Honoring the Bond
vmc.vet.osu.edu/services/
honoring-the-bond
The Ohio State University
Veterinary Medical Center - Columbus
601 Vernon L. Tharp Street, Columbus, OH 43210
614-247-8607
email: CVM-OSUVET.Hon[email protected]
How Will I Know?
Assessing Quality of Life and
Making Dicult Decisions for Your Pet
The Ohio State University Veterinary Medical Center Honoring the Bond Program
As pet owners, we accept the loving responsibility of making decisions about the health and
well-being of our animals. These may be pleasant decisions, like what food to choose or what
type of activities we enjoy together. However, pet ownership also means being faced with dicult
decisions, such as whether or not to go forward with surgery or treatment of a disease. Often the
hardest decisions we face regarding our pets involve geriatric and end-of-life care. The needs
and beliefs of each family are dierent, and what might be the right choice for one pet may not
be right for another. It is our hope that this guide will help and support you, whether you are
considering a particular treatment plan or end-of-life care.
The Ohio State University Veterinary Medical Center Honoring the Bond Program
vmc.vet.osu.edu/services/
honoring-the-bond
The following questions are provided to help guide and support you, whether you are considering a particular treatment
plan or end-of-life care.
Questions to ask yourself before making a treatment decision (such as surgery or chemotherapy):
• What will happen in the near future that will be
significant to my pet? Can my pet’s pain or anxiety
about upcoming procedures be well-controlled
while hospitalized or healing? Is the procedure
likely to give my pet good quality of life for some
period of time? How do I feel about the medical
information I’ve been given about my pet’s
prognosis (the likely course of my pet’s illness and
treatment)?
Making Dicult Decisions
• Do I have the financial resources to go forward
with the procedure and handle ongoing treatment
expenses? If I do not have health insurance for my
pet (which is true for the majority of pet owners),
can I sacrifice from other areas of my family’s
budget to provide this care?
•
Do I feel like I have all the information I need
to make this decision comfortably? Are there
questions I need to ask my veterinarian to better
understand my pet’s treatment options?
•
Do I have the emotional and physical stamina to
provide the ongoing care my pet needs, or do I
have the means to have someone else to provide
care? Am I ready to undertake the care that may be
required, such as lifting or assisting with walking,
assisting with bathroom functions, performing
physical therapy, giving medication, maintaining a
feeding tube, preparing special food, or monitoring
overnight?
•
What is my personal “bottom line” with regard to my
family’s lifestyle and how it will be impacted by this
decision? Are there any aspects of this treatment or
aftercare that I am unable to accommodate?
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The Ohio State University Veterinary Medical Center Honoring the Bond Program
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honoring-the-bond
Making Dicult Decisions
Questions to ask yourself before making an end-of-life decision (such as euthanasia or hospice care):
• What are my religious, spiritual and personal beliefs
regarding end-of-life care? Do I have a trusted
friend, spiritual advisor or veterinarian who can help
me make this decision?
•
Have I asked the questions I need to ask in
order to feel knowledgeable about euthanasia?
Do I have fears or concerns that I would like to
discuss with my veterinarian, so that I have a better
understanding of how euthanasia is handled and
what my pet and I would experience?
•
Are there friends or family members who are close
to my pet and would like to be included in this
decision, or who would like to be present for my
pet’s euthanasia? Might I be comforted by including
those close to me?
•
What is the value for my pet to continue to live
this way? What is the value for me or my family
members for my pet to continue to live this way?
Is the value higher for us than for our pet?
•
If I elect to provide hospice care for my pet, are
my veterinarian and I able to adequately control
my pet’s discomfort or anxiety? Am I willing to give
the medications or provide the treatments that
will be necessary to minimize my pet’s distressing
symptoms? Will I be honest with myself if my
pet’s symptoms and anxiety are no longer well-
controlled?
Anticipatory Grief
When a pet goes through a serious illness or a decline in health,
it is very natural for a pet owner to experience a phenomenon
known as “anticipatory grief,” which is grieving before the pet’s
death. Just like grief after a death, anticipatory grief involves a
host of physical, emotional and mental reactions that can create
sadness, denial and diculty processing information. There
may be many reasons that making the end-of-life decision
feels overwhelming. The impending loss of a pet may bring
back emotions related to other losses or deaths you may have
experienced, which compounds the dicult emotions.
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The Ohio State University Veterinary Medical Center Honoring the Bond Program
vmc.vet.osu.edu/services/
honoring-the-bond
Euthanasia Myths and Misconceptions
• “My pet will die peacefully at home surrounded by
family.”
-
Only a very small percentage of our pets experience
a “good” death without our help. Many distressing
changes can happen during the dying process: for
you, your family and your pet. Anxiety, diculty
breathing, severe nausea, and seizures are some
examples.
