Children and Pets – Grief following Loss of a Dog

How do children react to pet loss and grief?

The death of a cherished pet creates a sense of loss for adults and produces a predictable chain of emotions. The stages of grief are typically denial followed by sadness and depression, then guilt, anger, and finally, relief or recovery. However, the effects on children vary widely depending upon the child’s age and maturity level. An individual child’s response to the death of the family dog depends on their ability to understand death and mortality.

What should I tell my child?

The death of a pet may be the child’s first experience with death and loss. It can be a valuable opportunity to teach the child how to express grief in a healthy way.

With all children, it is important to be as direct and honest as possible. Phrases such as “put to sleep” can be very frightening to younger children, who may develop a fear of going to sleep. Stories such as the dog “ran away” or “went to live on a farm” may leave the child feeling abandoned or else believing that the pet will return some day. Although it may cause the child some initial pain, it is far better to tell the truth, such as the pet “died” or “our veterinarian gave the pet a drug to stop its heart”.

Exactly what you should tell your child depends on the age of the child, their personality and emotional maturity, the relationship that the child had with the dog and the reason that the pet died. Child development experts advise us that children may have “magical thinking”, believing that they are responsible for things that happen in their lives, including a pet’s illness or death, or that if they wish hard enough their dog will get better.

If the pet is being euthanised, you should talk openly with your child about whether they want to be involved in the process. You should also allow the child to talk openly about death, so that you can understand it from the child’s point of view and provide reassurance as needed. Children may ask the same questions repeatedly. They also have fewer taboo subjects than many adults and may ask pointed questions that might seem morbid to adults.

It is important that you act as a good role model; if you shield your child from the emotions that are part of your own reaction to grief, your child may feel that it is more ‘grown-up’ to hide their feelings. It is also important to tell other adults who play a significant role in the child’s life (a favorite relative, teacher, neighbor, or school counselor) about the pet loss, so that they can offer support in this difficult time.

What is the typical reaction to pet loss and grief in different ages of children?

Two and Three Year Olds

Children who are two or three years old typically have no understanding of death or permanent loss. They often consider death as a form of sleep.

“Most psychologists agree that children should be told that their pet has died and will not return.”

Most psychologists agree that children should be told that their pet has died and will not return. The child may react by misbehaving, withdrawing or refusing to speak. The two or three year old should be reassured that the dog’s failure to return is unrelated to anything the child may have said or done. They should be told that this is a natural and expected event and that they were an important part of the pet’s life. Most children in this age range will accept a new pet with little fuss.

Four, Five, and Six Year Olds

Children in this age range grasp the basic concept of death but they believe that the pet is physically living somewhere else, such as in the ground or the sky. In the child’s mind, the pet continues to eat, drink and play, or is ‘sleeping’ in this new place, and may still return home in the future. These beliefs may have been shaped by the child’s previous experience with death or loss of a family member and the explanation of that event offered by adults or other children.

Children in this age group may believe that the dog died because the child was angry or had ill feelings towards the pet. Further, they may worry that if they become angry with another person or animal, they may cause the death of that person or animal. Some view death as contagious and begin to fear that their own death or that of others they care about is imminent. You need to talk about these feelings in a positive, non-patronizing manner. It is important not to be dismissive of these concerns; you should spend time exploring the child’s feelings and reassuring them that death and grief are a normal part of life. When discussing the child’s feelings, it is better to have several short informal talks rather than a long discussion.

Children of this age group often show their grief by disturbances in bladder and bowel control, eating, and sleeping.

 Seven, Eight, and Nine Year Olds

“The permanence of death becomes real to seven to nine-year old children.”

The permanence of death becomes real to seven to nine-year old children. Although children in this age group often believe that they will not die, some may develop concerns about the impending death of their parents. They also may become very curious about death and its implications. Parents should be ready to respond frankly and honestly to questions that may arise regarding mortality, either for the child or for others, including animals.

Several manifestations of grief occur in these children and may include withdrawal, over-attentiveness, and “clingy” behavior. The child may develop problem behavior at school or home, showing learning difficulties, aggression, or imaginary health problems. Some children may initially act as if the loss of the pet is inconsequential, but react with feelings of deep grief several weeks or months later. It is important that parents not dismiss the delayed feelings; the child should NEVER be told that they “should be over that by now” or that “it happened so long ago, I’ve almost forgotten it”. Rather, the child needs support and reassurance that what they are feeling is normal and natural.

Ten and Eleven Year Olds

Children in this age range generally understand death as natural, inevitable, and universal. Consequently, these children often react to death in a manner very similar to adults. Even though they appear to be reacting in an adult manner, they should be treated in a similar fashion to seven to nine year old children.

Adolescents

“Many adolescents exhibit various forms of denial, especially during the initial stages of grief.”

