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Can Quality of Life be Measured with a Number?

Many pet owners are told, “you’ll know when it’s time,” but this often isn’t true. For many pets, there is a gradual decline from health to debilitation with ups and downs along the way; where we draw a line to stop this progression is not exact. With many illnesses, it’s impossible to know what each day will bring. While every euthanasia decision is incredibly sad, sometimes there are conflicting inputs that make the decision especially difficult. Are any of the following situations familiar?

Pet owners who are conflicted about a euthanasia decision may turn to a Quality of Life (QOL) scoring scale for guidance. Benefits of these scales include:

The best known QOL scale for pets is the “Five H Two M” Scale created by Dr. Alice Villilobos and it is at the bottom of this page. Other QOL measuring systems exist. While such scoring systems can be helpful, they are by no means the only means for deciding when it’s time to consider euthanasia. Here are some things to think about if you look at a QOL score:

In general, QOL scales are less helpful for pets who have severe orthopedic disease, cognitive decline, or illnesses that cause pain, difficulty breathing, or internal bleeding. Do not lose sight of the big picture as you focus on the details of your pet’s well being. Also, please remember that every pet’s medical and emotional situation is unique, as is every family and home situation. QOL scales are not always good at taking such unique differences into account.

Often, there really is no such thing as a precise Right Time to euthanize. Most importantly, the timing of euthanasia is almost never a purely medical decision - it’s an emotional one, too. Whatever your pet’s medical problem is, no QOL scale can tell you if your pet is happy or not: you are the best expert on your pet’s well-being. A QOL score may help guide you, but the ultimate decision lies within your heart, telling you what is best for your beloved friend.

Quality of Life Scale (The HHHHHMM Scale)

Score the pet on each item below using a scale of 0 to 10 (10 being healthy).

See the above caveats when interpreting the result.

HURT - Adequate pain control & breathing ability is of top concern. Trouble breathing outweighs all concerns. Is the pet's pain well managed? Can the pet breathe properly? Is oxygen supplementation necessary?  

HUNGER - Is the pet eating enough? Does hand feeding help?

HYDRATION - Is the pet dehydrated? For patients not drinking enough water, subcutaneous fluids daily or can supplement fluid intake.  

HYGIENE - The pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores with soft bedding and keep all wounds clean.  

HAPPINESS - Does the pet express joy and interest? Is the pet responsive to family, toys, etc.? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be moved to be close to family activities?  

MOBILITY - Can the pet get up without assistance? Does the pet need human or mechanical help? Does the pet feel like going for a walk? Is the pet having seizures or stumbling?

MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be too compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. The decision for euthanasia needs to be made if the pet is suffering. If death comes peacefully and painlessly at home, that is okay.  

*TOTAL SCORE (0 - 70)* A total over 35 points represents acceptable life quality to continue with pet hospice.  

Original concept, Oncology Outlook, by Dr. Alice Villalobos, Quality of Life Scale Helps Make Final Call, VPN, 09/2004; Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, Blackwell Publishing, 2007. Revised for the International Veterinary Association of Pain Management (IVAPM) 2011 Palliative Care and Hospice Guidelines.

Available for download at www.pawspice.com.

Other Euthanasia Topics:

Knowing when it’s Time

What to Expect, How to Prepare


QOL Scales