that final decision. This seven-point scale can help you know when it's time to stop asking your pet to bear the burden of living and unbridle his body.
Reviewed by Dr. Becker
Join the Bark & Whiskers™ Family
Sign up today for our FREE newsletter, packed with expert advice and insider tips to keep your beloved pet in tip-top shape.
View our Privacy Policy and Terms of Service.
STORY AT-A-GLANCE
- It’s extremely difficult to think about the impending death of a pet — so difficult, in fact, that it’s tempting to simply block all thoughts of it; however, it’s important to understand your options when your animal companion enters the end-of-life stage
- Pet hospice, or “pawspice,” can be a safe space between the thought of euthanasia and the final act of euthanasia for pets who still have a quality of life
- It’s important to constantly monitor end-of-life pets using a quality-of-life scale developed by pawspice pioneer Dr. Alice Villalobos; it’s also important for pet hospice staff to help owners understand when their dying companion has been pushed far enough
- The gift of euthanasia helps pets experience a good quality death
Editor's Note: This article is a reprint. It was originally published May 21, 2023.
Saying good-bye to a precious furry family member at the end of their life is something many of you have faced or will face one day. It can be an overwhelmingly sad thing to contemplate, and it doesn’t get any easier no matter how many much-loved pets you’ve lost.
But as difficult as end of life issues are to think about, it’s important to know what your options are when the time comes. You want to keep your animal companion with you for as long as possible, but never at the cost of their comfort or quality of life.
Since our pets can’t tell us when they hurt or feel miserable, it’s up to each of us to be proactive in keeping them as healthy and comfortable as possible, including at their end of their lives. Thankfully, pet hospice programs are becoming more common in recognition of the need for beloved companion animals to finish their lives in comfort, and with dignity.
Pet Hospice: The Space Between ‘Still Okay’ and ‘Time to Go’
One of the trailblazers of the pet hospice movement is veterinarian Dr. Alice Villalobos, who was also a pioneer in the field of cancer care for pets. Dr. Alice, as she is called, founded the concept of “pawspice,” a pet hospice service that works with pet parents and veterinarians to take a positive and compassionate approach to terminal illness. After 48 years of practice, Dr. Alice retired on March 1, 2020.
The goal of pawspice is to support the emotions of family members while providing comfort and quality of life for their animal companions by offering a unique quality of life care program. The Pawspice philosophy (from the now-retired website):
“As pets get older the human-animal bond gets stronger. Many books, articles and even cards describe the love and devotion that animal companions have for their owners, but overlook the dedication that pet owners have for their animal family members.
Pawspice partners with pet owners and their referring veterinarians to challenge their pet's cancer and other terminal illness with a positive and compassionate approach. Supporting the heartfelt emotions of the family while providing quality of life and comfort for their deeply loved animal companions.”
In-home pet hospice care is essentially the interval between the thought of euthanasia and the final act of euthanasia for pets who still have a quality of life. Many terminally ill animals who no longer respond to treatment live on for months, and those are ideal patients for in-home hospice care.
Quality of Life Scale for Hospice Pets
Dr. Alice explained that she wanted to call pet hospice “pawspice” because the word hospice is confusing for those who want to adapt the concept for veterinary medicine. She says that in human hospice, the arrival of death isn’t slowed down. Patients receive pain management, but what everyone is doing is simply waiting for the patient to die.
In veterinary medicine, however, we can apply a quality of life scale to each patient. Dr. Alice developed her own tool in 2004 that quickly went viral. It’s the easy-to-remember HHHHHMM scale:
- no Hurt
- good Hydration
- no Hunger
- good Hygiene
- Happiness
These are the five basic areas that pet hospice professionals must be able to talk to their clients about.
The first M is for Mobility. Mobility is extremely important for large pets, for example, Great Danes. If a Great Dane can’t move around on his own, quality of life vanishes unless there are some very strong family members who can physically move him as often as necessary. In smaller animals, mobility isn’t such a huge factor, as they can be easily repositioned throughout the day and carried outside.
On the quality of life scale (0 to 10) it’s possible animals can be immobile and still be okay. It’s similar to people in wheelchairs — they can have great quality of life even though they don’t have full mobility.
The second M is for More good days than bad days. This is something the pet’s family has to focus on. Is this a good day for Buddy? Or is this a bad day? If you are doing all you can to manage all aspects of quality of life and there are still more bad days, or really bad days in a row, and no really good days filled with happy moments, it’s time for the family to consider the gift of euthanasia.
Switching Focus from Treating to Providing Comfort
During our interview, Dr. Alice explained that when pet parents arrive at those final moments, they’re often paralyzed with doubt or fear about causing the pet’s passing by making that final decision to euthanize. Pawspice caregivers provide comfort to those pet owners by letting them know it’s actually a veterinarian’s duty by the oath he or she takes to prevent suffering.
The decision to help a pet transition is, of course, the most difficult decision owners may ever make. As their veterinarians, the most important thing we can do is help their pet die well rather than poorly. The owners will be heartbroken either way, but for their pet’s sake, we can help by offering a good and peaceful transition. A good quality of death.
One of the things I’ll always be grateful to Dr. Alice for is helping veterinarians understand that it’s okay to tell a pet parent, “We’ve pushed this animal far enough.” It’s human nature to want to keep trying even when our pets no longer want to keep going and their bodies are painful and tired. Animals can become frustrated, depressed or despondent, and there comes a point where we should stop asking them to bear this burden and unbridle their bodies.
Sometimes, veterinarians need to give their clients permission to say, “You know what? It’s kindest to stop pushing and we’re going to voluntarily withdraw all proactive treatment.” Instead of trying to cure, slow or change the disease situation, we’re going to switch our focus to helping the animal have a peaceful, good quality death. In many cases this means only administering medications to keep the animal pain-free and comfortable.
It’s About a Good Quality Life and a Good Quality Death
Our pets only think in present time. They exist in the now. Even if you’re five hours late coming home, they’re still full of joy and not mad at you. They’re just happy to see you now, because they exist in the now. If they’re suffering now, that’s all they know, and if there are too many times of suffering, frustration and bleakness builds up.
When there’s no light at the end of the tunnel, we must ask ourselves why we’re encouraging our pets to continue walking that dark path.
Sometimes people don’t understand this. It can be difficult to understand things from a pet’s viewpoint. When there are more bad days than good days, euthanasia offers relief; a light at the end of the tunnel. They don’t need to live for the graduation of a niece or nephew. They’re not looking back with regret and hoping to reconcile with someone before they die.
The human hospice philosophy simply doesn’t apply at the end of an animal’s life. They’re here to enjoy the moment. If their quality of life is poor with no hope of improvement, it’s up to us as their protectors not to make them endure further suffering.
This is the way Dr. Alice talks to her clients, “You are his protector. Buddy needs you to make the decision to help him, you know, change worlds.” She says Barbara Myers, a pet loss consultant, uses that beautiful phrase, “Let’s help them change worlds.” It’s often comforting to families to use euphemisms like “transitioning,” or “crossing the Rainbow Bridge.”
It’s not necessary to use tough words when talking about the death of a beloved companion animal. Families, and especially children, welcome thoughtful, loving words to describe what will be happening to their pet.