Although this age group also reacts similarly to adults, many adolescents exhibit various forms of denial, especially during the initial stages of grief. This usually takes the form of a lack of emotional display, meaning that teenagers may experience deep grief without any outward manifestations. It is important to encourage adolescents to discuss their feelings about death and not become emotionally apathetic about such a serious and important topic. An open and honest discussion with caring adults will have tremendous impact on how adolescents develop coping mechanisms as adults.

Young Adults

The loss of a pet can be particularly difficult at this age, especially if the pet has been a family member for many years.

“Young adults need the same opportunities to voice their feelings as any of the other age groups.”

Some psychologists say that loss of such a pet represents a “rite of passage” to adulthood. Young adults need the same opportunities to voice their feelings as any of the other age groups.

Summary

Young children usually cannot express their grief in words, mainly due to a lack of verbal skills. However, they can be encouraged to deal with their grief through drawings, play, or other activities such as planning a memorial for the pet. There are a number of well-written children’s books that deal with the subject of pet loss, that are readily available for purchase or at a lending library. Pet loss can disrupt the normal balance in a family and it can be helpful to solicit outside assistance.

“Professional bereavement counselors are available in most cities.”

Professional bereavement counselors are available in most cities. If you are having difficulty with grief over the loss of the family dog, please contact our veterinary hospital. We can provide assistance and contact numbers of professionals and pet loss support groups in our area who can help you and your family.

This client information sheet is based on material written by: Ernest Ward, DVM © Copyright 2009 Lifelearn Inc. Used and/or modified with permission under license.

Euthanasia Decisions and Your Cat

Our culture has evolved to embrace the human-animal bond with love and respect. Our cats are members of the family, and many of us describe ourselves as “pet parents.” Because of advances in veterinary medicine and preventive care, as well as the migration of cats from the barnyard catching mice to the bedroom sharing a pillow with us, cats are living longer and in closer relationships with humans than ever before. The longer the relationship, the stronger the bond. The stronger the bond, the more challenging it is to consider the end of a cat’s life, including the difficult decisions around euthanasia. Although it is heart-breaking to think about the fact that our cats’ lives are generally shorter than our own, thinking about a cat’s eventual need for euthanasia and making a plan ahead of time will relieve much of the stress associated with decisions made when the end of life is near.

“Making a plan ahead of time will relieve much of the stress associated with decisions made when the end of life is near.”

How will I know when euthanasia is the most appropriate and humane option for my cat?

Open and honest communication with your veterinarian and veterinary healthcare team throughout a cat’s life lays the foundation for effective communication when that cat’s life begins to draw to a close. At some point, most cats will develop a life-limiting disease (such as chronic kidney disease or cancer). As soon as such a diagnosis is made, it is time to begin measuring the cat’s quality of life.

Quality of life is a fairly subjective concept, which is why Dr. Alice Villalobos, a veterinary oncologist, has created a qualityof-life scale to help cat owners assign some objective scores to everyday aspects of their cat’s life (see the handout “Quality of Life at the End of Life for Your Cat”). This quality-of-life scale helps us identify trends over time—specifically, declining quality over days and weeks. Your veterinarian will be better equipped to help you identify the right time for euthanasia if you keep him or her informed about the day-to-day details of your cat’s life at home. Discussion with your veterinarian will clarify any specific medical implications of your cat’s disease that can serve as benchmarks to suggest that euthanasia should be considered.

Quality-of-life-related questions that should be asked and answered as the time for euthanasia approaches include:

  • What disease signs and symptoms will I see that will let me know it is time for euthanasia?
  • What day-to-day activities will disappear from my pet’s routine?
  • How will I measure day-to-day quality of life?
  • How often will I measure quality of life?
  • How often will I discuss quality-of-life trends with my veterinary healthcare team?
  • Which categories on the quality-of-life scale will be the most important for my cat?

My spiritual beliefs prevent me from actively or willingly ending an animal’s life. Because I will not consent to euthanasia, how can a discussion of euthanasia benefit my cat and me?

“It is certainly possible to honor spiritual beliefs that prevent euthanasia while still providing and delivering appropriate pain management and comfort care.”

In this scenario, speaking with your veterinarian about your cat’s approaching end of life is even more important. It is certainly possible to honor spiritual beliefs that prevent euthanasia while still providing and delivering appropriate pain management and comfort care. In this case, your veterinary healthcare team may need to be a bit more involved in measuring quality-of-life trends to prevent your cat from suffering unnecessarily.

Where will euthanasia happen?

Most often, euthanasia is provided at the veterinary practice or in your home. In general, the location can be left to the discretion of the family. If you choose euthanasia at home, your primary care veterinarian may be able to provide that service. If not, there are house-call veterinarians as well as veterinarians who dedicate their entire practice to providing inhome euthanasia services. Veterinary professionals can help you, your family, and your cat to be quite comfortable at this challenging time.

