“How do I know when it’s time?”

The following tools may aid you in making the decision to euthanize.

• Enlist the help of your veterinarian. While your veterinarian cannot make the decision for you, it is helpful for him/her to know that you are considering euthanasia.

• Remember how your pet looked and behaved prior to the illness. Sometimes changes are gradual, and therefore hard to recognize. Look at photos or videos of your pet from before the illness.

• Mark good and bad days on a calendar. (Some may choose to distinguish morning from evening.) This could be as simple as a happy or sad face for good or bad. If the bad days start to outnumber the good, it may be time to discuss euthanasia.

• Write a concrete list of three to five things your pet likes to do. When your pet is no longer able to enjoy these things, it may be time to discuss euthanasia.

Deciding to euthanize your companion animal may be one of the most difficult choices you ever make. Often, well-loved pets are euthanized to minimize unnecessary suffering. The quality of animals’ lives is defined by their overall physical and mental well-being, not just one aspect of their lives. The assessment on the opposite side of this sheet attempts to consider all aspects of your pet’s life. It is important to remember that all pets are different. What may be considered a poor quality of life for one may be different for another. Higher numbers on this scale 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 effects of the treatments that your pet is undergoing. It is important to discuss these symptoms and side effects with your veterinarian.

Questions to ask yourself:

What is the most important thing when considering my pet’s end-of-life treatment? What are my thoughts about euthanasia? Would I consider euthanasia if the following were true about my pet: Feeling pain? Can no longer urinate and/or defecate? Starts to experience seizures? Has become uncontrollably violent or is unsafe to others? Has stopped eating? Is no longer acting normally? Has a condition that will only worsen with time? Financial limitations prohibit treatment? Palliative (hospice) care has been exhausted or is not an option? The veterinary team recommends euthanasia? The veterinary team recommends euthanasia, but the required symptoms or situations that are listed above are not present?

Pets add so much joy and companionship to the lives of the people who love them that it is painful to imagine a time when they won’t be around.

Unfortunately, illness, disease, and old age are all factors that impact an animal’s life. As a pet nears the end of its life, hard and often heartbreaking decisions must be made.

When should you say goodbye to a pet in declining health? Should you let your pet pass away naturally? One way to make a difficult decision is by judging your pet’s quality of life.

When you look at a pet’s quality of life, you are considering how much your pet is suffering and the effects age or medical issues are having on how it is living.

Determining Your Pet’s Quality of Life

Veterinarians often suggest using a pet’s quality of life scale to help people make serious end-of-life decisions. A common quality of life scale for pets is called the HHHHHMM Scale.

This scale assesses seven criteria and was developed by Dr. Alice Villalobos. Each of these criteria are assessed and given a score on a scale of 1 to 10, with 10 being the highest quality of life.


Is your pet’s pain controlled, and are there breathing difficulties? It is often hard to determine if dogs or cats are in pain, but it is important that pain is well-managed.

Some common clues that a pet may be in pain include excessive vocalization, changes in breathing, difficulty resting, or increased aggression.


It is important that pets get proper nutrition, but both age and illness can make it difficult for a pet to maintain an appetite or keep their food down.

This can cause extreme weight loss and weakness. Does your pet have an appetite? Has the vet tried changing medications? Is a feeding tube needed to feed your pet, and is it helping?


Is your pet staying hydrated? Drinking insufficient amounts of water is a common cause of dehydration, but pets that are vomiting or have diarrhea are also at risk.

In addition, take into consideration whether your pet may benefit from supplemental fluid intake.


Older and ill pets may have problems with incontinence that could cause skin infections if they are not regularly cleaned.

Pressure sores may also develop if pets have difficulty moving. Are you able to keep your pet clean and groomed?

Is your pet able to groom itself?


Your pet’s emotional well-being is as important as its health. Take into consideration whether your pet shows excitement or recognition around people it is familiar with.

If engaged, is it able to or interested in play? Is your pet listless or easily disturbed?


Some pets may no longer have the ability to move around as they once did. Pain or weakness may prevent them from going up stairs or taking walks.

In severe cases, a pet may even have difficulty moving to their food and water. When using the quality of life scale for pets, ask yourself if age or illness is hindering your pet’s mobility and to what degree.

Is there a fixable remedy for its mobility issues?

More Good Days Than Bad

Ideally, one wants their elderly or sick pet to have more good days than bad. Unfortunately, there may come a time when one’s pet routinely experiences more bad days than good.

This is one of the greatest indicators that your pet’s quality of life has diminished and its suffering has magnified.

A total greater than 35 is generally an acceptable quality of life for pets.

Add up your numbers from each category above. If your total is more than 35 points, quality of life is acceptable, with the caveat that your pet may need supportive care such as pain medication, mobility aids, a change in diet, etc. If the score is less than 35 points, We encourage you to reach out to your veterinary team, who can assess your pet’s condition and make recommendations for supportive care, or in some cases, for euthanasia.

As Dr. Villalobos points out on her website, our companion animals are fortunate: society protects them from suffering and grants them a peaceful and painless death.