Guiding pet owners through end-of-life decision-making

Pet owners living with senior pets or a pet with a terminal disease often come to their veterinarian asking, “When is it time?” or “How will I know when it’s time to euthanize?”. There is not a one-size-fits-all answer to this question. As veterinarians, it is our duty to respond compassionately and provide owners with the education and tools they need to assess their pet’s quality of life. During a recent session at the Fetch dvm360 Conference in Charlotte, North Carolina, Leigh Ann Collins, DVM, CVA, CPEV, regional veterinary director with Lap of Love, discussed strategies veterinarians can use to help their clients with this difficult assessment.1

Four factors to consider

In many disease processes, there is not an obvious time when euthanasia becomes appropriate. Instead, there is often a range of time during which euthanasia is appropriate, depending on the individual pet and family. Collins suggested that veterinarians discuss 4 factors with clients to help them answer the question of “When is it time?”: ailment, family beliefs, pet personality, and budgets.

Ailment

“Every disease is different,” Collins said, and death looks different in each. Veterinarians must educate clients on the disease process their pet is experiencing and set expectations for how the disease will progress and what they may expect. Conversations will look different depending on the disease process as well.

In general, diseases can be divided into 3 categories:

• Imminent, such as a hemoabdomen or respiratory distress, where a decline happens quickly and often does not allow families to plan for euthanasia or schedule in-home care.
• Intermediate, such as heart failure, where there will be ups and downs over time. Some changes can happen quickly.
• Non-imminent, such as chronic kidney disease or osteoarthritis, where the decline is slow and families will have time to plan for end-of-life care, including scheduling euthanasia or utilizing an in-home euthanasia service.

Collins likened imminent diseases to a cliff, whereas intermediate diseases are a winding road, and non-imminent are a slow fade. Identifying which category of disease a pet family is facing can help frame the conversation around quality of life and euthanasia.

Family Beliefs

Euthanasia is an emotional decision for families and can be impacted by many factors. This includes cultural and/or religious beliefs, personal experiences, relationship with the individual pet, and the pet’s use, which is a particularly important factor for working animals. Collins encouraged veterinary teams to ask questions if you aren’t sure how a family’s beliefs are affecting their decision.

Pet Personality

Collins encouraged veterinarians and pet owners to consider this question: “Just because there are options [for treatment], is it appropriate for the pet?” Families should consider how easy treatment will be and what their pet’s tolerance for medication, diet change, recheck veterinary appointments, and other treatment considerations may be. Treatment plans should be tailored to the individual pet’s personality. Although some pets may tolerate strict rest for medical management of intervertebral disc disease in dogs or subcutaneous fluids for chronic kidney disease, others could be extremely stressed. This will impact not only the pet’s quality of life but the relationship between pet and client.

Budgets

The last factor to consider includes the family’s budgets. Although finances are often a factor, there are other budgets that need to be considered, including:

• Physical ability to medicate and provide nursing care
• Time to perform treatments like bathing or maintain a medication schedule
• Emotional capacity to provide care.

Caregiver burden can be experienced when caring for a sick pet and may be influenced by many factors including caregiving responsibilities for other pets or human family members as well as past experiences with sick pets. Collins encouraged veterinary teams to ask questions about clients’ previous experiences with euthanasia and end-of-life decisions to guide conversations about the current pet.

Objective approaches to measure quality of life

In Collins’ experience, “the [pet owner] who is doing the majority of the caretaking comes to the decision to euthanize first.” However, other family members may have differing opinions, and it is important that veterinarians compassionately guide the family through the decision-making process. Often, this starts with a discussion of assessing a pet’s quality of life.

Quality of life can be difficult to define and often looks different for each individual pet and family. Six major categories can be considered: mobility, hydration, appetite, hygiene, happiness, and pain. Collins noted that there are also many sensations that can detract from a pet’s quality of life, including physical pain, nausea, pruritus, breathlessness, thirst, and hunger. Additionally, social and emotional factors like anxiety or phobias, fear, isolation, loneliness, boredom and frustration, and stress can have major negative effects on quality.

Ultimately, we must find a way to measure a subjective concept. Collins encourages veterinary teams to give owners ways to evaluate quality of life at home and not assume that pet families know how to do this. Some common strategies for measuring quality of life include:

• Make a list of the pet’s 5 favorite things to do and assess if they are still able to do them.
• Consider things the pet hates/dislikes and determine if they are still reacting in the same way to these events (ie, mail delivery, thunderstorms).
• Assess whether the pet still has their five freedoms, as defined by the ASPCA: freedom from hunger and thirst, freedom from discomfort, freedom from pain, injury or disease; freedom to express normal behavior, and freedom from fear and distress.2
• Quantify good and bad days on a calendar or with colored marbles in a jar. This requires families to agree on how they define “good” and “bad” and what percentage of the day needs to fall into the category.
• Provide quality of life assessments to owners. There are numerous tools available including Lap of Love resources (quality of life scale, calendar, daily assessment), the Ohio State University’s quality of life scale, and Dr. Alive Villalobos’ H5M2 scale.
• Make a bucket list of experiences for the pet to celebrate their life together.
• Encourage families to compare videos or pictures over time to see how the pet’s appearance and activity compares to previous times.

Supporting owners in denial

At times, pet families may not see how bad things are, even when it seems obvious to us as veterinary professionals. It is essential that we avoid judgment during these conversations. Collins suggested that veterinarians start by discussing the disease process and setting expectations for how the disease will progress, including what death without assistance will look like. She also encouraged owners to set a “line in the sand” that they would not want to cross, such as their pet entering respiratory distress or being unable to stand.

Another approach is to have the owner do a quality of life scale in the office and compare their answers to one filled out by the veterinarian. Ultimately, end-of-life decisions belong to the pet family. Veterinarians can discuss the family’s beliefs, concerns, and fears to determine how best to help both the pet and family. Veterinarians should consider the pet’s condition and prescribe pain and sedation as needed to maximize the pet’s comfort.

“In traditional general practice, we don’t have as much time to have these conversations,” Collins noted. General practitioners should be aware of resources for pet owners to help with anticipatory grief and consider referring clients to a hospice and palliative care veterinarian to continue the end-of-life conversations, often in the home environment.

Take home points

When guiding owners through end-of-life decision making, assessing quality of life is an essential component. Veterinarians should maintain compassion and withhold judgment throughout the process while educating owners and providing tools clients can use to objectively assess their pet’s quality of life.

Kate Boatright, VMD, is a 2013 graduate of the University of Pennsylvania in Philadelphia, a practicing veterinarian, and freelance speaker and author in western Pennsylvania. She is passionate about mentorship, spectrum of care, and addressing common sources of stress for veterinary teams and recent graduates. Outside of clinical practice, Boatright is actively involved in organized veterinary medicine.

References

1. Collins L. Helping owners with assessing quality of life. Presented at dvm360 Fetch Charlotte 2025: Charlotte, NC. March 16, 2025.
2. Five freedoms. ASPCA. Accessed April 16, 2025. https://www.aspca.org/sites/default/files/upload/images/aspca_asv_five_freedoms_final1.ashx_.pdf