Knowing When It Is Time

Assessing the Right Time for Pet Farewells

Dr. Sandra provides support to assess your pet’s well-being and make informed decisions, ensuring a compassionate and timely farewell.

From Dr. Sandra

Words of Wisdom

Dog laying in lap

Is it time to euthanize and give my pet peace? This is one of the hardest questions for anyone to answer. Part of the difficulty lies in that what’s right for one family, or even person, isn’t necessarily what’s right for another. I’ve helped families where I would have made the decision sooner and other families where I would have waited, but it’s not my decision to make. I don’t live with that pet. I don’t wake up with them 4 times overnight. I don’t have to cook 5 different things just trying to get them to take one single bite and shed a tear when they don’t. I don’t have to worry all day at work wondering what I’ll come home to. The decision to euthanize is a very personal one. I generally don’t encourage people to ask coworkers, friends, or outside family what they think, unless they have a similar bond with that pet. It’s often much easier for an outsider to pass judgement, but remember, they’re not the one living with the pet, you are.

I’ve seen families divided over this question, with the pet stuck in the middle. What I can assure every family is that no one wants to see their family member suffer and no one wants to take away time from them that may be acceptable or even good. I’ve had families say in the same appointment, even the same sentence, that it’s too soon, but maybe we waited too long. I think it’s important for families to understand that there are feelings of guilt on both sides of the equation. No one wants to deprive their pet of quality time, but they don’t want to see them suffer. What’s most important is that you keep your pets quality of life your number one priority. As long as whatever your decision is has that as the number one goal, you’re making the best decision. The longer I help guide families through this time, the more I find families feeling a sense of relief when their pet is at peace. They often don’t realize the amount of stress they are under knowing that the time is coming or the amount of caregiver fatigue they themselves are suffering from. As important as your pets quality of life is, don’t forget to keep yours in mind too. It’s normal to feel frustrated, sad, angry, and defeated.

My final input is to remember the “right” time is not a moment. It’s not black and white, but a gray zone and for some that gray zone may be a few hours and for others, potentially years. When their quality of life falls into the gray zone or is approaching the gray zone, it’s appropriate to start considering euthanasia. If you’re still unsure, that’s ok and very common, as I said before, it’s a very difficult decision. If you feel you would benefit from a one on one discussion, a virtual quality of life consultation may be just what you need to get a clearer picture of where things stand medically and what to expect going forward. We are here to help during this difficult and confusing time.

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Take Home Points

  • Make the timing of your decision to euthanize based on your pets quality of life no longer being acceptable to you and your family.

  • The decision of when to euthanize is one of the hardest decisions a person/family will make.

  • As important as your pets quality of life is, don't forget to keep yours in mind too. Caregiver fatigue is a real thing.

  • No one wants to make the decision "too soon", but realize that on the other side of the equation is "waiting too long" and the guilt of "waiting to long" seems far more painful long term, than knowing suffering was ended or even prevented a bit earlier.
  • Biological Death vs. Peaceful Passing

    Thoughts on Natural Death

    In this day in age, the word “natural” is often associated with “healthy”. However, natural doesn’t always mean healthy. It’s important to understand that a natural or unassisted death is not necessarily one without suffering. Natural death is better defined as a biological death and it is often not as peaceful as we would hope, and rarely quick. 

    Beyond 'Natural' Endings

    Dog in Leaves
    I hear time and again people say “I wish they would just pass in their sleep so I don’t have to make this decision.” I couldn’t agree more! Whereas this is an understandable statement and a sentiment that just about everyone shares, this desire is more about us, than our pet. Pets live on survival instinct, so they keep going, often with discomfort, anxiety, and even suffering until their body gives out – biological death. Most of our pets don’t live in the “natural” world, they live with us, their guardians, their family, and often under ideal circumstances – a temperature-controlled home with free access to water, an abundance of food, no predators, and often with medical interventions. If our pets did live in the “wild” they would not survive nearly as long as they do under the comfort of our care, as they are vulnerable to nature and the elements. We often see this vulnerability arise when pets start to decline. The pacing, panting, restlessness, anxiety, and “sundowner’s” signs that we very commonly see in an ailing pet are often them feeling increasingly vulnerable and feeling less able to protect themselves.
     
    Beautiful autumn forest

    Take Home Points

  • "Natural" or unassisted death does not necessarily mean without suffering.

  • Our pets will often mask their signs of disease until they are in an advanced stage of their disease progression.

  • Many pets will feel particularly anxious and vulnerable as they get older and/or weaker - pacing, panting, restless, unable to settle.

  • Most of our pets don't live in a "natural" setting (at least not full-time), so we shouldn't expect a "natural" passing.
  • Exploring the Natural Transition for Pets

    With this feeling of vulnerability in mind, it’s important to remember that pets tend to not show how they are feeling until their clinical situation is relatively advanced and often overwhelming to them. For example, we may see subtle signs like our pet acting a little quiet, not quite finishing their breakfast, or moving a bit slower when they walk, but diagnostics and/or physical examination may reveal significantly progressed disease, like a bleeding abdominal mass or advanced heart disease, situations that could quickly become life threatening.
     
    So while some pets will simply close their eyes peacefully and simply not wake up, this is more the exception than the rule and important to keep in mind when hoping for a “natural” death.
     
    One last thing to consider is that although it was just stated that falling asleep peacefully and not waking up is uncommon in our pets, euthanasia (when combined with sedation) is simply a medically induced sleep and passing.  So in a sense we are allowing our pets to “just pass away peacefully in their sleep”.

    Understanding Pet Comfort

    Quality of Life Assessment

    Evaluating a pet’s Quality Of Life (QOL) is inherently challenging and subjective. The TLC QOL Assessment aims to introduce more objectivity to this process. We encourage honesty in scoring the categories, recognizing the difficulty in accepting when a pet is no longer thriving. Daily fluctuations are normal, and conducting the assessment at the same time each day is recommended.

    There is no specified cutoff value for when to consider euthanasia, as the decision is deeply personal and should be made when a pet’s quality of life is no longer acceptable to the family. Establishing written boundaries for what is considered acceptable and unacceptable may aid in this decision-making process.

    The TLC Quality of Life Assessment and Tracking Chart serves as a tool to evaluate a pet’s QOL, with a score of 24 indicating excellent quality of life and 0 suggesting minimal quality of life.

    QoL Tracking Graph

    The TLC Quality of Life Tracking Graph complements the Quality of Life Assessment and Tracking Chart. Its primary purpose is to visually represent the progression of your pet’s quality of life over time. Values can be plotted on the graph, and when connected, a steady line indicates consistent quality of life, an upward line shows improvement, and a downward line signifies decline. While fluctuations are normal, sustained shorter steady states, fewer increases, and steeper declines are often observed as a pet approaches the point where euthanasia is being strongly considered.

    QoL Monthly Tracking

    If you find the assessment and graph beneficial, we’ve included a combined chart and graph on one page for convenient month-to-month tracking. Ideal for pets with an anticipated slower disease progression over an extended period. This is not meant for the initial assessment tracking or graphing, but for those experienced with them for long-term use.
     
    For an excellent description of Quality of Life Scales, their use, and interpretation, please see the following article written by Dr. Julie Buzby, an integrative veterinarian with a focus on senior pet wellness: toegrips.com/quality-of-life-scale-dogs
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