What should I consider or plan for regarding what will happen after my cat’s passing?

There are a number of questions that should be asked and answered in preparation for the approaching death of your beloved cat. Some examples include:

  • How will my cat’s body be handled after death?
  • Do I want my cat to be cremated or buried?
  • Do I want to keep a memorial, such as a lock of hair or my cat’s footprint in clay?
  • How will my cat’s body be transported after death?
  • What should I do if my cat dies on his or her own?

By having a detailed plan in place ahead of time, you may feel a sense of quiet or peace that will allow you to f ocus on the remaining time you and your cat will share.

“The veterinary healthcare team will be an important partner as you negotiate the difficult days and decisions leading up to your cat’s death.”

The veterinary healthcare team will be an important partner as you negotiate the difficult days and decisions leading up to your cat’s death. It is important to communicate your wishes clearly so that they can be honored appropriately. A bit of planning can make this challenging event a little less painful.

This client information sheet is based on material written by: Robin Downing, DVM, CVPP, CCRP, DAAPM © Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license.

Euthanasia Decisions and Your Dog

Our culture has evolved to embrace the human-animal bond with love and respect. Our dogs are members of the family, and many of us describe ourselves as “pet parents.” Because of advances in veterinary medicine and preventive care, as well as the migration of dogs from the backyard to the house and even into our bedrooms, dogs are living longer and in closer relationships with humans than ever before. The longer the relationship, the stronger the bond. The stronger the bond, the more challenging it is to consider the end of a dog’s life, including the difficult decisions around euthanasia. Although it is heart-breaking to think about the fact that our dogs’ lives are generally shorter than our own, thinking about your dog’s eventual need for euthanasia and making a plan ahead of time will relieve much of the stress associated with decisions made when the end of life is near.

“Making a plan ahead of time will relieve much of the stress associated with decisions made when the end of life is near.”

How will I know when euthanasia is the most appropriate and humane option for my dog?

Open and honest communication with your veterinarian and veterinary healthcare team throughout a dog’s life lays the foundation for effective communication when that dog’s life begins to draw to a close. At some point, most dogs will develop a life-limiting disease (such as organ failure or cancer). As soon as such a diagnosis is made, it is time to begin measuring the dog’s quality of life.

Quality of life is a fairly subjective concept, which is why Dr. Alice Villalobos, a veterinary oncologist, has created a qualityof-life scale to help dog owners assign some objective scores to everyday aspects of their dog’s life (see the handout “Quality of Life at the End of Life for Your Dog”). This quality-of-life scale helps us identify trends over time—specifically, declining quality over days and weeks. Your veterinarian will be better equipped to help you identify the right time for euthanasia if you keep him or her informed about the day-to-day details of your dog’s life at home. Discussion with your veterinarian will clarify any specific medical implications of your dog’s disease that can serve as benchmarks to suggest that euthanasia should be considered.

Quality-of-life-related questions that should be asked and answered as the time for euthanasia approaches include:

  • What disease signs and symptoms will I see that will let me know it is time for euthanasia?
  • What day-to-day activities will disappear from my pet’s routine?
  • How will I measure day-to-day quality of life?
  • How often will I measure quality of life?
  • How often will I discuss quality-of-life trends with my veterinary healthcare team?
  • Which categories on the quality-of-life scale will be the most important for my dog?

My spiritual beliefs prevent me from actively or willingly ending an animal’s life. Because I will not consent to euthanasia, how can a discussion of euthanasia benefit my dog and me?

“It is certainly possible to honor spiritual beliefs that prevent euthanasia while still providing and delivering appropriate pain management and comfort care.”

In this scenario, speaking with your veterinarian about your dog’s approaching end of life is even more important. It is certainly possible to honor spiritual beliefs that prevent euthanasia while still providing and delivering appropriate pain management and comfort care. In this case, your veterinary healthcare team may need to be a bit more involved in measuring quality-of-life trends to prevent your dog from suffering unnecessarily.

Where will euthanasia happen?

Most often, euthanasia is provided at the veterinary practice or in your home. In general, the location can be left to the discretion of the family. If you choose euthanasia at home, your primary care veterinarian may be able to provide that service. If not, there are house-call veterinarians as well as veterinarians who dedicate their entire practice to providing in-home euthanasia services. Veterinary professionals can help you, your family, and your dog to be quite comfortable at this challenging time.

What should I consider or plan for regarding what will happen after my dog’s passing?

