When you first brought home that bouncy kitty, end-of-life decisions were the farthest thing from your mind. But things have changed. Either the years have flown by and you’re now looking at a frail old kitty, or your vet has handed you a devastating diagnosis. Or maybe your cat is fine but you’re just worried about the inevitable.
The sad truth is that unless you are elderly or terminally ill, chances are you will someday have to face your cat’s mortality. It’s an issue that no cat parent wants to confront.
I have nursed my own kitties and foster cats through pancreatitis, fatty liver disease, and cancer. Sometimes we win, sometimes we lose. But when, for the good of your cat, do you throw in the proverbial towel? I’ve said so many times, "I wish they could talk to me."
Until recently, vets have told me it’s time to say goodbye to a sick kitty when she stops eating. But any number of treatable or temporary conditions can cause a cat to ignore the food bowl: dental disease, nausea, viruses, and parasites, among others.
How do you know when mounting symptoms and cascading organ failure reduce your kitty’s quality of life to an intolerable level? Whether your kitty is facing advanced age or a terminal illness, you have an obligation to assess his quality of life and to maintain the best quality possible.
It’s also important to determine if the recommended treatment will further deteriorate your cat’s quality of life. Is the potential benefit worth the cost to your pet? When should you abandon treatment?
Alice Villalobos, a renowned veterinary oncologist, founded pet hospice service Pawspice and has been a pioneer in end-of-life-care for animals for 20 years. In 2004, she developed the Feline Quality of Life (QoL) Scale (PDF), based on the Five Freedoms of Animal Welfare for farm animals in the United Kingdom, to help veterinarians and families assess a pet’s life quality and help pet owners look at hard-to-face issues.
You can assess your pet’s QoL on a monthly, weekly, daily, or hourly basis as needed and make end-of-life decisions more objectively. "Focusing on QoL for companion animals with life-limiting disease may avoid futile medicine, over-treatment, and reluctant early euthanasia," she says.
As I recently learned firsthand, the QoL Scale may help you objectively make one of the most difficult decisions of your life — and help allay the guilt that comes with the decision to humanely euthanize your beloved pet rather than force her to linger.
"The QoL scale helps all caregivers to ask themselves if they are truly able to provide enough care to properly maintain their ailing pet’s QoL," Dr. Villalobos says.
The scale rates seven basic factors (Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days Than Bad) from 1 to 10, with 10 being the best possible score. A total score of 70 is perfect, while a total greater than 35 is deemed acceptable for maintaining a good feline hospice or treatment program.
"Modern pain management, high-tech medicine, and good nursing care can restore and maintain QoL, and can extend the period between the diagnosis of a terminal disease and death,” Dr. Villalobos says.
When my 18-year-old cat Nixie was fighting pancreatitis, I pulled up the QoL Scale and rated her condition. The first time I used it, Nixie scored 36. A few days later, I could no longer hydrate her with subcutaneous fluids because fluid was collecting in her abdomen, a symptom of heart failure. The score dropped to 33.
I was willing to nurse Nixie 24/7 and mortgage my house to pay to keep her going, but her QoL had deteriorated. By continuing to force-feed and medicate, I would only be prolonging her misery. Thankfully, the QoL Scale opened my eyes, and that day I released my Heart Kitty. My life hasn’t been the same since, but I know I didn’t prolong her pain for my own benefit.
Here’s how to interpret the seven stages of the Quality of Life Scale:
Adequate pain control, including the cat’s ability to breathe, is first and foremost on the scale. People don’t realize that in human medicine, not being able to breathe is ranked at the top of the pain scale. "Breathing is No. 1 on the QoL Scale because if you can’t breathe, nothing else matters," Dr. Villalobos says. Humans describe breathing difficulty as being more painful than a broken bone.
“Monitor the pet’s respirations to identify labored breathing so you won’t wait too long to provide relief," she says. "Respiratory distress is an emergency and it must be relieved immediately, or there is no QoL for the animal, and there is no humane justification to continue the hospice.”
Symptoms of pain in a cat include increased vocalizations, panting or open-mouth breathing, constantly licking a particular area, hiding or avoiding interaction with family, irritability when touched, not eating, not being able to jump up to favorite places, change in litter box habits, and nonstop purring (yes, cats purr to soothe themselves).
Often kitties can hide weight loss beneath their coats, so monitoring your sick or senior pet’s weight is essential. If your cat isn’t willingly eating, your veterinarian can prescribe appetite stimulants such as mirtazapine. Under your vet’s supervision, you can coax, hand-feed, force-feed, or even have an esophageal feeding tube surgically implanted.
Every ailing kitty should receive adequate fluids: two teaspoons or 10 ml per pound per day. You can check your kitty for dehydration by lifting his skin between the shoulder blades and see how fast it returns. The skin of a hydrated animal will spring back to his muscle almost immediately, while a dehydrated animal’s skin will return more slowly. Dehydrated kitties will have tacky-feeling gums and their eyes may appear sunken.
To supplement your cat’s fluid intake, your vet will probably prescribe subcutaneous fluids, which your vet can teach you to give your kitty. Providing fluids at home can make a huge difference in your cat’s life QoL and can save you a great deal of money.
Is your kitty brushed and clean? Is his coat matted? Can he use the litter box or does he lie in his own eliminations?
Cats who can’t move away from their waste will develop painful sores. Cat with oral disease can’t groom themselves, so they quickly become demoralized. You can help your unkempt kitty stay clean by dampening a sponge with a highly diluted solution of lemon juice and hydrogen peroxide, and gently stroke his face, paws and legs, similar to the way a mother’s tongue would do it.
Happiness is important for both you and your kitty. Dr. Villalobos believes that even at end-of-life there should be a two-way exchange of pleasure and contentment between you and your cat. You need to provide enrichment that encourages as much fun and mental stimulation as possible.
Schedule some fun time. Does he paw at his favorite toy or does he ignore it? Does he sleep with you? Does he still enjoy sitting on your lap and being caressed? It is easy to see that our pets communicate with their eyes. Does he respond to a pinch of catnip? Or does he seem depressed, lonely, anxious, bored, or afraid? Does he isolate himself?
This is relative. Is your cat able to get up and move around enough to satisfy normal desires? Is he having seizures or stumbling? Does he need help to get in the litter box to eliminate?
Bad days might include vomiting, nausea, diarrhea, frustration, falling down, or seizures. "When there are too many bad days in a row (or if the pet seems to be turned off to life), the quality of life is compromised," Dr. Villalobos says.
Making the decision to end your beloved cat’s life by euthanasia is probably one of the most difficult decisions you’ll ever make. In the last two months, I have had to use the Quality of Life Scale for two kitties. The scale helped me make the correct and humane yet heartbreaking decision.
Was there guilt? Yes, some. But the QoL Scale helped me understand that I saved my babies a long, painful, lingering death. Knowing how Nixie was miserable took most of my guilt away. For the first time, I know I didn’t wait too long. I also know I made the right decision.
Hopefully it will be many years before you need the QoL Scale, but when the time comes, use the compassionate tool together with your vet to prevent your pet’s unnecessary suffering. Freedom from pain is a gift for your cat. Freedom from guilt is a gift for you.
Have you ever faced end-of-life decisions with your cat? What did you base them on? Tell us your story in the comments.
Read more by Dusty and more about end-of-life issues:
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About the author: Dusty Rainbolt ACCBC, is the vice president of the Cat Writers’ Association, editor-in-chief of AdoptAShelter.com and a member of the International Association of Animal Behavior Consultants. She’s the award-winning author of eight fiction and non-fiction books including her most recent paranormal mystery, Death Under the Crescent Moon.