As pet lovers ourselves, we understand the deep bond you have developed with your best friend. We know that you only want the best for your pet but that sometimes knowing what is best can be incredibly challenging. Many owners, when faced with an aging pet or an incurable medical diagnosis need guidance and support to make decisions about their care. Whilst you may feel that there is simply no ‘right’ answer when it comes to end of life considerations, this article aims to help you be the best advocate you can be for your pets needs.
One of the most commonly asked questions from my time in general veterinary practice was ‘how do I know when it’s time?’ So often, owners struggle with this decision and feel immense guilt no matter which way they turn. Although every situation is invariably different, there are three important considerations that help owners to better evaluate the euthanasia decision.
1. Are there signs of pain or suffering that cannot be adequately treated or controlled?
Your local veterinarian is best placed to help you with options for treatment of your pet’s particular condition. Whilst age itself is not a disease, it is true that debilitating arthritis, cancer, kidney failure and other serious medical problems are more likely to affect our senior patients. Some of these conditions can be successfully treated whilst palliative care may be your only option for others. Signs of pain include vocalisation, panting, reduced appetite, vomiting, difficulty rising, reluctance to play/interact, uncontrollable anxiety and restlessness.
2. Quality of life
Quality of life is a reference to your pets general well being and happiness. It is a collective assessment of many factors and should also be considered in reference to whether there is likelihood of improvement in your pet’s condition over time. If you have noticed a dramatic decline in your pet’s quality of life and there is little hope of improvement, euthanasia may be appropriate. I encourage pet owners who are unsure about quality of life considerations to download our QOL assessment form and complete the daily diary over the coming days and weeks.
3. What is my ability to meet my pet’s requirements for care?
Depending on the veterinary diagnosis, day to day care for some patients can become unrealistically expensive and labour intensive. It is not uncommon for nursing care to become a full time job. For most people this is unsustainable and if your pet’s needs begin to overwhelm your physical, emotional and financial resources it will often impact your relationship and your memory of your beloved pet.
Although no one can make this difficult decision for you, there are many who can support you along the road. Discuss your concerns with friends and family, explore possible treatment options with your vet and allow our team of veterinary professionals to help you in any way they can. Whilst there is no one sign that signals a pet is ready for us to let them go, trust your intuition and remember that you know your pet better than anyone else. If you do decide that in-home euthanasia is the right decision for you, you can be sure that the Sunset Vets experience will be one of dignity, compassion and the gentlest of care.
The decision to say goodbye is always difficult but it doesn’t have to be frightening. At Sunset Vets, we approach this appointment with your pet’s individual needs as the guiding force for all that we do. It may be that they feel more comfortable in a certain part of the house or perhaps their happy place is under a tree in the backyard? We’ve even performed these visits in open spaces such as at the beach or a favourite park. Whatever your preference, this day is about them and about the lives they have touched. Our team aim to have already helped you make all the necessary decisions regarding your pet prior to your appointment day. This may include helping you to select your urn if applicable and we will happily liase with your regular veterinarian both before and after your visit should the situation require it.
At your scheduled appointment time, your Vet will arrive with all the equipment needed to make your pet comfortable. A home visit will usually take between 30 and 60 minutes however this greatly depends on you and your family. Your Vet will ensure your family members have all their questions answered and are comfortable with all decisions that have been made.
Your Vet will then administer a sedative and analgesic (pain relieving) injection under the skin which means that even the most nervous of patients are able to settle and become sleepy over a period of a few minutes. At this point your Vet will ensure that you are ready to say goodbye before administering a dose of anaesthetic. You and your family are able to stay with your pet at all times and can be assured that all steps are taken to minimise any distress or discomfort during this time.
Once administered, your Vet will carefully assess that your pet has passed and at this point, many owners like to take some time alone with their pet. When you are ready, we will assist you with your home care wishes or assist with transport of your pet to one of our personally vetted crematoriums. We only work with businesses that we know will treat your pet with dignity and care. If you have chosen to have your pets ashes returned to you, the crematorium will make contact to confirm your instructions and arrange the return.
Our pets need us to be their advocates. They rely on us for everything from exercise and nutrition to medical care and of course emotional support. In return for their loyalty and love we encourage you to think unselfishly about the factors that affect and determine the quality of their life at this critical stage. Often, people attribute symptoms of illness and disease to simple ‘ageing’ and because they are sometimes subtle, owners are unaware that these are signs of their pet suffering. We want you to make careful and considered decisions that are always in the best interests of the pet who has generously shared their life with you. We hope this guide may help you navigate the confusion of ageing, terminal/chronic or debilitating illness and better understand your options for effective palliative care.