There are a number of questions that should be asked and answered in preparation for the approaching death of your beloved dog. Some examples include:

  • How will my dog’s body be handled after death?
  • Do I want my dog to be cremated or buried?
  • Do I want to keep a memorial, such as a lock of hair or my dog’s footprint in clay?
  • How will my dog’s body be transported after death?
  • What should I do if my dog dies on his or her own?

By having a detailed plan in place ahead of time, you may feel a sense of quiet or peace that will allow you to focus on the remaining time you and your dog will share.

“The veterinary healthcare team will be an important partner as you negotiate the difficult days and decisions leading up to your dog’s death.”

The veterinary healthcare team will be an important partner as you negotiate the difficult days and decisions leading up to your dog’s death. It is important to communicate your wishes clearly so that they can be honored appropriately. A bit of planning can make this challenging event a little less painful.

This client information sheet is based on material written by: Robin Downing, DVM, CVPP, CCRP, DAAPM © Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license

Grief and Bereavement – Loss of a Pet

Unfortunately, our pets do not live as long as we do. In fact, compared with us they live relatively short lives and although we realize this, nevertheless when the time comes to say goodbye, we experience feelings and emotions that sometimes embarrass us, and often confuse us.

“Stages of mourning and grief are universal and are experienced by everyone following the loss of a loved one.”

These feelings actually follow a well-recognized cycle, with stages of mourning and grief that are universal and are experienced by everyone to a greater or lesser extent following the loss of a loved one, be it a person or a pet.

What are these stages of grief?

There are five stages of grieving; the length of each stage may vary in any individual case.

1. Shock and denial – The first reaction to loss of a loved companion is one of shock. You cannot believe it and initially deny the reality of the situation. Obviously, there must be an alternative explanation! Remember that shock followed by the stages of denial and isolation helps to carry us through the first wave of pain.

2. Anger – This commonly follows our initial shock reaction. You may direct your anger within (I did not do enough), at your veterinarian (they did not do enough) or at the animal who is the subject of your grief. If you direct your anger inwards, you are likely to also feel the pain of guilt. Remember that feelings of guilt and helplessness are quite normal and are part of the grieving cycle. During this period, you might want to discuss your concerns with your veterinarian, especially if you have any worries or doubts. Often a heartfelt discussion will do much to ease your pain and distress, and help with the emotional loss of your animal.

3. Bargaining – In order to overcome feelings of helplessness, it is not uncommon to try to strike real or imaginary deals in order to change the circumstances: “if only I had sought medical attention sooner,” “if only I had asked for a second opinion,” “perhaps I should have changed my pet’s diet,” etc. These again are all normal reactions under the circumstances, but do not be afraid to discuss them.

4. Depression – This is a very common and often prolonged part of the grieving process. Actually two types of depression are recognized with mourning. The first concerns the practical implications relating to the loss of the pet. Sadness and regret predominate. You worry that while caring for the animal you have just lost, you have neglected your other commitments. The second type of depression is perhaps more subtle and is certainly more private. You feel isolated and unable to express your feelings. There is a general sense of confusion and an inability to concentrate on normally routine matters. A change in appetite and insomnia are also common signs. Kingsbrook Animal Hospital 5322 New Design Road, Frederick, MD, 21703 Phone: (301) 631-6900 Website: KingsbrookVet.com

5. Acceptance – This is the recovery stage. You can talk more freely about the loss of your pet and furthermore begin to realize the benefit of communicating your feelings. You soon realize that you are assessing the situation more objectively and rationally. Unfortunately, in the case of a sudden or unexpected death, for example, if your pet is run over and killed, you may get stuck in the stage of anger or denial. It is important to remember that other people understand the bond you had with your pet and can offer you support and understanding.

Should I seek help?

By now, it should be clear to you that your mixed and confused feelings are really quite normal. Do not be ashamed of them or bottle them up inside. It is important to talk to somebody sympathetic to your feelings when you have suffered a loss. Talking helps you come to terms with your feelings and accept your loss more quickly. If you feel particularly vulnerable or feel that you are having difficulty with the mourning cycle, do not be afraid to discuss this with your family doctor or your veterinarian; there is nothing abnormal about the reaction and it is amazing how helpful a little bit of counseling can be. Professional bereavement counselors are available in many cities and towns. If you are having difficulty with grief over the loss of your family pet, please contact our veterinary hospital. We can provide assistance and contact numbers of professionals and pet loss support groups in our area that can help you and your family.

This client information sheet is based on material written by: Debra Horwitz, DVM, DACVB & Gary Landsberg, DVM, DACVB, DECAWBM © Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license.

Hospice Care for Pets – Overview – Part 1

Providing hospice care for pets as they approach their end of life is a relatively young discipline within veterinary medicine. Although the foundational principles of veterinary hospice care are derived fairly directly from those of human hospice care, there are some critical differences between providing hospice care to a human family member and providing hospice care to an animal family member. It is appropriate first to have an understanding of how human hospice and end-of-life care began and evolved before turning attention to hospice and end-of-life care for pets.

