When you first brought home that energetic young dog, end-of-life decisions were the farthest thing from your mind. But things have changed. Either the years have flown by and you’re now looking at a painful old pooch, or your vet has handed you a devastating diagnosis. Maybe your dog is really fit and healthy, but you worry about the future. The sad truth is unless you are elderly or are terminally ill, you will someday have to face your dog’s mortality. It’s the decision no pup parent wants to make.

I have had dogs my entire life, and as they grew older, I struggled with those end of life decisions. Wolf, my 14-year old Dachshund, was one of those once-in-a lifetime dogs. In the last six months of his life he was diagnosed with chronic and painful gastroenteritis. After we’d exhausted all our treatment options, and with no way to adequately control his pain, I decided to put him to sleep. I’ve said so many times, “I wish they could talk to me.” Wolf has been gone 25 years and I still question my decision to euthanize him.

Until recently, vets told me it’s time to say goodbye to a sick pet when he stops eating. But any number of treatable or temporary conditions can cause an animal to pass up his food bowl: dental disease, nausea, viruses, or parasites.

What does quality of life mean?

How do you know when mounting symptoms and cascading organ failure reduce your dog’s quality of life to an intolerable level? Whether your dog is facing advanced age or a terminal illness, you have an obligation to maintain the best life as possible for your dog. It’s also important to determine if the recommended treatment will further deteriorate your dog’s quality of life. Is the potential benefit worth the cost to your dog? When should you abandon treatment?

Alice Villalobos, a renowned veterinary oncologist, founded pet hospice service Pawspice and has been a pioneer in end-of-life-care for animals for 20 years. In 2004, she developed the Quality of Life (QoL) Scale, based on the Five Freedoms of Animal Welfare for farm animals in the United Kingdom, to help veterinarians and families assess a pet’s life quality and help pet owners look at hard-to-face issues.

Dr. Villalobos’ “HHHHHMM QoL Scale” helps you to assess your pet’s QoL on a monthly, weekly, daily, or hourly basis as needed and make end-of-life decisions more objectively. “Focusing on QoL for companion animals with life-limiting disease may avoid futile medicine, over-treatment, and reluctant early euthanasia,” Dr. Villalobos says.

It may also help you objectively make one of the most difficult decisions of your life and help allay the guilt that comes with the decision to humanely euthanize your beloved pet rather than force him to linger. That same guilt has haunted me for a quarter of a century. How I wish I’d had this scale when making that tough choice.

The “HHHHHHMM Quality of Life Scale”

The scale rates seven basic factors (Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days Than Bad) from 1 to 10, 10 being the best possible score. A score 70 is perfect, while a total score of greater than 35 is acceptable — but you should assess your dog individually. “Modern pain management, high-tech medicine, and good nursing care can restore and maintain QoL and can extend the period between the diagnosis of a terminal disease and death,” Dr. Villalobos says.

1. Hurt

Adequate pain control, including your dog’s ability to breathe, is first and foremost on the scale. Trouble breathing outweighs all concerns. People don’t realize that in human medicine not being able to breathe is ranked at the top of the pain scale. “If you can’t breathe, nothing else matters,” Dr. Villalobos says. Humans describe breathing difficulty as being more painful than a broken bone.

Keep an eye on your dog’s respirations to identify labored breathing. “Respiratory distress is an emergency and it must be relieved immediately or there is no QoL for the animal, and there is no humane justification to continue the hospice,” Dr. Villalobos says.

Signs of pain in our dogs include:

• Increased vocalizations (whining, howling, whimpering, yelping, groaning, and grunting)
• Panting excessively at rest or open-mouth breathing
• Constantly licking a particular area, trembling

• Hiding or avoiding interaction with family; irritability when touched in specific spots or (the opposite) is more affectionate than usual
• Growls or bites
• Sleeps more than he used to
• Not eating or changes in drinking habits
• Not able to jump up to favorite places
• Lapses in housetraining
• Excessively licking, biting, or scratching a particular part of his body
• Limping
• Restless, circling or lying very still, reluctant to move, repeatedly gets up and lies back down, difficulty getting up, may lie hunched with his hind-end raised and his front down on the floor, or lie on his side
• Grimaces, has enlarged pupils or a glazed, wide-eyed or sleepy expression, or flattened ears
• Dull coat, hair stands up in places

2. Hunger

Is your dog eating enough? Often dogs can hide weight loss beneath their coats, so monitoring your sick or senior pet’s weight is essential. If he isn’t eating on his own, your veterinarian can prescribe appetite stimulants such as mirtazapine. Under your vet’s supervision, you can coax, hand-feed, force-feed, or even have an esophageal feeding tube surgically implanted.

