When its time

Defining Quality of Life

by Moira Anderson Allen, M.Ed.

Whenever one considers the painful choice of euthanasia, one is always advised to take the pet's "quality of life" into account. But what is "quality of life"? How can you determine whether a pet is still experiencing a good quality of life -- or whether its level of suffering is no longer acceptable?

That decision is individual to every pet, and every owner. Following, however, are some factors to consider when attempting to assess a pet's quality of life:

Mobility. An older pet often loses mobility. A dog may no longer be able to climb stairs or hop into a car; a cat may lose the ability to jump onto a bed or chair. At this stage, however, your pet may still be healthy and happy, and you can easily make accommodations for its reduced ability.

If, however, your pet can barely move, that's another matter. Can your pet get to its feet without assistance? Can it sit or lie down without collapsing? Can it walk? Can it handle basic functions, such as squatting on a litterbox? Does it whimper or growl if you attempt to move it? I've seen dogs so crippled with hip dysplasia that they literally had to drag their immobilized hindquarters across the floor; this hardly represents the "quality of life" I want for my pets.

Appetite/Eating Ability. Is your pet able to eat? Can it consume enough food (or digest that food) to remain properly nourished? Does it regurgitate immediately after eating? Is it unable to chew, or does it have difficulty swallowing? Does it enjoy eating, or do you have to coax every bite past its lips? A pet that is unable to eat or gain sufficient nourishment from its food is on a slow road to starvation.

Breathing. A number of illnesses, including cancer, can affect the lungs. When a condition causes the lungs to fill with fluid or foreign matter (such as cancer cells), a pet quickly loses its ability to breathe easily or comfortably. You'll notice that your pet may seem to be panting, or that it is laboring to breathe; often, you'll see its stomach or flanks "pumping" as it can no longer breathe with just the chest muscles. It may also experience wheezing attacks. If such symptoms occur, ask for a chest x-ray to determine the condition of the lungs. If the problem is due to an allergy, infection, or asthma, medication may help; if it is due to fluids that are the result of cancer or a heart condition, however, little can be done.

Discomfort. It can be difficult to determine whether a pet is in pain, as animals instinctively mask discomfort as much as possible. You can pick up clues, however, by watching its posture and expression. Does your pet's face appear furrowed or "worried", rather than relaxed and happy? Does it sit hunched or "hunkered" and tense, rather than relaxing and lying down? Lack of mobility can also be a sign of pain.

Another indication of pain is "denning." An animal in pain will seek a safe place where it won't be disturbed by other animals. If your pet has forsaken its usual territories or sleeping places for the back of the closet or a spot under the bed, this may be a sign that it is pain or distress and feels vulnerable.

A more obvious indication of pain is a pet's reaction to touch. If your pet responds to touch by flinching away, hissing, snarling, or even snapping, this is a clear indication of pain. Sometimes this can indicate a localized pain; if the pet doesn't want to be touched at all, however, it may indicate a broader discomfort.

Incontinence. Many pet owners feel terribly guilty over the natural annoyance they feel when a pet becomes incontinent. They feel they should be more loving, more patient. Incontinence, however, can also be stressful for the pet. As a basic survival mechanism, animals learn not to "mess where they sleep" (for the smell would draw attention to the location of one's den). When an animal can no longer control when or where it urinates or defecates, you can be sure it is not happy with the situation.

Mental Capacity. Older pets occasionally develop signs of diminished mental capacity. They may seem to "forget" things, such as where a toy is located or what a command means. Such a pet may become confused by its surroundings, and this confusion can develop into fear. (In some cases, this "confusion" may be the result of hearing or vision loss, to which both you AND your pet can often adapt.)

Happiness. Determining whether your pet is "enjoying" life is certainly a subjective decision. However, if you have been a keen observer of your pet's behavior and attitude during its lifetime, you are likely to be able to determine when it no longer seems "happy." You'll know when it no longer seems to take any pleasure from its food, its toys, its surroundings -- and most of all, from contact with you and the rest of its family. Most pets are tremendously easy to please; when it no longer becomes possibly to raise a purr or a tail-wag, you can be fairly certain that your pet is receiving little joy from life.

Response to Treatment. When a pet becomes ill, our natural response is to provide whatever treatment we can. This may mean tests, medications, even surgery. But drugs have side effects, repeated trips to the vet cause emotional distress, and more invasive treatments take a physical toll. Eventually, we may conclude that our efforts to treat a pet's illness are more stressful to the pet than the condition itself -- and that our efforts to save a pet's life are actually diminishing, rather than enhancing, the quality of that life.