What were the origins of human hospice and end-of-life care?

“Hospices” were originally charitable places for travelers on long or difficult journeys to find rest and shelter. Typically, such travelers were on pilgrimages to sacred places and shrines. Hospices that focused on care for the incurably ill emerged during the 11th century and were often overseen by religious orders. In the 19th century, hospice care shifted focus specifically to the dying. Dame Cicely Saunders, an activist nurse, is credited with defining and implementing hospice as we know it today, founding St. Christopher’s Hospice in south London in 1967. Currently, more than 100 countries around the world provide formal hospice care for their citizens.

What exactly is hospice care?

Hospice is supportive care provided to individuals in the final phases of terminal disease so that they may live as fully and comfortably as possible. Hospice care, by definition and as practiced, recognizes that death is a part of life and focuses on maximizing the quality of life for the patient during whatever time remains. Typically, hospice care avoids aggressive interventions, although no specific therapies are excluded from consideration.

Hospice care recognizes that death is a part of life and focuses on maximizing the quality of life for the patient during whatever time remains.

The primary emphases for hospice care are pain management and comfort care. These are very general terms that encompass many different approaches to and interactions with the patient in hospice. For humans, the concept of relief from “total pain” encompasses physical, psychological, social, and spiritual aspects of life. Although a physician ultimately oversees the coordination of hospice care, the key to hospice’s success is an interdisciplinary team that includes medical professionals, trained volunteers, the patient’s family, and the patient working together to honor the patient’s wishes. One Kingsbrook Animal Hospital 5322 New Design Road, Frederick, MD, 21703 Phone: (301) 631-6900 Website: KingsbrookVet.com aspect of hospice is palliative care, which generally involves more specific medical procedures, medications, and interventions to contribute to patient comfort (see the handouts “Quality of Life at the End of Life for Your Cat” and “Quality of Life at the End of Life for Your Dog”).

Where does hospice care take place? Is a hospice like a hospital?

It is important to understand that hospice is a philosophy of caring rather than a place where that care is delivered. Although there are physical hospice facilities, hospice care can be delivered anywhere—including in the home. It is this philosophy of caring that has been applied to pet end-of-life care in developing principles for pet hospice. The goal is to allow the pet to be comfortable in its own home, with its human family by its side, maintaining a mutually interactive relationship for as long as life remains desirable for the pet—either until death comes on its own or until humane euthanasia becomes the most appropriate choice.

The goal of hospice care is to allow the pet to be comfortable in its own home, with its human family by its side.

How does pet hospice care compare to human hospice care?

In its delivery, pet hospice care actually closely mirrors human hospice care. The veterinarian coordinates and oversees medical procedures, medication prescription and delivery, and comfort care, but the day-to-day hospice care happens in the home. The single biggest difference between human and pet hospice care is the opportunity veterinarians have to provide humane euthanasia when quality of life for the pet becomes unacceptable.

As with dying humans, pets with life-limiting disease (illness that cannot be cured) benefit from having a system that measures their quality of life day by day (see the handouts “Quality of Life at the End of Life for Your Cat” and “Quality of Life at the End of Life for Your Dog”). Once a baseline quality-of-life measurement is in place, it is important for the human family to partner with the veterinary healthcare team to determine the most appropriate interval for re-evaluation and to create a plan for responding to changes in the quality-of-life measurement—specifically how to define declining quality of life (see “Hospice Care for Pets – Overview – Part 2” for additional details).

With planning, forethought, and honest communication, it is possible to provide a dying pet with very reasonable and acceptable quality of life as the end of life approaches.

This client information sheet is based on material written by: Robin Downing, DVM, CVPP, CCRP, DAAPM Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license.

Hospice Care for Pets – Overview – Part 2

Hospice care for pets is an emerging niche of veterinary medicine that creates and relies on a unique caring collaboration between the pet owner and members of the veterinary healthcare team. Pet hospice is patterned after the delivery of the end-of-life care provided for human patients, with the additional provision from the veterinarian for humane euthanasia when the pet’s day-to-day quality of life becomes unacceptable.

How will I know if my pet needs to enter hospice care?

Open, honest, and direct communication with your pet’s veterinarian and members of the veterinary healthcare team throughout the pet’s life lays the necessary foundation for effective communication as the end of life approaches. As soon as a life-limiting disease is diagnosed, it is time to open a dialogue about treatment options and how the approaching end of life will be handled.