-
Many pets who are allowed to die naturally will do so
overnight or while the owner is away. Some owners
feel regret afterwards because their pet was alone
when they died.
-
At-home euthanasia is oered by many veterinarians
and provides a controlled, pain-free option for owners
who prefer end-of-life care to happen at home.
•
“I would be killing my pet.”
-
Try to remember that your pet’s illness, disease
or injury is doing the harm to your pet. Euthanasia
provides the opportunity to allow your pet to die
humanely and with dignity. It is their illness which
causes suering; you are relieving that suering in a
loving and respectful way.
•
“Euthanasia is not natural.”
-
Many owners have religious or spiritual beliefs that
euthanasia is wrong. Please be honest with us so that
we may try to honor and respect your beliefs, as we
help to plan end-of-life or hospice care for your pet.
-
Much of the medical care we provide our pets is,
by definition, interrupting a “natural” process or
illness. “Euthanasia is often not so much a question
of ‘artificially ending’ a life, but of when to cease
artificially extending that life.” – Moira Anderson Allen
pet-loss.net/euthanasia.shtml
•
“Planning and scheduling the euthanasia is strange.”
-
It can feel odd or wrong to schedule a time or place
for your pet’s euthanasia. By scheduling ahead (even
by a few hours or days), you are taking some control
over a situation over which you have little power. Many
owners find comfort in scheduling a time when friends
or family members can be present, or in scheduling a
time before their pet is truly suering.
•
“My pet will know what is happening.”
-
When handled properly, the euthanasia process is
a loving, peaceful, dignified end of a pet’s life. Your
veterinarian can give many medications (including
sedation and pain medication) that will relieve your
pet’s anxiety and pain. Our veterinarians often induce
deep sleep (anesthesia) just prior to the euthanasia
injection, to ensure that your pet does not experience
pain or anxiety.
- Animals live in the present moment. Unlike us, they
don’t know that a choice is being made—they only
know that they are being loved, that you are with
them, and that they don’t feel pain anymore.
•
“I will just know when it’s time.” or “My pet will let me
know.”
-
While there are sometimes signs, events or symptoms
that occur that make the choice obvious, often the
choice is not clear.
-
Many families tell us that they waited too long; families
rarely tell us they made the decision too soon. Please
know that it is normal and natural to second-guess a
decision and that second-guessing does not mean
you made the wrong choice. In cases of illness or
declining quality of life there is truly no wrong decision
to be made, only the decision you feel is best for your
pet and your family.
-
While some euthanasia decisions are made in a crisis
(such as an acute injury or illness), many euthanasia
decisions are made after a gradual
decline in quality of life. It can be
challenging to trust, moment to
moment, that now is the time.
Read on for some
techniques you
can use to make
this decision
easier.
Making Dicult Decisions
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The Ohio State University Veterinary Medical Center Honoring the Bond Program
vmc.vet.osu.edu/services/
honoring-the-bond
Making Dicult Decisions
Determining the quality of life for a pet is often used to make end-of-life decisions. It’s important to remember
that each pet is an individual, and what constitutes a poor quality of life for one pet (such as lying around
all day) may be normal for another. Although a pet’s enjoyment of life depends on a variety of factors,
physical symptoms — such as unrelenting pain or extreme diculty breathing — should weigh heavily in the
euthanasia decision. These factors constitute very poor quality of life, regardless of other factors.
As hard as it may be to consider end-of-life decisions, it is recommended that you start thinking about these
issues early in the process, when your mind may be more clear. Decisions may seem forced or pressured if
you wait until there is a crisis.
Evaluate Your Pet’s Quality of Life
Enlist the Help of Others You Trust
It may be helpful to ask those closest to you (and your pet)
for their honest opinion about your pet’s health and quality
of life. Of those trusted friends, you may want to ask
someone who sees your pet less frequently, since your
pet’s gradual decline in health, mobility or comfort may be
more obvious to them. Remember that even members of
the same household may have diering opinions of a pet’s
quality of life, and that these opinions may be colored by
each family member’s anticipatory grief process.
Your veterinarian and veterinary team may be able to
provide valuable information about what treatment options
remain for your pet and your pet’s prognosis. Even though
your veterinarian cannot make the euthanasia decision
for you, they will be able to give you an honest medical
perspective about your pet’s current condition and
comfort. To help you make a decision, your veterinarian
may be able to answer the following questions:
•
What are the best and worst case scenarios for the
available options?
•
What is your perception of the pain (or suering)
that my pet may be experiencing?
•
Are you able to estimate my pet’s life expectancy?