3. Hydration

Check for dehydration by lifting your dog’s skin between the shoulder blades and see how fast it returns to place. The skin of a hydrated animal will spring back to his muscle almost immediately. A dehydrated animal’s skin will return more slowly. Dehydrated dogs will have tacky-feeling gums. The eyes may appear sunken in. His nose feels dry.

If your dog isn’t drinking enough water, your vet may recommend subcutaneous fluids and can teach you to give these to your dog. Providing fluids at home can make a huge difference in your dog’s life QoL and can save you a great deal of money.

4. Hygiene

Good hygiene is a must! You should brush and clean your dog, especially after he eliminates. Is his coat matted?

Can he go out to the bathroom, or does he lie in his own mess? Dogs who can’t move away from their waste will develop painful sores. To avoid pressure sores, provide soft bedding and keep all of his wounds clean. You can help keep your unkempt dog clean by dampening a sponge with a highly diluted solution of lemon juice and hydrogen peroxide and gently stroke his face, paws and legs, similar to a “mother’s tongue.”

5. Happiness

Dr. Villalobos believes that even at end of life there should be a two-way exchange of pleasure and contentment between the two of you. You need to provide enrichment that encourages as much fun and mental stimulation as possible.

Schedule fun time. Does he still respond to his favorite toy and to family members? Does he sleep with you? Does he still enjoy being petted or does he hide? Or is he depressed, lonely, anxious, bored or afraid? Does he isolate himself? Can you move his bed closer to family activities?

6. Mobility

Mobility is relative. Can your dog get up without assistance? Is your dog able to get up and move around enough to satisfy normal desires? Can you help your dog get around with a towel sling or a cart? Does she feel like going for a walk? Is the having seizures or stumbling? Although some people feel euthanasia is preferable to amputation, a happy, responsive dog with limited mobility can still have a good quality of life as long as you’re are committed to helping him.

7. More Good Days Than Bad

Bad days include vomiting, nausea, diarrhea, frustration, falling down, or seizures. When bad days outnumber good days, or if your dog seems to be “turned off” to life, she may be seriously ill. “When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near,” Dr. Villalobos says.

Making the decision to end your beloved dog’s life by euthanasia is probably one of the most difficult decisions you’ll ever make. In the last two months, I have had to use the Villalobos Quality of Life Scale for two of my own cats. The scale helped me make the correct and humane yet heartbreaking decision.

Was there guilt? Yes, some. But the QoL Scale helped me understand that I saved my babies a long painful, lingering death. I only wish I had this wonderful tool when I was considering the fate of my little Wolf so long ago.

Hopefully it will be many years before you need to use the QoL Scale, but when the time comes, use the compassionate tool together with your vet to prevent your dog from suffering unnecessarily. Freedom from pain is a gift you give your dog. Freedom from guilt is a gift for you.

Read related stories on Dogster:

• Let’s Talk About Dogs and Euthanasia: When Is It Time?
• What’s Euthanasia Like for a Vet?
• I’ve Reached the Point Where Euthanasia Is My Only Option
• Miley Cyrus Stages a 60-Foot Tribute to Her Late Dog Floyd
• Addressing Pain in Senior Dogs
• 5 Tips for Caring for Senior Dogs
• 3 Things My Senior Dog Has Taught Me About Aging Gracefully

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• Be Polite to Your Dog — It Benefits Both of You

About the author: Dusty Rainbolt ACCBC is the vice president of the Cat Writers’ Association, editor-in-chief of AdoptAShelter.com and a member of the International Association of Animal Behavior Consultants. She’s the award-winning author of eight fiction and non-fiction books including her most recent paranormal mystery, Death Under the Crescent Moon.