When the Consternation Is Not About Death But About the Decision to Allow Death
“When to euthanize is a very deeply spiritual decision,” says Alicia Karas, DVM, who heads the Tufts Pet Loss Hotline and therefore knows that people often call in not only once their dog has died but also when they have to make the decision about whether to put their pet down. “Compassion is called for” when it comes to hearing people out about this, she says.
In a number of cases, helping them through is relatively simple. People will say they would like to see their dog through Thanksgiving or Christmas, “but it’s important to recognize that the concepts of time and holidays don’t mean anything to the dog and that holding off is not for the dog’s sake,” the doctor points out. “There is a lot of bargaining people do for time, sometimes at their dog’s expense,” she says, “and it’s our job to help them reach a decision about what will be best for their pet, which ultimately will be best for them because it won’t leave them with guilt after the fact.”
When it’s not yet clear if a dog’s time has come, Tufts Pet Loss Hotline staff will send out the HHHHHMM (H5M2) Scale, a quality-of-life scale, so people can go through a checklist about the key aspects of what defines quality of life. Should the checklist show that most of what a dog needs to have life worth living is no longer present, an owner may find it easier to opt for euthanasia. On the flip side, Dr. Karas says, “it is important for people to know that if their dog is limping but able to go for walks, chase a ball, and get on the bed, that dog is still having quality of life. People benefit from this guidance because if you euthanize your dog too soon, you will suffer, and if you choose to do this too late, your dog will suffer.”
Quality of Life (HHHHHMM) Scale
“Pawspice,” a quality-of-life program that takes terminally ill pets from diagnosis through the eventual transition to hospice before death, is the creation of renowned veterinary oncologist Alice Villalobos, DVM, FNAP. It includes a scoring system called the HHHHHMM (H5M2 Quality of Life) Scale to assist a dog’s family members in considering key aspects of an ailing dog’s experience. The five H’s are Hurt, Hunger, Hydration, Hygiene, and Happiness; the two Ms, Mobility and More Good Days than Bad. The criteria are judged on a scale of 0 to 10. A total less than 35 suggests that the dog may be better served with euthanasia rather than continued life. However, if a pet can’t breathe properly, nothing else matters.
The HHHHHMM Scale*
Based on a scale of 0 to 10, with 10 ideal.
____ HURT: Is the pet’s pain well managed? Can the pet breathe properly? Pain and breathing difficulty are top concerns, and trouble breathing outweighs all concerns.
____ HUNGER: Is the pet eating enough? Does handfeeding help? Would a feeding tube help?
____ HYDRATION: Is the pet properly hydrated? For patients not drinking enough water, will using subcutaneous fluids daily or twice daily be enough of a supplement?
____ HYGIENE: Can the pet be kept clean, including after eliminations, or is self-soiling persistent and difficult to tend to? Can pressure sores be avoided with soft bedding and frequent turning?
____ 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?
____ MOBILITY: Can the pet get up without assistance? Can the pet get by without human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, but an animal with limited mobility yet still alert, happy and responsive can have a good quality of life as long as caregivers are committed to helping their pet.)
____ MORE GOOD DAYS THAN BAD: When bad days outnumber good days, quality of life might be too compromised.
____ TOTAL: A total of more than 35 points represents acceptable life quality.
*Wording was modified slightly for Your Dog readers. Adapted with permission from Dr. Alice Villalobos on August 6th, 2017. See www.pawspice.com.