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Friday, 11 December 2020 11:07

Measuring quality of life Featured

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Preparing ahead for your pet’s passing might seem an odd thing to do. But for many, it helps to give comfort that you’ve covered all the bases for your pet, yourself and any family that are involved. 

Planning for Goodbye

If you have time, then it can be better for both you and your pet to plan your pet’s end-of-life care, rather than leaving everything to decide on at the end. Planning ahead allows you to think through what you’d really like to do, how you would like to remember your pet’s end-of-life, and how you’d like to remember your pet after their death. It takes the pressure off having to make decisions when under emotional distress. In these circumstances you might make decisions that you’d later wish you hadn’t or wish you had done differently. Spending a little time forward-planning, even if it’s just to be prepared for what you can expect if your pet is being euthanased, will help you cope both at the time and in the period beyond.

Capturing end-of-life wishes

Preparing ahead for your pet’s passing might seem an odd thing to do. But for many, it helps to give comfort that you’ve covered all the bases for your pet, yourself and any family that are involved. It will help to ensure that your pet receives the kind of care in death that was important to you when they were alive. Gathering together anyone that you feel has a part in your pet’s life and whose wishes you’d like to take into consideration can also to start to formulate a network of support you can call upon later if you need to. 

There are step-by-step guides available to work through (available from Compassion Understood via your vet) that will help to cover each aspect surrounding your pet’s passing. In short, these can be broken down into:

Making your pet’s final arrangements

  • If your pet falls seriously ill, would you wish for euthanasia or would you want to explore palliative or animal hospice care?
  • If you and your veterinarian decide that euthanasia is the best and most loving option for your pet, should this take place at your veterinary practice or at home?
  • Who should be there when your pet is euthanased?

After-life care

  • Would you want your pet to be buried after passing away, or to be cremated? 
  • If buried, would you want this to be at home or in a pet cemetery?
  • If cremated would you wish to have your pet’s ashes returned to you?

Capturing your thoughts about end-of-life care, even when your pet is well and healthy will help to take the stress away later on. Of course, you can revisit your plan at any point and change it, even right at the end, but it helps you to think through every aspect in advance so you can research anything you need to, and ensures you don’t forget anything at the last moment.

Other things you may wish to consider

  • Would you wish to have a remembrance ceremony for your pet and what would this look like?
  • Would you want to spend time at the crematorium with your pet before they are cremated? (It’s unlikely that you would be allowed to see your pet’s cremation directly, but many crematoria offer private time with your pet in a remembrance room to say your goodbye.) 
  • Are there any personal items that you would want to bury with your pet, or would you want to take a lock of hair or take a paw print to remember your pet by?
  • Would you wish to create a memorial in remembrance of your pet, for example, a memory box, a plaque, plant a small tree or pot?

When the time comes, having given some thought to what you would want can be of great help at the emotional time of saying good-bye to your pet.

Measuring quality of life

Quality of Life (sometimes shortened to QoL) has different meanings to different people. What constitutes a reasonable quality of life for one person for their pet might not for another. One pet owner might consider that urinary incontinence in the house is too much for them to cope with and undignified for their pet. Others will be comfortable with clearing up after their pet, and be OK with this as long as their pet is eating and is mobile. 

For this reason, measuring Quality of Life, in qualitative or quantitative terms, is difficult and is also challenging for the veterinarian or care-giver looking after the pet. Compassion Understood seeks to help veterinary professionals with this challenge through training. Having some understanding of what constitutes quality of life can help us to know when to intervene if our pet needs medical or palliative intervention if no treatment is available. It can help us decide on ‘the right time’ for euthanasia if we feel this is best for our companion.

