Defining quality of life can feel a bit like defining air. You obviously know what it is, but what if you had to explain it to an alien living in deep space?
We know quality of life is a reflection of how one feels about life in general, not just the particular moment. If I jammed a toe on the coffee table, once I stopped jumping around and cursing, it would be silly to say my quality of life was poor, even as I hobbled to the freezer for a bag of frozen peas for my throbbing foot.
It’s no wonder, too, that so many of us struggle to make end-of-life decisions on behalf of an animal companion. Our own feelings inevitably compound the issue. “I don’t want to be selfish and keep her around just for me,” many people will say. How do we know what a pet thinks and feels about their life in general?
The uncomfortable truth is that we can never make a perfect decision because we can’t really know. What we can do is make informed choices using clues from the animal’s behavior, preferences, and physical abilities. A number of scales are available to identify the most salient factors, and I will share some of my favorites at the end of this article. First, let’s take a look at quality of life from an animal welfare perspective. The Five Freedoms, first articulated by the U.K. Farm Animal Welfare Council in 1965, serve as a guide to monitor the well-being of animals kept in intensive farming operations. These same concepts can be applied to evaluate quality of life for anyone.
Freedom from Fear and Distress
The exact triggers of fear and distress, of course, vary between individuals. In the context of end-of-life care, it’s important to consider how the pet responds to medical treatment. Different decisions might be made for a dog that cowers and trembles the minute her car pulls into the vet clinic’s parking lot versus the one that who bounds into the waiting room seeking treats and affection from the front desk staff. Along with finances, the emotional impact of medical interventions must be balanced against the potential gain.
Fear and distress can also originate from the home environment (for example, loud noises from construction) as well as internally, as certain medical conditions can cause behavioral and cognitive changes which may lead to anxiety, disorientation, and difficulty sleeping.
Freedom from Pain
Pain clearly has a significant impact on how we view and experience our world. Although we are duty-bound to minimize it as much as reasonably possible, some degree of pain may be compatible with good quality of life. What impact does the pain have on the pet’s ability to engage in daily routines and preferred activities? Has he withdrawn from the world or lost interest in interacting with loved ones? The brain’s emotional and pain-sensing circuitry are intricately intertwined to a degree that researchers are just beginning to understand.
Freedom from Discomfort
Many internal and external factors can affect comfort and a sense of well-being. Temperature, noise level, hygiene, and a comfortable place to rest are examples of environmental factors, depending on the pet’s particular preferences. Internal sources of discomfort could include nausea, abdominal distension, and the need to urinate or defecate.
Freedom from Hunger and Thirst
It goes without saying that adequate food and water are essential to quality of life. It’s distressing to caregivers when the pet refuses food or water, and when this happens it’s important to try and rule out physical barriers to eating and drinking (such as with an oral tumor) as well as contributing factors such as nausea. As life draws near its end, it is common for the pet to voluntarily stop eating and/or drinking. In this particular case, this is a reflection of the body’s reduced metabolism and need for food and water and does not indicate suffering. In fact, force feeding or supplementing fluids can cause more discomfort or even distress. Caregivers should work with a veterinarian trained in hospice to ensure the pet’s needs are being met without causing further harm.
Freedom to Express Natural Behaviors
Cats are fastidious and instinctively prefer to void in soft, loose materials that they can use to cover up. Most dogs like to explore their world through smell, sights, and sounds. The caregivers are best qualified to identify those behaviors critical to their pet’s well-being. How much effort is she willing to invest in performing that behavior? What is he willing to endure or give up in order to do it?
Modifying routines can do wonders for maintaining quality of life. We helped a beautiful Rhodesian Ridgeback who loved regular car rides and day trips to see family. When a painful bone tumor emerged in his back leg, his caregivers were so terrified of causing even more pain and damage that his world shrank overnight, and he was spending almost all of his time in the living room at home. Some tweaks to his medications, changes around the house , and a homemade car ramp enabled him to once again enjoy those activities, and his whole demeanor brightened almost immediately.
Now that we understand the basics, how do we apply this knowledge? Here are two scales that we frequently share with caregivers who are facing difficult end-of-life decisions. Consult with a veterinarian or veterinary technician trained in animal hospice if you still have questions about your pet’s unique needs.
Quality of Life Scales – Pawspice
How Do I Know when It’s Time – Ohio State University