When To Euthanize a Senior Dog - Quality of Life Considerations

Pain

Pain management is crucial to a pet's quality of life. Lots of dogs, like people, live with various aches and pains and are still being able to be active and enjoy life. When pain interferes with your pet's ability to enjoy himself, though, it becomes a serious consideration when thinking about the "right" time to euthanize.

• When getting up is agony, so your pet prefers to stay lying down all day. This can result in even more pain if pressure sores develop from staying in one position.

• When lying down is too difficult, so your pet prefers to remain standing. When he is finally forced to lie down because he's too tired to keep standing, it's clear that doing so is painful - for example, he simply "collapses" instead of a lying down in a controlled way, or he inches down little by little, groaning in pain.

• When walking becomes so painful that your dog just hangs around all day, doing nothing.

• When they're in such pain, they don't want to be touched and may snap if you try.

• Note that not all dogs will cry or whine when they're in pain. Many will hide signs of pain. If, however, you see that they're reluctant to move or engage in their usual activities, that's a pretty good indicator that pain may be the culprit.

It's important to discuss pain management with your veterinarian. It can take time to find the right combination of drugs, supplements, or therapies that work for your individual pet. Discuss complementary therapies with your vet, including acupuncture, physical therapy, laser therapy, massage therapy, chiropractic, and Bowen therapy are some options available to pet owners. There may come a time when nothing appears to work to adequately control your dog's pain. You will need to think about how long you want to try various pain management methods before you set your dog free.

Mobility

Mobility plays such a huge role in quality of life. Many dogs in particular love to explore and to play, whether it's on walks or out and about in the yard. Mobility goes beyond that, though:

• Compromised mobility may mean that your pet cannot do simple things for himself. This can include getting a drink of water when he wants one, or changing positions when he's lying down - which in turn can lead to pressure sores and sore joints.

• For "velcro dogs" that love to follow their humans everywhere, decreased mobility can mean that they can no longer do so. It is particularly tough if they need help up or down stairs, especially if the dog is large and it becomes too difficult or impractical to try to allow them to be with you all the time.

• Pets can have accidents if they're not able to move quickly or easily. This can be mentally distressing for some. Physically, it can mean that they need to be cleaned more frequently and their bedding changed (or floors cleaned).

That's not to say that dogs need to be able to run and romp around like puppies to enjoy their lives. It all depends on the individual dog's personality. It's true that for some dogs, the ability to go for those exciting walks and adventures is critical to their enjoyment of life. Others are perfectly happy to slowly wander around the yard, enjoying a casual sniff around, before lying down to bask in the sun. Some dogs enjoy playing "games" like using their noses to sniff out treats. Pet owners need to figure out what constitutes an "acceptable mobility" for their pet to have a good quality of life.

Incontinence

Pets may become urine or fecal incontinent, or both. This isn't just about being inconvenient for the owner - there are lots of things you can do to manage accidents and make life easier - you can find some tips in this article on helping a dog with degenerative myelopathy - dogs with DM frequently become incontinent.

Accidents affect your pet, too. No one enjoys lying in their own waste. If your pet has mobility issues, then he or she has to wait for help to get cleaned up and have their bedding changed. Extended periods can result in urine scald of their skin, which is uncomfortable and even painful for the dog. Some dogs also find it mentally distressing when they "mess".

Managing incontinence is possible but requires dedication on the part of the caregiver; the time and ability to handle incidents quickly; and the physical and financial means to acquire and use the right tools. That said, it's not always practical (ie. when everyone works and cannot be home to manage), nor is it always kind (ie. the dog feels badly for messing himself), to keep your dog around just because it's medically possible.

Mental State

Dogs can become depressed, frustrated, and confused. If they begin to feel this way all the time, or more often than not, their quality of life suffers.

• Depression can result when dogs can no longer do the things they enjoy the most. For example, a severely arthritic dog may not be able to play fetch anymore, or go on fun hikes.

• Dogs can get frustrated when they're unable to do things they enjoy, or things that were so easy for them previously. A simple example is a dog who cannot get up to get a drink for himself whenever he wants one ... or who is forced to urinate in his bed, and then lay in it until help arrives, because he's incontinent.

• It's not uncommon for senior dogs to have some level of senility (called Canine Cognitive Dysfunction). This can cause behaviours like sundowning, confusion, lack of interest in interacting with family, and forgetting behaviors they once knew (like housetraining).

Ask yourself: Is your dog still eager to participate in his favorite activities? Does he willingly interact with his family (and his friends)? Does he seem mentally engaged and interested in life?

Eating and Drinking

• Is your dog eating and drinking a normal amount?

• Is he becoming fussier, eating less, eating more slowly, or takes several trips to finish his food? An underlying health issue, both physical and mental, can cause eating changes. A trip to the vet may be in order.

• Is he refusing food or water altogether? A dog with a poor appetite will gradually waste away if he can't be persuaded to eat. A slow death by starvation isn't a "good death" in anyone's books; nor is force-feeding a sick and unwilling dog over an extended period a kind option.

• Does eating or drinking result in vomiting and/or diarrhea? Again, an underlying medical condition may be the cause. Chronic vomiting or diarrhea is hard on the body.

Breathing

The stress and fear of not being able to breathe easily dramatically affects quality of life. It can cause pets to avoid activity; to eat or drink less (or not at all) because they're trying to breathe instead; to simply lie around, struggling to get enough air, as sometimes seen when dogs breathe through an open mouth. Difficulty breathing can also result from issues like persistent coughing or wheezing.

