When Is It Time to Let Go?

Euthanasia:  The why, when and how of saying goodbye to a beloved pet.

Probably the most difficult decision a pet owner faces is when to put a beloved pet “to sleep.”  And as the holidays approach, veterinarians throughout the US notice a definite increase in the number of euthanasias we are asked to perform.  No one knows exactly why this is, but it happens every year, in all climates and across socioeconomic lines.  Many cases are the culmination of a long, slow deterioration in health; others are sudden – such as accidents or acute illness.  And clearly, these can happen at any time of year.  But in all situations, pet owners may simply feel overwhelmed with the responsibility of making such a decision.  When is it time?  How can you know?

The word “euthanasia” comes from the Greek: “Eu” means “Good, and “Thanos” refers to “death.”  So “euthanasia” is literally “the good death.”  It has been used in various forms over the millennia for both animals and humans when it was felt that death was imminent or inevitable, and that to postpone it would only mean profound suffering.  Over time, our ability to identify and treat the underlying causes of this suffering has given us the ability to take a step back and in most cases, plan ahead. The process begins long before the act itself.  Even if your pet is basically healthy, it’s a good idea to recognize that you will probably be faced with this decision at some point in the future.  Knowing how you feel about certain things can help immeasurably when the day arrives.

As veterinary medicine evolves and pets fill an increasingly important role in our lives, this decision becomes ever more subjective.  Add to this the fact that our pets can’t speak – can’t tell us how they are feeling, so we must interpret their behavior, physical findings and test results to determine when the distress is too great to prolong.  This article will attempt to provide some broad guidelines, but because every circumstance is unique, ultimately the decision is between you and your veterinarian.  In fact, we will primarily consider those cases where death is the culmination of an illness lasting more than a day, rather than an urgent decision resulting from immediately life-threatening injury, but many of the same principals apply.

Step One: The Diagnosis

Once your pet is diagnosed with a chronic or terminal illness, it’s time to recognize that you will probably be faced with making life-and-death decisions on his or her behalf.  Depending on the exact issue in question, that day may be years away!  But it will be based on numerous factors.

  1. How does the condition affect the pet?  It’s important to realize that while we tend to equate “suffering” with “unrelenting pain,” there are ways to suffer that do not involve pain, and there is pain that doesn’t warrant euthanasia.  Chronic, unremitting nausea, severe itching that can’t be addressed medically, or profound physical disability may lead to death without being painful.  On the other hand, for example, ongoing arthritis pain cannot be “cured,” but does not justify euthanasia in most cases.
  2. This is one time when well-intended advice from people on the “outside looking in” may not be ideal.  You are the person or people bonded with your pet.  You are the only one(s) truly in a position to decide whether the animal is ready to move on.  Your friend/ neighbor/ relative who visits one day and is sure “it’s time” is not; even your veterinarian can only give advice based on what we see at that moment and on our experience with other, different, cases.  I’ve seen pets that were blind, deaf, skinny, toothless and arthritic but still obviously content to lie on their owners’ laps and nibble treats.  But of course, your decision may also affect those close to you, so their opinion has to be considered.

Step Two:  Therapy –

  1. Being able to offer relief of symptoms makes all the difference in some cases.
    Is treatment available?  Is it likely to be effective?  For how long?  Ask lots of questions, to get as clear a picture as possible of what to expect.
  2. Can you afford the financial cost?  Is it worth the cost for the benefit expected? (Some treatments are very expensive for minimal gain.)
  3. Can you manage the caregiving?  Many people simply are not in a position to manage the day to day demands of caring for a dying pet.  This MUST be considered!  More important, it’s OK to make this number one.  For example, if you decide to seek treatment for a pet’s cancer, this may involve a number of trips to a specialist out of town, and some people just can’t face the traveling.   I find that people are often comfortable making decisions based on financial necessity but will beat themselves up for not being available to provide ongoing intense nursing care due to other obligations.
  4. Are you willing to deal with the problem?  This is a separate issue, and it’s OK to say “no!” or to draw a firm line.  I’ve seen cases where owners would happily medicate three times a day and hire a carpenter to build ramps for the aging pet to move around, but when it became incontinent they drew the line.  I can’t fault them for this – in fact, I respect pet owners who recognize their limits.
  5. Is the pet on board with being cared for?  It doesn’t matter how willing you are to provide medication if giving treatment is harder on the pet than the original medical problem.  A cat patient I had in vet school would literally vomit when she saw me coming, knowing I was about to give her several pills – her reaction was so severe she would literally start gagging at the sight of me.  Her condition was treatable, but she refused treatment the only way she could!