Many life-limiting diseases, or illnesses that cannot be cured, can be treated aggressively and managed well in some pets—sometimes for many years. Examples of these diseases include diabetes mellitus (also called “sugar” diabetes), the degenerative joint disease associated with osteoarthritis, and various cancers. Treatment strategies are as varied as the diseases themselves and the pets involved. Your veterinarian can create a “big picture” perspective to clarify specific appropriate treatments, the schedule for medication delivery, a recommended schedule for reassessment at the veterinary practice, and the costs associated with all aspects of the recommended therapies and rechecks.

Communication with your veterinarian truly is the key to success in transitioning from chronic disease management to hospice.

As veterinary medicine has matured and advanced, treatment options for chronic incurable diseases have advanced as well. It is commonplace to see pets living with successful management of chronic diseases that until recently would have precipitated euthanasia soon after diagnosis. Although this has been a boon for older pets—those at greatest risk for developing these conditions—it complicates our decision making as our pets age. Communication with your veterinarian truly is the key to success in transitioning from chronic disease management to hospice.

I am worried that I will not be able to provide what my pet needs in a hospice setting. How can I be sure that I do?

Delivery of hospice care is as individual as the pet and the family. There is no one “right” way to provide pet hospice. Instead, there are many different aspects of care that may be appropriate for your pet in a hospice setting. Ask your veterinarian and veterinary healthcare team to be as specific and detailed as possible in creating a hospice care plan. That way, you can ask all the necessary questions to feel confident in the care you will provide.

It is important not to be intimidated by the idea of providing hospice care in your home for your pet.

If a particular procedure or treatment is uncomfortable to perform, seems to make the pet uncomfortable, or is simply impossible to perform, be sure to communicate openly so that an alternative can be explored. A particular pet’s hospice care “plan A” may need to evolve into a “plan B” or “plan C,” depending on the pet’s response to the actual treatments/ procedures as well as the progression of the life-limiting condition. It is important not to be intimidated by the idea of providing hospice care in your home for your pet. Your veterinarian and veterinary healthcare team will help in any way they can. And euthanasia remains the final compassionate gift we can provide our dying pets when that time comes.

How will I know when hospice care for my pet should end?

When a pet enters hospice, palliative, and end-of-life care, we need to identify the benchmarks by which we will measure the quality of day-to-day life for that animal. Dr. Alice Villalobos’ quality-of-life scale is an easy-to-use document that helps us make a somewhat objective measurement of a very subjective experience (see the handouts “Quality of Life at the End of Life for Your Cat” and “Quality of Life at the End of Life for Your Dog”).

As death approaches for a pet and we struggle with the timing and details that surround euthanasia, it is often easier to “begin with the end in mind”—that is, to begin with a detailed discussion and plan around euthanasia, specifically when during the course of the disease euthanasia would be considered most appropriate, how and where euthanasia will be performed, and your desires for taking care of your pet’s body. As difficult as these discussions are, it is easier for all involved when the important decisions are made before the crisis of impending death is before us. Establishing a plan for the very end of a pet’s life merely creates guidelines. The final details of such a plan will be determined by the pet itself as its life comes to a close, so it is appropriate to maintain some flexibility.

Living and caring in the day-to-day way that is associated with hospice care supports a unique emotional connection and intimacy with the pet.

Applying hospice and palliative care principles to our pets as they approach the end of their lives can be an emotionally rich and satisfying experience. This honors the precious, loving relationship we have with our pets, and it honors the pet’s own life force and desire to live. It may be frightening to think about the death that is inevitable and coming soon. That said, living and caring in the day-to-day way that is associated with hospice care supports a unique emotional connection and intimacy with the pet that is difficult to replicate. The hurt and the happiness go hand in hand in this scenario.

With a bit of help and guidance, we really can help our pets “live until they die.”

This client information sheet is based on material written by: Robin Downing, DVM, CVPP, CCRP, DAAPM © Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license.

Quality of Life at the End of Life for Your Cat

Each and every pet has certain needs that should be recognized and respected. Quality of life is a way to refer to and discuss the day-to-day life and lifestyle of a cat reaching the end of its life. If we can successfully meet an ailing or chronically ill cat’s basic needs, then we can feel confident that our efforts in preserving life are justified.

If we can successfully meet an ailing cat’s basic needs, then we can feel confident that preserving life is justified.

What are some of the conditions that might cause a cat’s quality of life to deteriorate?

Most senior pets develop one or more medical conditions that tend to worsen over time. Examples of chronic medical conditions common in the older cat include:

  • Blindness—Generally occurs gradually from fibrous changes in the lens of the eye.
  • Cancer—The risk of cancers of all types increases with age.
  • Chronic renal disease—This degenerative kidney disease leads to the decreased ability of the kidneys to filter biological waste from the blood.
  • Deafness—Generally occurs gradually over time as the eardrum becomes less flexible.
  • Osteoarthritis—Painful inflammation and deterioration of the joints.