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The Ohio State University Veterinary Medical Center Honoring the Bond Program
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honoring-the-bond
Several tools or techniques may provide more concrete answers to this subjective question.
How Do I Know It’s Time?
• When your pet’s health, mobility or comfort have
been declining slowly, it may be helpful to view
photos or videos of your pet from before the illness.
Remember how your pet looked, behaved and
interacted with you.
•
Make a list of three to five things your pet likes
to do, such as going for walks, playing with other
pets, or enjoying their meals. When your pet is
consistently unable to enjoy these things, it may be
time to discuss euthanasia.
•
Mark good and bad days on a calendar. This could
be as simple as a happy or sad face for good or
bad. As the bad days start to outnumber the good,
it may be time to consider euthanasia. (The Grey
Muzzle phone app is an example of an easy quality
of life calendar for your smartphone.)
•
Complete a quality of life scale worksheet
- It may be helpful to have each family member
complete a scale independently and then
compare answers, since each family member
may interact with the pet dierently and therefore
have a dierent perspective.
-
While completing a scale may help some owners
come to a euthanasia decision immediately, most
owners find these scales helpful to track changes
in their pet’s quality of life over time. Set a strict
interval for repeating the quality of life scale. For
example, decide to complete them every three
days or on every Tuesday or whatever works
best for your schedule.
One quality of life scale worksheet is on the next page of
this booklet. Additional scales may be downloaded from
vmc.vet.osu.edu/services/honoring-the-bond
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My pet…
Strongly Agree
(All the Time)
(Severe)
Agree
(Most of the Time)
(Significant)
Neutral
(Sometimes)
(Mild)
Disagree
(Occasionally)
(Slight)
Strongly Disagree
(Never)
(None)
does not want to play 1 2 3 4 5
does not respond to my presence or does not
interact with me in the same way as before
1 2 3 4 5
does not enjoy the same activities as before 1 2 3 4 5
is hiding 1 2 3 4 5
demeanor/behavior is not the same as it was
prior to diagnosis/illness
1 2 3 4 5
does not seem to enjoy life 1 2 3 4 5
has more bad days than good days 1 2 3 4 5
is sleeping more than usual 1 2 3 4 5
seems dull and depressed 1 2 3 4 5
seems to be or is experiencing pain 1 2 3 4 5
is panting (even while resting) 1 2 3 4 5
is trembling or shaking 1 2 3 4 5
is vomiting and/or seems nauseous 1 2 3 4 5
is not eating well - (may only be eating treats or
only if fed by hand)
1 2 3 4 5
is not drinking well 1 2 3 4 5
is losing weight 1 2 3 4 5
is having diarrhea often 1 2 3 4 5
is not urinating well 1 2
3 4 5
is not moving normally 1 2 3 4 5
is not as active as normal 1 2 3 4 5
does not move around as needed 1 2 3 4 5
needs my help to move around normally 1 2 3 4 5
is unable to keep self clean after soiling 1 2 3 4 5
has coat that is greasy, matted, or rough-looking 1 2 3 4 5
How is my pet’s overall health compared to the
initial diagnosis/illness?
1
Worse
2 3
Same
4 5
Better
Current Quality of Life
(place “X” along the line that best fits your pet’s
quality of life)
Poor Good
This scale has been adapted, with permission, from The HHHHHMM Quality of
Life Scale: Dr. Alice Villalobos; Quality of Life Survey: Dr. David Vail; End-of-Life
Values and Goals worksheet: University of Tennessee Veterinary Social Work
The Ohio State University Veterinary Medical Center Honoring the Bond Program
vmc.vet.osu.edu/services/
honoring-the-bond
Deciding to euthanize your companion animal may be one of the most dicult decisions you ever make. Often, well-loved
pets are euthanized to minimize unnecessary suering. The quality of animals’ lives is defined by their overall physical and
mental well-being, not just one aspect of their lives. The following chart attempts to consider all aspects of your pet’s life. It
is important to remember that all pets are dierent. What may be considered a poor quality of life for one may be dierent
for another.
Higher numbers on this chart equal a better quality of life. This chart may help you to better visualize the general well-being
of your pet. In some cases, even one item on the left-hand side of the chart (for example: pain) may indicate a poor quality
of life, even if many of the other items are still positive. Some items or symptoms on the list may be expected side eects of
the treatments that your pet is undergoing. It is important to discuss these symptoms and side eects with your veterinarian.
Survey Date:
Weight:
Poor Quality of Life Good Quality of Life
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The Ohio State University Veterinary Medical Center Honoring the Bond Program
vmc.vet.osu.edu/services/
honoring-the-bond
If you have decided that euthanasia is the kindest choice for your pet, you may wonder whether it is
appropriate to include your other pets in the process.