Below are some key attributes that help us systematically consider quality of life for your pet. As time goes on, their illness changes or their capacities reduce you may need to repeat the evaluation. Some people find it useful to fill out the assessment every day and record their results over an extended period. We have provided logs for you to do this for as long as you feel appropriate. Remember quality of life considerations are subjective but you know your pet well and you should trust your intuition when completing the chart. In some cases, this process will give you reassurance that your pet is still enjoying life, whilst in others it may make you realise your pet is suffering more than you were aware. Either way, awareness and careful observation will be your pet’s best friend.
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1 Point – Your pet does not appear to be in pain. They are moving freely, keen for exercise and sleeping well.
2 Points – Your pet has been assessed by a vet recently and prescribed appropriate pain relief for their condition. This medication is working well.
3 Points – Your pet appears painful. They may be vocalising, crying, unable to rest or reluctant to move. Pain medication has been prescribed and is not working adequately or the side effects of medication are severe. Alternative therapies such as acupuncture as a pain management technique have been exhausted.
Note – Signs of pain can be subtle such as an elevated respiratory rate or laboured breathing, pacing in the house or yard, stiffness, difficultly sitting or standing and reluctance to exercise. Remember lameness is a definite indicator of pain even if they are still running / playing readily.
1 Point – Your pet is eating normally and their appetite is good.
2 Points – Their appetite is reduced and they need encouragement to eat or are only eating favourite foods. They may seem to eat more slowly than usual.
3 Points – Appetite is intermittent or even gone completely. Alternatively your pet may be keen enough to eat but there is then vomiting and nausea or diarrhoea.
1 Point – Your pet appears happy and is keen to interact with you. They greet you readily and are willing to receive attention.
2 Points – Your pet may be a bit irritable and grumpy compared with their normal self. They are still interested in daily family activities but may also be seeking more time to themselves.
3 Points – Hiding and avoiding interaction have become the norm. They appear depressed much of the time and no longer enjoy activities they previously did.
1 Point – Energy levels are good and exercise or play is still a normal part of their day.
2 Points – Your pet is starting to ‘slow up’ but is managing well with their prescribed medications and can happily do about half the amount of activity they could do in their youth.
3 Points – Your pet’s mobility is dramatically reduced. This may mean they need assistance to stand and navigate the house or that they have little capacity for exercise. You may have noticed they can no longer manage stairs or get into the car by themselves.
Note – Mobility issues and osteoarthritis should be carefully considered when reviewing a pet’s quality of life. They can be incredibly debilitating and are often a valid reason for compassionate euthanasia, but can also often be dramatically improved by physical therapy, medication and mobility aids such as boots/ramps/lifts/etc.
1 Point – Water intake is normal.
2 Points – Water intake is abnormal to some degree. In many cases drinking will increase, in others your pet will not be drinking enough.
3 Points – Your pet’s level of hydration is inadequate and they require intervention from you (such as syringing or fluids under the skin) to get through the day. Vomiting or diarrhoea may be contributing.
1 Point – Your pet is in an ideal body weight range and is maintaining their body condition well.
2 Points – Your pet is an unhealthy weight however you are monitoring their body shape and change is slow.
3 Points – Weight changes are uncontrolled and increasing or decreasing their food doesn’t seem to make any difference. You may have noticed a rapid change to their body shape such as narrowing at the hips from muscle wasting or bloating of the belly.
1 Point – Toileting patterns are normal and your pet is still grooming normally.
2 Points – You have noticed toileting is not quite normal. They may have difficulty eliminating, be urinating more frequently or passing stools that don’t look normal. You may find their personal hygiene has deteriorated and they require some assistance to keep clean.
3 Points – Your pet is unable to toilet normally. They may have developed urinary or faecal incontinence, may be unable to get up from soiled bedding, are often less likely to groom and may go on to develop pressure sores on parts of the body. Their requirement for hygiene care has dramatically increased and is exceeding your capacity to provide it.
1 Point – Your pet is sleeping normally.
2 Points – Your pet sleeps normally most nights but has started sleeping for longer periods than before. They are occasionally disorientated or confused by where they are and who is around.
3 Points – Your pet is unable to settle, anxious and uncomfortable when lying down. They may whimper or cry at night and require medication for a restful sleep. They are often disorientated and cannot be easily calmed.
Your Personal Thoughts:
And finally we have allowed a section for your own uncensored thoughts.
This is not something we want you to score out of 3 and is purely a place for you to write your observations and concerns.
Jot down notes on how you are feeling and coping as you approach these end of life questions. We know that caring can be daunting and exhausting for even the most dedicated of pet parents.
You may be constantly worried about your pet or there may be tension and disagreement within the family about how to proceed.