Cats can provide special challenges as they age because they are already very adept at disguising illnesses. The signs and symptoms associated with chronic degenerative conditions can be quite subtle, even for owners who are “tuned in” to their cats’ needs and routine behaviors

Cats can provide special challenges as they age because they are already very adept at disguising illnesses.

Is there a way to objectively measure my cat’s quality of life?

Dr. Alice Villalobos, a veterinary oncologist, has developed a quality-of-life scale for cats so that owners can act on behalf of their beloved animal family members as a pet’s end of life approaches. The quality-of-life scale provides guidelines that help owners and veterinarians work together to maintain a healthy human–animal bond. The scale provides a tool with which to measure the success of a palliative care or hospice plan for a cat with life-limiting disease and to fine-tune that care/plan. Kingsbrook Animal Hospital 5322 New Design Road, Frederick, MD, 21703 Phone: (301) 631-6900 Website: KingsbrookVet.com Dr. Villalobos’ quality-of-life scale looks at seven different parameters and scores each parameter from 1 to 10, with 10 being the best. A score above 5 in each category, or an overall score greater than 35, suggests that the cat’s quality of life is acceptable and that it is reasonable to continue end-of-life care and support.

The categories to be measured can be remembered as “HHHHHMM.” This list of letters stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad.

The quality-of-life scale helps owners act on behalf of their beloved animal family members as a cat’s end of life approaches.

What does each category mean for a cat approaching the end of its life?

The HHHHHMM scale:

Hurt: 1–10

Adequate pain control, including the ability to breathe properly, is an absolute necessity. Most pet owners do not know that being able to breathe is ranked as an important pain management strategy. Cats hide their pain extremely well. They will become very still if breathing is a problem. Pain control may include oral or injectable medication.

Hunger: 1–10

If a cat cannot eat properly or willingly, first try hand-feeding. If this is not successful, it may be appropriate to consider a feeding tube for blended or liquid diets, particularly if oral medication must be given.

Hydration: 1–10

Fluid under the skin is generally an easy and well-tolerated way to supplement what an ailing cat is drinking. This is not a “heroic” measure and can really help an older cat feel better.

Hygiene: 1–10

Can the cat be brushed, combed, and kept clean? Is the coat matted? Cats are very sensitive about keeping themselves clean. If they have an oral tumor or back pain, they may not be able to groom and may need help. Waterless shampoo works well to keep the coat clean, and a regular “lion cut” can keep the coat short and easy to manage.

Happiness: 1–10

Is the cat experiencing joy or mental stimulation? Cats communicate with their eyes as well as by purring. Is the ailing cat still interacting with family members and with the environment? Placing comfortable beds near family activities helps a cat remain engaged in life.

Mobility: 1–10

If the cat can no longer move around on its own, it may be time to consider a mobility device. Cats are surprisingly accepting of two- and four-wheel carts as long as any pain is well managed. Mobility and hygiene go together when a cat is bedridden. The veterinarian is an important resource when working through mobility issues.

More good days than bad: 1–10

When there are too many bad days in a row, or if the cat seems to be “turned off” to life, quality of life is compromised. Bad days may mean nausea, vomiting, diarrhea, seizures, frustration, unrelenting pain/discomfort, or inability to breathe.

How will I know it’s the right time to consider euthanasia?

A healthy human–animal bond requires a two-way exchange, and when that exchange is gone, the time for humane euthanasia has arrived. It is important to plan for the end of life before that time arrives, and the quality-of-life scale can be an integral part of that planning. You can help your cat maintain a good day-to-day life experience by using this scale to regularly measuring the parameters that evaluate how well your cat’s basic needs are being met. The scale can also help you clarify the decision for euthanasia, hopefully relieving anxiety and regret about your beloved cat’s end of life

Can my veterinarian help me decide when to let go?

Veterinarians are often asked to help cat owners with the heart-breaking decisions around euthanasia. Your veterinarian is there to help with these very difficult decisions.

This client information sheet is based on material written by: Robin Downing, DVM, CVPP, CCRP, DAAPM © Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license.

Quality of Life at the End of Life for Your Dog

Each and every pet has certain needs that should be recognized and respected. Quality of life is a way to refer to and discuss the day-to-day life and lifestyle of a dog reaching the end of its life. If we can successfully meet an ailing or chronically ill dog’s basic needs, then we can feel confident that our efforts in preserving life are justified.

If we can successfully meet an ailing dog’s basic needs, then we can feel confident that preserving life is justified.

What are some of the conditions that might cause a dog’s quality of life to deteriorate?

