Quality of Life Scale - Is it time?
If you are considering “whether it is time” for euthanasia please view the constructing a “quality of life scale” (Original concept, Oncology Outlook, by Dr. Alice Villalobos). It can assist those who are in the unenviable position to make a considered decision with respects to various aspects of pain, appetite, toileting habits, happiness, mobility and whether your pets still enjoy more good days than bad.
Quality of Life Scale or the The HHHHHMM Scale
Score patients using a scale of: 0 to 10 (10 being ideal) for each criteria. A total over 35 accumulative points represents acceptable life quality.
0-10 Hurt
- Adequate pain control & breathing ability is of top concern. Trouble breathing outweighs all concerns. Is the pet’s pain well managed? Can the pet breathe properly? Is oxygen supplementation necessary?
0-10 Hunger
- Is the pet eating enough? Does hand feeding help? Does the pet need a feeding tube?
0-10 Hydration
- Is the pet dehydrated? For patients not drinking enough water, use subcutaneous fluids daily or twice daily to supplement fluid intake.
0-10 Hygiene
- The pet should be brushed and cleaned, particularly after elimination. Avoid pressure sores with soft bedding and keep all wounds clean.
0-10 Happiness
- Does the pet express joy and interest? Is the pet responsive to family, toys, etc.? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be moved to be close to family activities?
0-10 Mobility
- Can the pet get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, but an animal with limited mobility yet still alert, happy and responsive can have a good quality of life as long as caregivers are committed to helping their pet.)
0-10 More Good Days Than Bad
- When bad days outnumber good days, quality of life might be too compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. The decision for euthanasia needs to be made if the pet is suffering. If death comes peacefully and painlessly at home, that is okay.
Total = N.B. A total over 35 points represents acceptable life quality.
Original concept, Oncology Outlook, by Dr. Alice Villalobos, Quality of Life Scale Helps Make Final Call, VPN, 09/2004; scale format created for author’s book, Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, Blackwell Publishing, 2007. Revised for the International Veterinary Association of Pain Management (IVAPM) 2011 Palliative Care and Hospice Guidelines.