Making a Decision

Assessing a pet's quality of life is an ongoing process, not a one-time decision. Initially, we're likely to attempt to compensate for the problems we see. Pain medication may relieve a pet's discomfort and improve its mobility. A change in diet may improve a pet's appetite or provide better nutrition. We may resolve that we're willing to clean up after a pet and carry it wherever it needs to go, for as long as necessary. But eventually such measures will cease to be effective. The process of assessing "quality of life" is really a question of determining (and deciding) when that point has been reached -- and what you intend to do next.

It is often tempting, at this point, to postpone a decision still longer by deciding to "let nature take its course." Before choosing that course of action (or inaction), however, it's important to understand that, as a pet owner, you have been thwarting the "course of nature" from the beginning. By ensuring that your pet has food and shelter and is protected from predators, you have already guaranteed that nature will not take its course. By providing medical treatment, you have prolonged the life of your pet far beyond what it could have expected if left to "nature." In nature, an animal that becomes too ill to obtain food or protect itself will perish quickly, though not necessarily comfortably.

Nor does nature necessarily offer an "easy" death even if you choose to let it "take its course" in the comfort of your home. An animal that cannot breathe easily, cannot eat or digest food properly, cannot control its bodily functions, and can scarcely move or enjoy human contact because of pain, is hardly dying "comfortably."

This is really what the "quality of life" issue is all about. By usurping nature's role throughout the life of our pets, we must sometimes also accept its role in determining (and bringing about) the death of a pet. To accept this, we may also have to accept that, in some cases, the quality of life we're really trying to protect is our own: That we're allowing our pet to suffer out of a desire to avoid the anguish we know that we will experience when it dies. And that, ultimately, is the most unselfish act of love we can offer: To end a pet's suffering, we must choose to accept our own.

The Fourth Day

  If you ever love an animal, there are three days in your life you will always remember.

  The first is a day, blessed with happiness, when you bring home your young new friend.

You may have spent weeks deciding on a breed. You may have asked numerous opinions of many vets, or done long research in finding a breeder. Or, perhaps in a fleeting moment, you may have just chosen that silly looking mutt in a shelter ... simply because something in its eyes reached your heart.

But when you bring that chosen pet home, and watch it explore, and claim its special place in your hall or frontroom - and when you feel it brush against you for the first time - it instills a feeling of pure love you will carry with you through the many years to come.

  The second day will occur eight or nine or ten years later.

It will be a day like any other. Routine and unexceptional. But, for a surprising instant, you will look at your longtime friend and see age where you once saw youth.

You will see slow deliberate steps where you once saw energy.

And you will see sleep where you once saw activity.

So you will begin to adjust your friend's diet - and you may add a pill or two to her food.

And you may feel a growing fear deep within yourself, which bodes of a coming emptiness.

  And you will feel this uneasy feeling, on and off, until the third day finally arrives.

And on this day - if your friend and God have not decided for you, then you will be faced with making a decision of your own - on behalf of your lifelong friend, and with the guidance of your own deepest Spirit.

But whichever way your friend eventually leaves you - you will feel as alone as a single star in the dark night sky.

If you are wise, you will let the tears flow as freely and as often as they must. And if you are typical, you will find that not many in your circle of family or human friends will be able to understand your grief, or comfort you.

But if you are true to the love of the pet you cherished through the many joyfilled years, you may find that a soul - a bit smaller in size than your own - seems to walk with you, at times, during the lonely days to come.

And at moments when you least expect anything out of the ordinary to happen, you may feel something brush against your leg - very very lightly.

And looking down at the place where your dear, perhaps dearest, friend used to lay - you will remember those three significant days.

The memory will most likely be painful, and leave an ache in your heart -

As time passes the ache will come and go as if it has a life of its own.

You will both reject it and embrace it, and it may confuse you.

If you reject it, it will depress you.

If you embrace it, it will deepen you.

Either way, it will still be an ache.

  But there will be, I assure you, a fourth day when - along with the memory of your pet - and piercing through the heaviness in your heart -there will come a realization that belongs only to you.

It will be as unique and strong as our relationship with each animal we have loved, and lost.

This realization takes the form of a Living Love -

Like the heavenly scent of a rose that remains after the petals have wilted, this Love will remain and grow - and be there for us to remember.

It is a Love we have earned.

It is the legacy our pets leave us when they go -

And it is a gift we may keep with us as long as we live.

It is a Love which is ours alone -

And until we ourselves leave, perhaps to join our Beloved Pets -

It is a Love that we will always possess.

Martin Scot Kosins is the author of Maya's First Rose, published by Open Sky Books.

"The Fourth Day" originally appeared as the Foreword for Pet Loss by Nieburg and Fischer, published by HarperPerennial.

Reprinted with permission of Martin Scot Kosins. 3/7/08