Most senior pets develop one or more medical conditions that tend to worsen over time. Examples of chronic medical conditions common in the older dog include:

  • Blindness—Generally occurs gradually from fibrous changes in the lens of the eye.
  • Cancer—The risk of cancers of all types increases with age.
  • Chronic renal disease—This degenerative kidney disease leads to the decreased ability of the kidneys to filter biological waste from the blood.
  • Deafness—Generally occurs gradually over time as the eardrum becomes less flexible.
  • Osteoarthritis—Painful inflammation and deterioration of the joints.
  • Overweight/obesity—More than half of senior dogs are overweight or obese, undermining quality of life.

Is there a way to objectively measure my dog’s quality of life?

Dr. Alice Villalobos, a veterinary oncologist, has developed a quality-of-life scale for dogs so that owners can act on behalf of their beloved animal family members as a pet’s end of life approaches. The quality-of-life scale provides guidelines that help owners and veterinarians work together to maintain a healthy human–animal bond. The scale provides a tool with which to measure the success of a palliative care or hospice plan for a dog with life-limiting disease and to fine-tune that care/plan.

Dr. Villalobos’ quality-of-life scale looks at seven different parameters and scores each parameter from 1 to 10, with 10 being the best. A score above 5 in each category, or an overall score greater than 35, suggests that the dog’s quality of life is acceptable and that it is reasonable to continue end-of-life care and support. Kingsbrook Animal Hospital 5322 New Design Road, Frederick, MD, 21703 Phone: (301) 631-6900 Website: KingsbrookVet.com The categories to be measured can be remembered as “HHHHHMM.” This list of letters stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad.

The quality-of-life scale helps owners act on behalf of their beloved animal family members as a dog’s end of life approaches.

What does each category mean for a dog approaching the end of its life?

The HHHHHMM scale:

Hurt: 1–10

Adequate pain control, including the ability to breathe properly, is an absolute necessity. Most pet owners do not know that being able to breathe is ranked as an important pain management strategy. A dog may benefit from receiving oxygen at home, and it may not be as challenging to provide as you think! Other methods of controlling pain may include oral or injectable medication.

Hunger: 1–10

If a dog cannot eat properly or willingly, first try hand-feeding. If this is not successful, then it may be appropriate to consider a feeding tube, particularly if oral medication must be given. Blended or liquid diets may offer another alternative.

Hydration: 1–10

Fluid under the skin is an easy and well-tolerated way to supplement what an ailing dog is drinking. This is not a “heroic” measure and can really help an older dog feel better.

Hygiene: 1–10

Can the dog be brushed, combed, and kept clean? Is the coat matted? Can the dog move away from stool or urine if it has an accident? Is there a tumor that has outgrown its blood supply and now has an odor or discharge? Often, a dilute solution of lemon juice in water on a sponge or washcloth can be used to clear dead cells away without causing pain. The veterinary healthcare team can help work out the details of this kind of care. It is also important to turn bedridden pets regularly, keep them clean and dry, and ensure that they have adequate padding underneath to prevent bedsores.

Happiness: 1–10

Is the dog experiencing joy or mental stimulation? Dogs communicate with their eyes as well as by wagging their tails. Is the ailing dog still interacting with family members and with the environment? Placing comfortable beds near family activities helps a dog remain engaged in life. Dogs are social animals and can become depressed when they are separated from their “pack.”

Mobility: 1–10

If the dog can no longer move around on its own, it may be time to consider one of the many mobility devices that are available. A sling or harness for support may be all that is required. Other options, depending on how much support is needed, include two-wheel carts, four-wheel carts, and wagons. Mobility devices allow a dog to stay active. This is particularly important for bigger dogs that cannot simply be carried from place to place. Mobility and hygiene go together when a dog is bedridden. The veterinarian is an important resource when working through mobility issues.

More good days than bad: 1–10

When there are too many bad days in a row, or if the dog seems to be “turned off” to life, quality of life is compromised. Bad days may mean nausea, vomiting, diarrhea, seizures, frustration, unrelenting pain/discomfort, or inability to breathe.

How will I know it’s the right time to consider euthanasia?

A healthy human–animal bond requires a two-way exchange, and when that exchange is gone, the time for humane euthanasia has arrived. It is important to plan for the end of life before that time arrives, and the quality-of-life scale can help with that planning. You can help your dog maintain a good day-to-day life experience by using this scale to regularly measuring the parameters that evaluate how well your dog’s basic needs are being met. This scale can also help you clarify the decision for euthanasia, hopefully relieving anxiety and regret about your beloved dog’s end of life.

Can my veterinarian help me decide when to let go?

Veterinarians are often asked to help dog owners with the heart-breaking decisions around euthanasia. Your veterinarian is there to help with these very difficult decisions.

This client information sheet is based on material written by: Robin Downing, DVM, CVPP, CCRP, DAAPM © Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license.