End-of-Life Decisions
Owners who care for dogs with mobility impairments may develop caretaker fatigue but simultaneously be so dedicated to their pet that they are reluctant to consider euthanasia when an animal's condition deteriorates.
Owners need specific guidance as to the pain status of their animal and the secondary complications and management that come with a further decline in mobility. Contextual information is also critical for most owners. For example, a 15-year-old greyhound with progressive paresis and fecal incontinence will encounter significantly more challenges than a 3-year-old dachshund with grade 5 spinal dysfunction after intervertebral disc protrusion. The greyhound in this example likely has lesser functional capacity to accommodate for other comorbidities should they occur, and with their occurrence being far more likely as a function of aging. Owners may voluntarily raise the issue of euthanasia at the time of a deterioration but then indicate they are not ready for such a decision. In these cases, owners likely have reached a point whereby they subconsciously understand that their animal's quality of life may justify humane euthanasia. It is important for veterinarians to establish open communication with these clients during regular treatment assessments and to provide scoring systems if necessary for objective evaluation. Owners otherwise may delay the decision while their pet continues to worsen. Veterinarians with a long relationship with patients may also need to solicit outside opinions from colleagues to maintain objectivity. When the decision is reached that a patient is to be euthanized, the location, timing, and conditions of the euthanasia will all be important and care should be taken to accommodate owner's concerns and to create a supportive and comfortable environment in which the euthanasia occurs. Chapter 36 covers this issue in more detail.1.
How would you rate your pet’s current mobility?a. 1 = no mobility without complete assistance, 10 = normal mobility
2. How often does your pet need your assistance in any capacity due to his or her mobility?
a. 1 = more than 10 times daily, 5 = five times daily, 10 = never
3. Describe the three activities during which you feel your animal derives the greatest
enjoyment, and how your pet’s mobility interferes with that activity
a. Activity 1: 1 = unable to perform 10 = does not interfere at all
b. Activity 2
c. Activity 3
4. Please rate how your pet’s mobility influences eating and drinking:
a. 1 = completely interferes, 10 = causes no issues
5. Please rate how your pet’s mobility affects control of urination?
a. 1 = unable to urinate without assistance 5 = needs a moderate amount of assistance or has infrequent urinary accidents 10 = does not affect
6. Please rate how your pet’s mobility affects control of defecation?
a. 1 = unable to defecate without assistance 5 = needs a moderate amount of assistance or has infrequent defecation accidents 10 = does not affect
7. Describe the percentage of time you spend caring for your animal as opposed to interacting in a way which does not involve being a caretaker, providing food, assisting with mobility, etc.
a. 1 = 100 % of time spent caring for my pet when we interact, 10 = only care necessary is providing water and food; all other time is normal activity
8. Please describe your outlook on your pet’s condition
a. 1 = extremely pessimistic 10 = extremely optimistic
9. Please rate your pet’s quality of life given his or her current mobility
a. Extremely poor b. poor c. acceptable d. good e. extremely good
Figure 3.2 Questionnaire for patients with altered mobility but without significant pain.