I am sure that many people, and maybe even some veterinarians, may regard questions like this as being one of the most challenging and heartbreaking parts of my job as a veterinarian. But I appreciate when clients ask me for guidance, and it brings me a sense of purpose to help guide them through their questions (and often ultimately their final journey with their beloved pet).
Below is some of the advice I give and the things I discuss, and I hope many will find this helpful — whether as a veterinarian or pet owner.
I think it is important to note that, while many of us would like to just have our pets peacefully die in their sleep on their own, such things rarely happen.
Death, on its own, can be scary, painful, sudden, and traumatic to witness. I personally believe that being able to give animals a dignified and peaceful exit from this world is one of the greatest gifts that we as veterinarians can offer our patients and their owners.
I know from personal experience that not being present when your pet dies leaves you with a lot of questions. I had my cat die in her cage between the 15-minute checks I had the staff doing on her, while waiting on her blood work to come back from the lab. I would have euthanized her after receiving the blood work results, but I never got that chance, and I have always regretted that she died alone and wonder if she suffered.
Sometimes it’s easy. Sometimes as owners we just know. I have had some clients tell me “I just looked in his eyes and knew it was time.” In those cases, I validate what the owner tells me, because they truly know their animal best.
Sometimes people can doubt their decision once they get in the office. I know that even if a dog comes in wagging its tail, often the owner is distraught and feeling guilty since it’s “the first time he’s done this in a week.” And I know it is.
Believe it or not some animals like coming to the vet, and others can get an adrenaline rush just by coming in the door, making them temporarily perk up. I always reassure people that this happens, and does not mean that their decision was premature or should be second-guessed (the “high” will inevitably wear off once the animal gets back home).
Quality of life
Sometimes there is a sudden worsening or decline that makes the decision obvious (i.e., the 16-year old lab with cancer that finally stops eating). Sometimes there is one thing that is a quality-of-life deal-breaker for that animal.
To illustrate this, I often tell people the story of my greyhound, Smitty. Smitty had separation anxiety, and, well, anxiety about a lot of life in general.
He was 75 pounds, arthritic, and would panic if picked up. When he could no longer go up and down stairs in our house, I knew it was time. He was still eating, but his quality of life revolved around being able to follow us everywhere.
I knew if I let him continue, my last memory of him would be him falling to his death on the stairs. Instead, my last memory of him is stroking his head and telling him I loved him.
How do you know when it’s time?
Often, however, there is not a sudden change or worsening, and more of a gradual decline. These are the cases that I, as a veterinarian and pet owner, struggle with the most.
Most sick and/or elderly animals will have good and bad days. They may take one step forward, but then will take two steps back, and often they will rally just when you felt ready to make your decision. I have two methods that I suggest to owners to help them in these cases.
The 5 things
I have people make a list of the five things that their pet loves/loved to do — that define their happiness and who they are as an animal.
This list may include things like eating, barking at the mailman, following their owner around, sleeping in a favorite chair in the sunshine, digging in their favorite hole in the yard, or begging for their favorite treat after dinner.
When it gets to a point that the pet is no longer willing or able to do 3-4 of the things on this list, then I really start to question their overall quality of life.
Rate the days
I encourage owners (ideally all able owners in the home), to rate their pet’s days each day on a scale of 1 (worst day ever) to 10 (best day ever). These are helpful to compare and see if one owner potentially has a skewed view of the situation (i.e., mom and teenage son rate most days a 2-3, whereas dad rates days as 5-6).
They are also helpful to look at trends over time in a more objectified manner. As an owner you may feel like Buster is holding pretty steady, but when you look at your ratings over the past 4 weeks, the weekly average is going down each time.
Sometimes it can help to come to a predetermined “cut off” before starting this, which all owners agree is a point at which it’s no longer fair to keep going (i.e., Buster has 3 or more days of a 2 or less rating for 2 weeks straight).
Pet owner guilt
And then there’s guilt. This is the most common sentiment that I hear expressed from owners, even beyond sadness. And it goes both ways (“I waited too long” or “I feel like I am doing this too soon”).
My goal with the above points is to help prevent people from getting to point where they feel like they waited too long. But what is “too soon?” Is it too soon to say goodbye to the obese, elderly, Burnese mountain dog who is incontinent and urinating massive amounts all over herself and the rugs and the carpet every single night?
Is it too soon to say goodbye to the cat in renal failure who needs SQ fluid therapy to stay alive and feel better, but now runs from you and hides every time he sees you get the bag?
Is it too soon to say goodbye to the spaniel in heart failure who you have to spend 1.5 hours getting medication into 3 times daily because she refuses to eat the pills?
Is it too soon to say goodbye to the 5-year-old golden retriever with terminal cancer whose chemotherapy expenses are eating away at your kid’s college funds?
My answer to all of these questions is to say “it’s ok to let go.” Let go not only of your pet, but also of your guilt. The human animal bond is so important, and in all of these scenarios that bond is broken, or on the verge of being so.
It’s so hard — I’ve been there. I have had the elderly dog that I got so angry with because she would not take her medication and made me late for work constantly, no matter how early I got up.
Towards the end, I spent more time being angry at her and then hating myself for being angry with her than actually loving her and giving her good quality time. I needed someone to give me permission to let her go, and to let go of my guilt.
Quality of life for pets and owners
Here is where I am talking directly to pet owners and fellow veterinarians: As a pet owner, your quality of life matters, too.
Your pet doesn’t want you to suffer (except for maybe that one cat we’ve all owned — you know the one!). Sometimes they keep going purely because they feel like we want them to.
It’s ok to euthanize your animal when your quality of life is suffering… because whether you realize it or not, your pet’s quality of life is suffering too, as a result of this.
I know I am anthromorphizing here, but your pet loves you, and they want you to remember them with fondness and love, and not with guilt and resentment.
In closing, euthanasia is a valuable tool in veterinary medicine that I am so thankful we have.
The decision about when to do it is seldom an easy one, but I hope I have provided some guidance in that regard. I know that I have a whole slew of animals waiting for me over the rainbow bridge, and I know they all love me, no matter what.
Kristen Dewey, DVM is an Associate IndeVet practicing in North Carolina. She’s shown above with Cindy and Duchess.