With particularly high-need pets, it is also important to give some thought to your own capacity to provide the care required and if your resources for care emotionally, financially or physically are exhausted, it might be time to consider your preparations for peaceful euthanasia.
Many owners also like to record their thoughts on whether good days are still outnumbering the bad and whether their pet is still enjoying the things that previously brought them happiness. This may be food, or walks or as simple as pats. Whatever it is, this will likely play a large role in your decisions about your pets care.
Please Circle Your Pet’s Score
Pain : 1 2 3
Appetite : 1 2 3
Demeanour/Willingness to Interact : 1 2 3
Mobility : 1 2 3
Hydration : 1 2 3
Weight/Condition : 1 2 3
Toileting : 1 2 3
Rest : 1 2 3
Today’s Score :
<10 = Your pet’s quality of life is likely within an acceptable range. Keep monitoring for change or deterioration in your pet’s condition.
10 – 20 = There are some causes for concern and your vet may be able to suggest interventions that could improve your pet’s quality of life.
20 – 25 = Your pet appears to be suffering and quality of life is poor. Discuss these results with your vet as soon as possible.
There is a reason many veterinary euthanasia experts advocate for in home euthanasia however as with everything in medicine there is no one-size-fits-all recipe. Factors such as your relationship with your vet, your pet’s medical condition, their individual personality and your own family situation should all be considered when making the decision that is right for you. Here at Sunset Home Veterinary Care, we strongly believe that pets are more comfortable and relaxed in their own home and we know for most families, the opportunity to say goodbye in privacy is one they truly appreciate.
As well as the benefit of a more peaceful goodbye, we also deeply respect the relationship you may have formed with your local veterinarian. For some pet owners, ‘in-clinic’ euthanasia can make returning to that place for future visits or care of your other pets extremely difficult. It is not uncommon for clientele to change vets directly after the loss of a pet because of the emotional upheaval of returning to the hospital where their last pet has passed. We will always notify your vet of an in home visit so that important vet-owner relationship can be developed into the future.
As a specialised end-of-life veterinarian I’ve seen even the toughest of personalities struggle with that final trip to the vet. On the hardest of days we provide an alternative to the busy carpark… the bustling waiting room… the examination table… and that long drive home alone. Let us find your pet instead on their favourite chair or that worn patch of grass… and when you know it’s time we promise we will meet you there.
Euthanasia is a serious decision and is not appropriate for all cases. With medical advances happening all the time, treatment options for many diseases are improving and in fact, many patients can maintain good quality of life with careful veterinary management, in spite of a terminal diagnosis. Just as your doctor would discuss, palliative care is something we can and often should offer to our pets. Your veterinarian will likely introduce the concept of palliative care when appropriate but owners must also feel empowered to explore these options when making treatment decisions for their own pet. This involves ensuring pain is well controlled, dehydration and appetite are carefully monitored and any debilitating symptoms such as nausea/vomiting are prevented.
Sunset Vets provide both veterinary palliative care and end-of-life services. Our aim is to be an advocate for your pet’s needs and to help you make informed health care decisions in a supportive, non-judgemental environment. If you, or your pet, are not ready for euthanasia or you don’t believe in assisted euthanasia, we can offer you options for compassionate medical care (including referral to complementary and alternative practitioners) and home nursing where appropriate. We know that many owners are overwhelmed when their pet becomes unwell or is discharged from hospital with a terminal diagnosis. Let us help you proactively plan for the months ahead. We are able to train family members to perform specific nursing tasks such as injections and catheter care at home as well as educate owners to accurately identify and assess pain or discomfort. Let our experienced staff help you navigate your options to achieve the best health care solutions for your pet.
Grief affects us all differently. It runs to its own time line and there is no guidebook from which to follow. When we are faced with the loss of a much loved pet many people are surprised by the intensity of their grief. Their devastation is often a culmination of not just the pet’s passing, but also memories of the pet’s ill health and worry or guilt in the lead up to those difficult end-of-life decisions. If you have needed to be actively involved in intensive nursing care in the months prior to the loss of a pet, we know that mental, physical and emotional exhaustion will also play a role in your grief.
I frequently hear owners apologise for their grief during the euthanasia process. Yet it’s important to understand that any feelings of sadness, anger, guilt, confusion or fear about the future are normal. It is also common to feel simply overwhelmed by the situation you find yourself in. If you are experiencing any of these emotions, counselling may help you to make sense of your grief. This process is also useful for owners who are having difficulty remembering their pet in happier times. At Sunset Vets, we aim to ensure that you have access to the right support for your own unique situation. Let our team of compassionate veterinarians, experienced staff and trained pet loss councillors help you through this difficult time. Saying goodbye is hard. With the right support, loving and remembering is easy. We’re always with you.