In its most basic form, measuring Quality of Life means answering the question ‘Is my pet able to do the things that make him/her happy?’ ‘Is he/she having more bad days than good days?’ Other factors to consider are:

  • Whether your pet is in pain or discomfort
  • Your pet’s appetite
  • Your pet’s demeanour or mental state
  • Your pet’s level of mobility
  • Urinary or faecal incontinence

If you can, it’s a good idea to take snapshots of your pet’s Quality of Life at regular intervals throughout life. It’s very easy, in an emotional moment to forget about the things that you pet was able/ enjoyed doing. Capturing your pet’s every day activities and enjoyments help you to benchmark and give you something to later compare against. And you can decide on the level of importance of each of those things to you or your pet.

In the absence of specific Quality of Life training, it is not uncommon to judge a wagging tail or purring as an indicator of happiness in your pet, but these things alone do not give an overall picture.

Veterinary ethologists and scientists have deliberated quality of life and much is published on the subject. One commonly accepted tool for both pet owners and veterinarians to use is Dr Alice Villalobos’ Quality of Life scale. Dr Villalobos is a veterinary oncologist (a cancer specialist for pets) who developed a model ‘Pawspice’, a quality of life programme for terminally ill pets. Her HHHHHMM scale is helpful to put some measurements against: Hurt; Hunger; Hydration; Hygiene; Happiness; Mobility; More good days than bad.

Palliative and hospice care for pets

There is a growing movement to provide for needs of aging, sick and dying animals, in the same way that we provide for the needs of people. While we are fortunate in that we can ultimately spare our beloved pets suffering by way of euthanasia, and this for many will be their first choice, there is increased recognition of the significant benefits of animal hospice and providing palliative care to take care of symptomatic needs such as pain, poor circulation, respiratory distress or lack of mobility. 

Whether - and when - to choose palliative, animal hospice and/or euthanasia for a sick or dying pet is a very personal decision. Your veterinarian will be able to guide you as to what is best for your pet. However animal hospice and palliative care is a new concept and not every veterinarian will be familiar with it. There are however a growing number of veterinarians who specialise in this area and will be able to support your vet in advising you.

Palliative care and hospice care

Palliative care and hospice care are two separate concepts though often confused. Palliative care refers to relieving or soothing the symptoms of a disease at any stage of an illness. It is particularly significant in the context of terminal illness and end-of-life care. 

Hospice care is palliative care but it is also about giving patients and their caregivers control, dignity and comfort during the time they have remaining to live and until the end of hospice-assisted death or planned euthanasia. It doesn’t signify a particular place as we have come to associate with hospices for people, although in some countries, these can be now found for pets. 

Deciding on euthanasia

Euthanasia means “good death”. With pets, it refers to the ending of life by a painless medical intervention that provides death to the pet within minutes (American Veterinary Medical Association 2013). It is usually carried out to relieve pain or suffering that cannot be managed sufficiently by other means such as palliative or animal hospice care. Sometimes euthanasia is carried out for reasons other than illness. Unmanageable and dangerous pet behavioural problems can lead to euthanasia; sometimes it is carried out where an owner can no longer provide for their pet or afford to pay for necessary treatment, and there is no option of financial support or rehoming.

Whatever the reason, deciding on euthanasia is one of the most difficult decisions that a pet owner will have to make. Whilst in time, the decision will likely bring comfort in having given you the ability to end your pet’s suffering, at the time, it can raise many emotions, many of them upsetting and conflicting. Feelings of guilt can surface both for the pet that you are going to lose, but also for your family, if the decision is one you alone have to make. 

Ultimately what can cause us the most pain, is also one of the kindest and loving things we can do for our pet. And choosing to have your pet euthanased rather than to ignore or deny suffering shows courage and commitment to the best care of your companion.   

The Right Time

Deciding when the time is right to have your pet euthanased is very personal to you. You may find that you are influenced by previous experiences of pet loss, or, if this is your first pet, you may be given lots of well-meaning, but often conflicting, advice.

When making your decision, remember that there are many people who can help support you. You do not have to face this alone. Your vet will be able to help guide you through the decision-making process and advise you on Quality of Life and other physical needs that might mean the time has come.


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