The Human-Animal bond embraces love and respect for companion animals in society. People are emotionally shocked when their beloved pet is diagnosed with life-limiting or advanced stages of disease. Pet lovers are demanding that veterinarians step up to provide more comprehensive end of life services for their pets as long as the pet is able to maintain a good quality of life (QoL).
Society accepts that humane euthanasia (well, death) for companion animals is indeed the best option when QoL is lost or the best way to mercifully end pointless suffering. This viewpoint may have served the veterinary profession and society adequately in the past. But today, pet lovers want more options when their pets are aging or are diagnosed with life-limiting disease or cancer. Modern pain management, high tech medicine and good nursing care can restore and maintain QoL for longer periods.
Caregivers want to extend the timeline between the diagnosis of a terminal disease and death for their companion animals. Society’s wish to provide end of life care for companion animals raises lots of bioethical questions such as: What are one’s obligations to their companion animal? Must all of the disorders in my companion animals be addressed? Is palliative care (treating symptoms without intent to cure) good enough? How can one evaluate or assess an animal’s QoL? How can one restore and maintain QoL? How will I know when it is the right time to make the final call for the gift of euthanasia? What if my religious or personal beliefs about my animals are not in alignment with my community?
How will I know when it is the right time to make the final call for the gift of euthanasia?
All pet caregivers have an obligation to properly assess their pets’ QoL and to maintain the best quality of life for their animals as possible. The “HHHHHHMM” Quality of Life Scale In 2004, out of necessity, the HHHHHMM QoL Scale was created to help pet lovers look at issues that are difficult to face. The “HHHHHMM” acronym makes it easy to recall the five H’s and two M’s which represent: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad days.
The QoL Scale is not perfect but helps all caregivers to ask themselves if they are truly able to provide enough care to properly maintain their ailing pet’s QoL. Animals have certain needs and desires which should be recognized and respected by their caretakers.
The Five Freedoms of Animal Welfare was developed for farm animals in the United Kingdom. Yet this list is useable for all companion animals. The Five Freedoms are:
1. Freedom from Hunger and Thirst
2. Freedom from Discomfort
3. Freedom from Pain, Injury or Disease
4. Freedom to Express Normal Behavior
5. Freedom from Fear and Distress
The HHHHHMM QoL Scale (below) provides useful guidelines for caregivers to help sustain a positive and rewarding relationship that nurtures the human-animal bond at the end of life.
Table 1. Quality of Life Scale The HHHHHMM QoL Scale
Pet caregivers can use this scale to evaluate the success of their pet’s Pawspice program. Using a scale of 0 to 10, patients can be scored.
H: 0 – 10 HURT – Adequate pain control, including breathing ability, is first and foremost on the scale . Is the pet’s pain being successfully managed? Is oxygen necessary?
H: 0 – 10 HUNGER - Is the pet eating enough? Does coaxing and hand feeding help? Does the patient require a feeding tube?
H: 0 – 10 HYDRATION - Is the patient dehydrated? For patients not drinking enough water, 2 teaspoons for every ten pounds, give subcutaneous fluids once or twice daily to supplement fluid intake.
H: 0 – 10 HYGIENE - The patient should be kept brushed and cleaned, particularly after elimination, avoid pressure sores and keep all wounds clean and bandaged properly.
H: 0 – 10 HAPPINESS – Does the pet express joy and interest? Is he responsive to things around him (family, toys, etc)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be near the kitchen and moved near family activities so as not to be isolated?
M: 0 – 10 MOBILITY – Can the patient get up without assistance? Does the pet need human or mechanical help, a cart? Does he feel like going for a walk? Is he having seizures or stumbling? Some caregivers feel euthanasia is preferable to amputation, yet an animal with limited mobility may still be alert and responsive and can have a good QoL as long as the family is committed to quality care.
M: 0 – 10 MORE GOOD DAYS THAN BAD – When bad days outnumber good days, QoL 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= *A total >35 points is acceptable QoL for pets to maintain a good Pawspice
By Dr. Villalobos Table 10.1, p 304. Original article, QoL Scale Helps Make Final Call, VPN, 09/2004 From the book Your Dog’s Golden Years www.SeniorDogBooks.com