Some owners have reported fewer disruptions in their
surviving animal’s behavior when the surviving pet
was allowed to see and smell the deceased pet after
euthanasia. If you are considering having your other
pet present during the euthanasia event, an important
consideration is that your emotions may startle your
surviving pet, making the experience more stressful.
On the other hand, some owners feel comforted by the
presence of their surviving pet.
Keep in mind that you cannot predict how your surviving
pet will react to the presence of your deceased pet. It is
The Euthanasia Decision: How It Aects Other Pets
common for the surviving pet to sni the deceased pet.
Other behaviors that seem disrespectful may occur, such
as stepping on, urinating on, or barking at the deceased
pet. These are all normal behaviors for animals, especially
if they sense your stress at this dicult time. It is important
to prepare yourself for these possibilities so that you can
see them as normal pet grieving, rather than an insult to
your deceased pet. Changes in the social structure and
hierarchy of the pets still in the home can be disrupted by
a loss, and they may struggle to determine their new place
or allegiances.
Steve Uyehara
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The Ohio State University Veterinary Medical Center Honoring the Bond Program
vmc.vet.osu.edu/services/
honoring-the-bond
If you have decided that euthanasia is the kindest choice for your pet, you may wonder whether it is
appropriate to include your children in the process.
The Euthanasia Decision: How It Aects Children
Children can learn valuable lessons about responsibility,
compassion, commitment, and coping when they are
involved in the decision-making process regarding the
euthanasia of a family pet. Use your judgment as a parent
regarding your child’s personality, age, and level of
development to frame your discussion of your pet’s illness
and euthanasia.
It is important to avoid the phrase “put to sleep,” since
young children may interpret this literally and become
fearful of sleep for themselves or other loved ones. This
phrase may also create confusion and anxiety for children
regarding anesthesia for routine procedures, since the
line between “sleepy enough for surgery” and death
may be blurred. Using the simple term “die” or “help to
die peacefully” may eliminate confusion about the word
“euthanasia.”
If you decide to have your children present for the
euthanasia, prepare them ahead of time for what to
expect. Ask questions of your veterinarian prior to the
euthanasia so you feel able to guide your children through
the process. Use language that is simple and clear.
For example: “The veterinarian is going to give Buster
medicine (in a shot) that will make his heart stop beating
and make him stop breathing. It will not hurt Buster.”
Most importantly, it is okay to show your emotions. Allow
your children to see that being sad is normal and natural,
so they feel invited to express and share their own
feelings of sadness about your pet’s death. It is critical
for children to see you model appropriate emotional
responses so that they feel safe in doing so. This has
been shown to ease the grieving process for children and
adults alike.
For more detailed information, please see our brochure
Helping Children Cope with the Serious Illness or Death of
a Companion Animal.
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The Ohio State University Veterinary Medical Center Honoring the Bond Program
vmc.vet.osu.edu/services/
honoring-the-bond
Treasuring Your Time
If you have decided that euthanasia is the most
appropriate choice for all involved, you may choose a
variety of ways to spend the last months/weeks/days of
your companion animal’s life. You may want to spend
additional time with your companion animal, doing special
things together. That might mean giving extra attention,
including petting, grooming, holding them or making
them special meals to eat. (Be cautious about upsetting
gastrointestinal issues- check with your veterinarian if you
have any questions about what would be suitable). You
may decide to go on a special trip or walk. When you have
decided on the time for the euthanasia, you may choose
to be present or not. There is no right or wrong choice,
only a loving choice.
The mission of the Honoring the Bond (HTB) program
is to recognize and honor the human-animal bond by
providing support to companion animal owners.
Our social workers can assist in the following ways:
•
Act as a liaison between the companion animal
owner and veterinary medical team
•
Provide crisis intervention during dicult
situations
•
Assist in processing dicult decisions
(quality of life assessments, treatment
decisions)
•
Be present before, during, and/or after
euthanasia
•
Facilitate family discussions with children
• Provide assessment and referral for further
follow-up counseling, if needed
•
Provide resources, including reading lists,
websites, counselor and pet loss support group
referrals, cremation/burial resources, memorial
ideas, etc.
Honoring the Bond program services are available, at
no cost, to clients of the Ohio State Veterinary Medical
Center. If you would like to speak with someone from
HTB, you may:
• Ask your clinician, student or client services
representative to contact us
• Contact us directly at 614-247-8607
• Access our website and email at:
v
mc.vet.osu.edu/services/honoring-the-
bond
Honoring the Bond is a nonprofit program, relying on
the generous donations of owners, veterinarians and
businesses. To donate to the HTB program, please go
to go.osu.edu/giveHTB
The Honoring the Bond Program at
The Ohio State University
Veterinary Medical Center
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