Step Three: Knowing When It’s Time

This is the most subjective part.  Every pet has a unique level of tolerance, and responds to treatment on his or her own terms.  Your veterinarian will be able to help you understand what they are going through, and recommend therapies for the condition and/or its symptoms.  But as the pet’s caretaker, it falls on you to monitor their day to day progress.

Below is one example of a chart you might use to assess the quality of life for a pet whose health is failing.  Such charts are not intended to replace your “gut feeling,” but rather to help you take a step back emotionally and try to see things as you might if you were experiencing the same symptoms.  The lower the score, the more you should consider euthanasia as an option, or seek additional treatment options from your veterinarian.  This should be done on a regular basis – weekly, monthly, or quarterly.  An obvious downward trend is as important as any single score.

Consideration    1 = Poor, 10 = Excellent
Enjoys interacting with companions (humans or other pets)     1    2    3   4    5    6   7   8   9   10
Appetite score     1    2    3   4    5    6   7   8   9   10
Ability to stand without help     1    2    3   4    5    6   7   8   9   10
Ability to walk/ run     1    2    3   4    5    6   7   8   9   10
Ability to see/hear/ respond to owners     1    2    3   4    5    6   7   8   9   10
Toileting control/ soiling of self or bedding     1    2    3   4    5    6   7   8   9   10
Pain score – whimpering, reluctance to move, withdrawal     1    2    3   4    5    6   7   8   9   10
Nausea/ vomiting score     1    2    3   4    5    6   7   8   9   10
Other quality-of-life factors     1    2    3   4    5    6   7   8   9   10

Step Four: The Process Itself

While every pet has slightly different needs, and each vet has their preferred way of doing things, the basic process of euthanasia is this: an overdose of barbiturate or similar drug is administered, to first induce coma and then death.
Many vets offer this service in the home, especially for larger dogs.  However, give careful thought before choosing this option – some pets are upset when “strangers” enter their home and may hide or behave aggressively.  This can be very upsetting for the humans involved, and ironically, if the pet is highly excited, the drugs may not work as predictably.  In some cases, it might even be best to ask the vet to prescribe an oral sedative to be given in advance, to avoid distress for all concerned.

Treats may be given if the pet is interested – this is the time to offer those “forbidden” foods like hamburgers, chocolate, etc.!  When the time comes, most will first inject a tranquilizer, which works gradually over a few minutes.  That allows the pet to essentially drift off to sleep, often in the owner’s lap or on a favorite blanket while surrounded by loved ones.  This final injection is given intravenously, by which time the pet is completely unaware of it.

Finally: It helps to know in advance what you want done with the remains.  While some people do opt for home burial, this is a questionable practice, legally speaking.  Commercial pet cemeteries exist, and for some this is a great option.  In addition, I’ve heard of a few more exotic options including taxidermy and even freeze-drying.  But today, the most common (and simplest) option is cremation.   Your veterinarian can make arrangements for this, with the ashes returned in a lovely box.  Many then hold a small memorial, scattering or burying the ashes in a favorite spot – I’ve even known of cases where the ashes were interred with an owner’s remains.  Or, if you want to know they were cremated but don’t choose to keep the ashes, most crematoriums can arrange for them to be scattered at sea.
For more information, contact your veterinarian.

Lillian Roberts, DVM, is the owner of Country Club Animal Clinic which is located at 36869 Cook Street, in Palm Desert.  760-776-7555   www.countryclubdvm.com.