A dog experiencing respiratory issues should be immediately taken to the vet. Breathing problems need to be resolved to the point where your dog doesn't have to struggle to breathe, perhaps with the exception of very short bouts of coughing or wheezing (to be discussed with your vet). Otherwise, euthanasia may be the kindest option.

Overall Health

Life can become very difficult when there are multiple health issues. Things to think about include:

• Is your dog's health stable? Even if a dog has more than one medical condition, if the condition(s) are easy to manage then the dog's overall health may not be a concern. You may need to monitor your pet and check in with the vet periodically. Otherwise, you may feel confident about your ability to manage your dog's care, and your dog is still enjoying his life.

• Are your dog's medical condition(s) all being appropriately managed? If you're having trouble getting one or more conditions under control, it can affect your dog's overall well-being and may even impact how well the other conditions are managed.

  For example: let's say your dog has both arthritis and canine cognitive dysfunction (dementia / senility). The arthritis was initially well-managed with a combination of pain meds; but once the dementia started to get worse, your dog spends his time pacing endlessly, for hours at a time until he collapses. The endless pacing can make already-sore joints even more sore, and could mean that the meds and dosages previously used to manage the dog's arthritis pain is no longer enough.

• Are there questions about your pet's health? Or the possibility of a sudden, traumatic event? Some medical conditions are such that the vet isn't able to accurately predict what course the disease will take. Or in some cases, it may be that the particular disease has a known progression to a traumatic event but the timing is unclear. In these cases, some pet owners choose to spoil their pets rotten and then euthanize, while their dog is still enjoying a reasonable quality of life, in order to spare them that final, inevitable trauma.

Overall Quality of Life

In some ways, it is easier on pet owners when their pet is experiencing an extreme case of one of the factors that contribute to quality of life. It seems to make the decision to go on - or to euthanize - a little more clear. Otherwise, quality of life is going to be made up of a combination of all the factors put together. It's a highly individual decision.

Pet owners should take the dog's personality into consideration. For example: let's say a dog has health issues that can be managed but that requires repeated visits to the vet on an ongoing basis. The dog is timid and not fond of being handled by people outside of the family. Vet visits are extremely stressful to him. Would it be fair to ask him to endure these visits, when it's clear that it has a big impact on his enjoyment of life?

Here's another example: medical treatment may be available for a sick dog. That treatment, though, comes with side effects that make the dog feel unwell. His illness may be managed, but because of the side effects, the dog merely "exists", choosing to lie around or sleep all day, rather than being engaged and interested in life.

Caregiver Burnout and How It Affects Your Pet

Caring for ill or old pets can easily lead to caregiver fatigue or burnout. There's just no way around it; constant caregiving is exhausting. Putting aside the issue of how we feel as caregivers, how does caregiver burnout affect our pets?

• The more tired we are, the higher the likelihood that our pets aren't getting the very best care. When we lack enough sleep / rest / down-time, especially over a prolonged period, we can start to make mistakes. This can include forgetting to give medication (or double-dosing), or cutting corners (maybe we can wait until tomorrow to bathe the dog after he soiled himself).

• Tempers can flare when we're always exhausted. Yelling at your dog in frustration isn't helping anyone - especially not your dog, who isn't deliberately being "bad". Your dog doesn't want to feel like he's a burden or the cause of your anger.

Caregiver burnout can be even more difficult when there's a question of whether you can financially afford to continue care. It's also not uncommon for family members to disagree on the course of care, or how far they're willing to go (physically, emotionally, and financially).

The "X" Factor

Is your dog still living a life that's meaningful to him?

Veterinary medicine is pretty amazing and there are lots of things that can be done to keep pets alive. That doesn't mean that you should keep them alive just because you can. Ask yourself if your dog is still really and truly living his life doing the things he enjoys. He should be able to do the things that are important to him, rather than merely "existing" or enduring each day.

Making the Decision

It's not unusual to feel guilty about considering euthanasia... or to question yourself about whether or not you're making the right decision. Sometimes it is the anticipation of what's to come that's the hardest thing to manage. Anticipatory grief can feel overwhelming and it's not uncommon for pet owners to feel helpless or paralyzed by the looming decision.

I read something once, on the American Animal Hospital Association website, which I found helpful, in assessing quality of life:

"The five freedoms include freedom from hunger and thirst; freedom from physical and thermal discomfort; freedom from pain, injury, and disease; freedom from fear and distress; and the freedom to express normal behavior."

Euthanasia is a very individual choice. The process of making the decision about when it's the "right" time to say goodbye to a pet is agonizing. Trying to sort out what's best for them - rather than what's best for us, the family that will miss them so much - is a difficult and emotional process. Seek out support if you can; having someone around, even if just to listen, can be very helpful.

I'm often asked about my personal opinion on euthanasia. I've found it helpful to read other people's viewpoints, so perhaps my opinion may provide some food for thought. I'd rather let my pet go peacefully and with dignity... and if at all possible, I would rather let them go a little early than even an hour too late. I don't want them to die feeling scared, stressed, or feeling extreme pain, or during an emergency or a crisis. Ideally, given the choice, I want their passing to be "just a normal day" -- with some extra treats, loving, playtime, or adventure -- where they feel safe, happy, and loved.