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175 Canine and Feline End of Life Care 1557

different conditions enjoy the benefits of this approach
VetBooks.ir long before they are at the end of life, including those
with diabetes mellitus, systemic hypertension, and
chronic kidney disease.
At the end of life, with the many sophisticated inter-
ventional options available, it is appropriate for veteri-
narians to exercise a more formal approach to the
necessary decision making that occurs. Veterinarians
must combine the following elements in order to help
the pet owner make ongoing care decisions that are in
the best interest of the pet approaching its death.
Regular evaluations of the animal’s quality of life in
●
dialogue with the pet owner.
Regular assessment of the human family’s quality of
●
life as they care for the pet.
Regular reevaluation of the therapeutic goals of care.
●
Application of the foundational principles of clinical
●
bioethics (respect for autonomy, nonmaleficence,
beneficence, and justice) to both the patient and the
human family during decision making to maximize
outcomes and to act in the best interest of all
parties.
When considering any intervention as a pet approaches
the end of its life, it is important to ask the question, “Just
because we can, does that mean we should?”

Figure 175.1 A comfort room lends itself well to end of life
Evaluating and Maintaining Quality consultations with pet owners. Source: Courtesy of Robin
Downing, DVM.
of Life in End of Life Care
Dr Alice Villalobos has created a Quality of Life
As soon as a life‐limiting disease is diagnosed, it is Scale to use in dialogue with pet owners to offer a some-
appropriate to open a dialogue with the pet owner about what objective assessment of what is a very subjective
the anticipated arc of the disease process on the way experience (Table 175.1). The scale considers seven
to the end of the pet’s life. Likewise, it is important to lay parameters, each scored 1–10 (10 is best). A score at or
the foundation for periodic ongoing evaluations of the above 5 in each category with an overall score of 35 or
pet’s quality of life. Finally, it is important to consider greater generally suggests an acceptable quality of life.
the effects of pet end of life care on the family’s quality While a particular score is important, the trend of scores
of life. Caring for a beloved animal family member at the over time is a more accurate representation of how the
end of life can become overwhelming and fraught with pet is doing. A single low score may illuminate a weak-
emotional overload. The veterinarian’s obligation is to ness in the palliative care plan, calling for a fine‐tuning of
advocate on behalf of a being who cannot advocate care. On the other hand, a low score in even a single cat-
for itself, and that obligation becomes even more egory may signal the time when humane euthanasia is in
critical when choreographing care at the end of life the pet’s best interest. The seven parameters follow the
(Figure 175.1). mnemonic HHHHHMM.
Quality of life is an exquisitely subjective concept.
Quantifying a particular pet’s quality of life is equally ● Hurt
subjective. Each pet’s quality of life must be assessed on ● Hunger
a case‐by‐case basis as every animal is unique. Likewise, ● Hydration
every family situation must stand on its own merits in ● Hygiene
order to assess both the financial and emotional ● Happiness
resources that are available for care of the pet approach- ● Mobility
ing its death. ● More good days than bad