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Assessing Quality of Life

Assessing Quality of Life:
How Will I Know When It is Time to Say Goodbye?


 

Euthanizing a beloved companion animal is probably one of the hardest decisions a pet caregiver will ever make. When a pet’s death is inevitable, euthanasia may provide a compassionate end, while giving the family control over where, when, and how their pet will die.

However, the euthanasia decision is often racked with conflict, guilt, and confusion. This process can be particularly hard for someone who is facing a euthanasia decision for the first time.

Some individuals have religious, spiritual, or personal belief systems that do not support euthanasia. For others it is a thoughtful decision and considered a humane option. Euthanasia may be an act of mercy and kindness to preserve dignity at the end of life.

Guidelines to Help You Facilitate This Difficult Conversation and Decision Making Process

1. Provide information on the pet’s physical condition

Talk openly about the pet’s diagnosis, prognosis and treatment options. Use simple language and avoid technical jargon. Create a mental picture for the client. Discuss the best and worst case outcomes. Elicit the client’s ideas, perspectives and concerns. Create opportunities for the client to ask questions.

“What questions do you have about Max’s cancer?”

“What is important to you as we proceed with treatment?”

“What factors might we use to determine if Max is not responding well to treatment?”

“How do you think we should balance treating Max’s cancer and ensuring quality of life?’

2. Assist your client in defining priorities and bottom lines

“What makes life worth living for Max?”

“Under what circumstances would life not be worth living for Max?”

“What are your hopes for Max? What are your fears for Max?”

3. Express empathy for what the family is going through

“It can be challenging to switch gears from fighting the disease to ensuring quality of life.”

“You have done everything you can to fight this cancer.”

“I can see how much you love Max and that is why this is so hard.”

4. Partner with your clients through this process

“We will work through this together.”

“How might I help you?”

“I will assess Max along the way and give you updates on his progress.”

“I want you to feel free to ask questions and express your concerns at any time.”

5. Provide concrete tools to help the family assess the pet’s quality of life

“Recall Max’s lifestyle when he was well. You can use this as a point of reference to assess how much quality of life has changed. What is his quality of life like now?”

Suggest exercises to assist clients in assessing their pet’s quality of life. It is helpful to encourage the entire family to take part in these activities:

“One thing that might be helpful is to create a list of the qualities or activities that make Max happy day-to-day.”

What kinds of things would you include in this list?

How might you use this list as a guide to assess Max’s progress?

Are there any items on the list that are deal-breakers for you and Max?

“You might want to keep a journal and record notes on how Max is doing. You could record his eating and bathroom habits, activities, attitude and energy level. Sometimes it is hard when you are caring for someone daily to see the changes. You can use the journal to look back in time.

“You could mark Max’s good and bad days on a calendar using a “smiley” or “frowny” face. It may help you keep track of how Max is doing from day-to-day.”

6. Encourage your client to trust their own judgment and that of their pet

It can be helpful to acknowledge the client’s special relationship with their pet, to support the client’s ability to assess quality of life and to encourage the client to take time to listen to their pet. Some clients can feel like this is putting a lot of responsibility on their shoulders, so it is important to include the concrete measurements above along with this suggestion.

“You and Max share a special bond. Trust that the outcome will become clear at the proper time. Observe Max’s behavior. Spend time with him. In your time together, you have learned to recognize Max’s needs without the use of words. Given your special relationship, Max may let you know when it’s time to say goodbye.”

7. Support the client in taking into account their quality of life and that of their family

It can be physically, emotionally, and financially stressful to take care of a sick or injured companion animal. It’s normal for pet caregivers to feel guilty when they take their own needs into consideration. It’s important to check in to see if your client is feeling overwhelmed, exhausted, frustrated, or resentful in relation to taking care of their pet. It is helpful to validate that it is natural to feel this way. Financial concerns or limitations may also be raised during this discussion.

“How are you doing in caring for Max?”

“It is important that you take some time to care for yourself, so that you can continue to care for Max.”

“You have done such a wonderful job in caring for Max.”

“Who else might be willing to help you care for Max?”

“It is normal to feel exhausted from getting up several times in a night to check on Max.”

“It sounds like you are feeling guilty that money is part of this decision.”

8. Consider collaborating with a local pet hospice program

The Pet hospice philosophy is modeled after that of human hospices; it functions on the principle that death is a part of life. Pet hospices address pain control and attend to the physical and emotional comfort of the pet, while providing educational and emotional support to the family. Pet hospice supports the transition between terminal illness and end-of-life care.

Author: Jane R. Shaw, DVM, PhD, Assistant Professor, Argus Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University

Related Websites
Argus Institute
Offers a variety of resources to assist you in guiding your clients through the process of euthanasia and assist them in their grief.

References

  1. Lagoni, Butler, Hetts, The Human-Animal Bond and Grief. W. B. Saunders and Company, 1994.
  2. Shaw JR, Lagoni L. End-of-life communication: Delivering bad news and Euthanasia-decision making. Vet Clin Small Anim 37:1; 95-108, 2007.
  3. Bishop GA, Long CC, Carlsten KS, Kennedy KC, Shaw JR. The CSU Pet Hospice Program: Supporting the human-animal bond. JVME. 35:4; 525-531. 2009.
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