How will I know when it’s time to say goodbye?
By Jessica Fragola, VMD
How do I know when it’s time for euthanasia?
It’s a question filled with agony and dread: how do we know when it’s time to euthanize my beloved pet? Whether you’re planning ahead or having to face the end of your pet’s life soon, it can be one of the most difficult decisions you will ever make in your life. As a home hospice and euthanasia veterinarian in New York City, I hope this blog post can help.
First off, the WORST piece of advice you will ever get is “you’ll know when it’s time.” Yes, there are some situation where it’s obvious, but in most cases, it’s not. Moreover, it’s difficult to think rationally about losing our loved ones, so we often look for any glimmer of hope that this might not be happening.
When it came time to euthanize my heart dog Alice my mind refused to accept reality. I was in total denial. I let her suffer in the hospital for a few days before I had the courage to make the right decision for her. I will probably never fully live this down.
Second, while the numerous “quality of life” scales out there on the internet are helpful, they can also be confusing. These scales work as follows: you score a variety of factors on a scale and add the numbers up. If the score is below a certain number, it indicates a poor quality of life. But life doesn’t work like that. The scores often change drastically from day to day, leaving us on an emotional rollercoaster.
And thirdly, “how do I know when it is time?” is an unanswerable question to us mere mortals. We can use all the tools at our disposal to make an educated guess, but we cannot see the future. As doctors, we often give “average survival times” for various diseases, but individual patients are not averages, so we often get it wrong.
After being a hospice and home euthanasia doctor in NYC for a few years, I came to believe “how do I know when it’s time?” is the WRONG question to be asking.
A better question is, “how can I make my pet’s last days and weeks on this Earth beautiful, full of joy, and free of suffering?”
The strange thing is: while losing a pet can be one of the most difficult moments in OUR lives, it doesn’t have to be difficult for our pets. It can be a beautiful, joyous celebration of their life. Our pets give us so much throughout their lives. I’ve come to believe it is our duty to give them the best ending we can. And with a little planning we can often do just that.
So how do we do it?
A typical trajectory for pets that are terminally ill or experiencing poor quality of life is this graph:
It’s never a straight line down. There are always ups and downs and at some point they hit a cliff. When they hit the cliff, it’s all downhill from there.
THE GOAL IS TO MAKE THE DECISION BEFORE THE CLIFF.
The challenge is that we never know quite where this cliff lies, but as quality of life deteriorates, our risk of hitting it increases. It’s a bit like Russian roulette.
I often see people who try to wait for that very last good day and it leads to a traumatic end. They will schedule and cancel their home euthanasia appointment repeatedly. Then one morning I wake up to a voicemail saying they had to rush their pet to the ER in the middle of the night for euthanasia. They are so sad and full of remorse that their pet’s life ended with a traumatic visit to the ER. The pet hit the cliff.
So how do we choose the right time? Rather than hoping to find the LAST GOOD DAY (which is OF COURSE what we all want to do), we find that window of opportunity where the quality of life has deteriorated somewhat, but we haven’t yet hit that cliff.
Instead of trying to play chicken with that last good day, choose a period during the decline where you can plan some great hours or days for your pet. You can have your pet’s favorite friends over, you can plan to say goodbye on a beautiful sunny day while they are basking in the sunshine by their favorite window. They can take a trip to the beach or the best steakhouse in Brooklyn. You can plan it so that all your pet’s favorite people can be there for his or her last moments. You can sing songs, say prayers, light candles and incense, make a beautiful bed of roses, and honor your pet in a truly meaningful way.
I know, it’s weird to think of it that way, but when we do, we make the end of life so much better for them, and we can cherish their beautiful twilight moments instead of being constantly filled with dread. We HAVE to accept that death is coming, and once we do, we can turn it into a celebration of life.
I had a bit of a revelatory moment earlier this year. My mom’s dog Nella started to decline rapidly – she had developed severe pain in her belly and was having difficulty getting up and down. We took her to the hospital where she was diagnosed with advanced liver cancer.
In a panic, I started telling my mom all the medications we could put her on to get her a little more time.
My mom, in impressive mental clarity, asked, “if we give her medications, will she still be in pain?” I answered, “yes, but less.” To which my mom said “why would we let her go on in pain?” She bravely made a plan, gathered the family, and we had a beautiful last day with Nella. We gave her lots of pets, fed her all her favorite treats, and my colleague came out to help us say goodbye to her. It was so hard, but it was the right thing to do.
One last thing on quality of life assessment: it is STILL important – because it helps us determine where on this graph we are – but rather than numeric scales, I prefer a more holistic approach. Briefly consider a few important aspects of their happiness: did they eat? Did they play? Are they in pain? Do they seem happy? Are they hiding/isolating? Then combine all these questions in your head together and decide: was the day joyful? When we are starting to see a lot of days without much joy, it’s probably time.
There are some diseases, however, where the trajectory is especially tricky. Diseases such as heart failure, seizure disorders, and certain types of cancers that cause internal bleeding don’t exhibit this slow downward trajectory. In these diseases, there are often periods of total normality punctuated by periods of intense suffering. Pet parents in these cases often need to choose between saying goodbye on a good day and saying goodbye in an emergency. It’s a very personal decision. I strongly recommend discussing end of life decisions with one of our hospice veterinarians. Click here to schedule a teleconsult.
I hope this post helps some people think through some of these terrible decisions. But I truly do believe, when we think of the end of life as a beautiful celebration, it can be truly wonderful for our pets.
If you are in the 5 boroughs of NYC (Bronx, Queens, Manhattan, Brooklyn, Staten Island) and are grappling with difficult decisions, we offer 50 minute consultations with our experienced veterinarians. Click the button below to schedule a teleconsult.