When do you know it's time to let a pet go? Veterinarians weigh in on tough end-of-life decisions.

When we bring a new pet into the family, the last thing we want to think about is saying our final goodbyes to them. But life expectancies being what they are means the vast majority of pet owners will have to let go of their furry family members at some point. Either old age or terminal illness will force difficult decisions about when "it's time" for a dog or a cat, and determining if or when to euthanize can feel like an impossible choice.

Popular foster dog mom Isabel Klee found herself in a position of having to make that choice with a foster dog she had only been caring for for a short time. Zero came to her as a 12-year-old dog with medical and behavioral issues, and when it became clear that medical treatment and loads of love weren't enough to keep him from suffering, Klee decided the kindest course of action was to give Zero a loving family to hold him as he crossed "the rainbow bridge."

Klee received a lot of understanding and empathy, but also some criticism for putting Zero down, which prompted some discussion on the topic of when and how to determine when euthanasia is the right choice.

Euthanasia literally means "good death," though people often use other terminology like "putting down" or "putting to sleep" to describe the process of conscientiously ending an animal's life to save them from suffering. Our pets don't have the cognitive abilities to understand why they are experiencing pain or confusion and they don't have the ability to tell us what they are experiencing. So how do we know when it's time to make the choice to give them a painless end?

We asked veterinarians and people who work with end-of-life care for animals to weigh in.

Animals aren't able to tell us exactly how they are feeling.Photo credit: Canva

Prioritize the pet's quality of life

Dr. Bethany Hsia is a veterinarian and co-founder of CodaPet, a network of vets offering compassionate in-home euthanasia. She tells Upworthy that the primary consideration should always be a pet's quality of life and offers a "quality of life scale" to help owners objectively assess various aspects of their pet's daily life, such as pain, hunger, hydration, hygiene, happiness, and mobility.

Hsia says vets often see owners waiting until the animal is in severe pain or distress before deciding to euthanize, often due to emotional attachment. "Veterinarians are trained to guide owners toward the most humane decision without directly imposing it," she says, offering five approaches vets might use to help empower and support owners to arrive at the decision themselves, rather than feeling pressured:

1. First of all, a vet might say, "How many good days would you say your pet has had this week compared to bad days?" or "When the bad days start to outnumber the good days, that's often a sign that their quality of life is significantly impacted.”

2. Second, a vet may emphasize pain management limitations by saying, "We've tried increasing the pain medication, but it doesn't seem to be providing lasting relief anymore, and we're reaching the maximum safe dosage" or "At this point, any further increase in medication would likely cause more side effects than benefits.”

3. Third, a vet may highlight basic needs by saying, "Is he still eating and drinking adequately on his own?" or "Are you finding it increasingly difficult to keep him clean and comfortable?”

4. Fourth, a vet might describe the next phase of a disease by saying, “Given the progression of cancer, we anticipate that his condition will continue to worsen, and he will likely experience more discomfort in the coming weeks.”

5. Finally, a vet may discuss the "Gift of Euthanasia." While not directly saying it is time, a vet might gently introduce the concept of euthanasia as a final act of kindness. The most compassionate thing we can do for our pets is to prevent them from experiencing further pain and suffering.

Vets often share clues that "it's time."Photo credit: Canva

Don't wait for their worst day

Dr. Elizabeth Benson, veterinarian and founder of Paws into Grace, a Southern California-based company that specializes in end-of-life pet care, says that vets also help by ruling out things that are treatable. "For example, if a pet is vomiting and having anorexia, rule out pancreatitis or simple gastroenteritis," she says. "These are treatable diseases that can affect older pets. These diseases are very different from cancer that can present with the same clinical symptoms.”

"If I have a diagnosis and we know that something isn't treatable, then it goes into quality of life,” says Dr. Benson. “Is their physical health deteriorating and not responding to care? Is their social emotional health compromised? Are they in pain? Are there red flags that can have an acute crisis and we should intervene to prevent suffering? All of these things should be considered when deciding if it’s time.”

“Many times, we have pet parents who cancel their euthanasia appointment because they think the pet is recovering one day, only to later have an emergency situation where the pet is suffering and actively dying in their presence, unassisted by a veterinarian,” adds Dr. Benson. “As hard as it is to make the decision to euthanize a pet during this time, we encourage owners to let their pets be at peace while they are having a good day in order to minimize suffering and avoid an emergency.”

A little early is better than too late.Photo credit: Canva

Don't overemphasize eating or not eating

"Many owners become reluctant to euthanize their pet because they are still eating," says Dr. Ray Spragley of Zen Dog Veterinary Care. "Eating is necessary for survival and most pet's will eat unless they are very nauseous or extremely weak. If their pet cannot walk and is in pain but still eating their quality of life is not good. Owners should think about their pet's pain levels, overall independence, and ability to partake in things they enjoy. In many pets they will not have overt disease but due to age related decline they may have cognitive dysfunction (Dementia). If mentally they are not able to process what is going on around them and are confused that also constitutes a poor quality of life. Signs of pain pet owners should look for are excessive panting, shivering, sensitivity to touch, and aggression."

As a companion animal death doula, Kate LaSala, owner of Rescued By Training LLC shares similar advice:

"When assessing quality of life, it’s not just 'is he still eating?' Quality of life isn’t just about physical health but whether the animal still enjoys daily activities. Can they eat, drink, move and interact with family and their environment in a meaningful way? Are there things that still bring joy to them every day? Are they having more good days than bad days?

It can also help to understand the difference between pain and suffering when making end-of-life decisions. Pain can often be managed but suffering is not only physical but psychological.

I coach clients to look for behavior changes, like a pet that is confused, anxious, chronically uncomfortable, or unable to perform basic functions like breathing, walking, moving, eating, grooming, or relieving themselves. Even if their pain is 'under control' they are likely suffering if they cannot perform basic functions without struggling or assistance."

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Start thinking about end-of-life details early

Lisa Franzetta is also an animal end-of-life doula and a doctor of acupuncture and integrative medicine who treats animals at a holistic veterinary practice in the San Francisco Bay Area. She recommends pet owners pay attention to the signs their animal is well and happy before they decline:

"Ideally, I encourage companion animal guardians to start the process of end-of-life decision making before their animal is very sick, if they have this opportunity. If pet parents tell me their animal is feeling great–I ask them to describe how their animal shows them this. Are they eating their favorite food with gusto? Enjoying their daily walks? Seeking out snuggles and playtime?

By having these mental notes about our animals at their happiest, it can be easier to track when, closer to end-of-life, our beloved animals are no longer able to experience their greatest joys.

Conversely, if a pet parent relays that they think their animal is uncomfortable, stressed, or otherwise not thriving, I ask for details about how they show this. Does a dog who always loved walks now refuse to get out of bed? Does a formerly social cat now hide under the bed much of the day? I will also ask if their animal seems to have more good days than bad days, and help them see when there might be a shift occurring, if an ailing pet is now having more bad days than good ones.

Similarly, if the medication or treatment required to sustain an animal’s life is very stressful for the animal and/or their guardian, I like to share that this is also a quality of life factor worthy of consideration. For instance, if veterinary treatment requires frequent vet visits which are terrifying to a very anxious dog; or if a cat who formerly followed you around your home now hides from you to avoid daily medications–these factors are very reasonable to consider as part of assessing your animal’s quality of life."

Ultimately, end-of-life decisions boil down to what is kindest and most humane for our pet companions. Experts agree that quality of life is key, and that erring on the side of too early is better than too late. As hard as it is to let them go, a peaceful, painless passing is often the best gift we can give to thank our animal family members for the joy and love they shared with us throughout their lives.