Dog Quality of Life Scale: How to Know When It’s Time to Say Goodbye

The hardest part of loving your dog is saying your final goodbye, but determining when to say the words is a close second.

Some canines have a terminal diagnosis that makes the choice clearer, but others endure a slow decline that can leave their last weeks (and sometimes months) full of uncertainty.

Fortunately, there’s a tool that can help: the dog quality of life scale.

This scale breaks down canine health and happiness, allowing you to make the best choice for your pup and ease lingering doubts. 

Below, we’ll explain the dog quality of life scale, discuss some of the things the tool considers, and point out its strengths and weaknesses. It certainly won’t make end of life decisions easy, but it may make them a bit easier.

Dog Quality of Life Scale: Key Takeaways

• A dog quality of life scale helps you determine when euthanasia is appropriate. It factors in core activities, such as eating and drinking, as well as evidence of emotional well-being, such as daily happiness.
• Quality of life scales shouldn’t be used alone to weigh a need for euthanasia. Euthanasia is a complex decision, and scales may miss key areas of concern, so always speak with your vet to discuss your dog’s unique case.
• Feelings can cloud your judgment. Quality of life scales often rely on self-scoring, and grief can influence your choices and affect the outcome, so while these tools can help, they are not perfect.

What Is a Dog Quality of Life Scale?

A dog quality of life scale grades your canine’s overall well-being, including day-to-day aspects like happiness, hygiene, and eating habits.

It can determine how much your aging or ailing dog lives rather than merely exists. It can also help you understand whether your dog is actually suffering.   

Why do we need such a scale?

Many of us agonize over making the call to euthanize our pets at the right time. We worry that we will either wait too long or jump to euthanasia too quickly – either of which are enough to keep an owner awake at night, wrestling with the decision. 

But a quality of life scale breaks down your dog’s condition in a pseudo-quantifiable manner. 

Equipped with this kind of information, you and your vet can discuss what’s best for your dog, whether it’s trying new palliative measures or easing suffering through humane euthanasia.

Veterinarian Dr. Alice Villalobos is credited with creating the first of these scales. She’s also the founder of Pawspice, a program for terminally ill pet patients, making her keenly aware of the final chapter of an animal’s life.

However, other veterinarians and dog-care professionals have devised their own versions of quality of life scales.

Accordingly, owners have several from which they can choose. 

Are All Dog Quality of Life Scales the Same?

Quality of life scales for dogs may differ in verbiage, but they all have the same end goal: determining your pup’s comfort and well-being. 

Some assign point values for coming up with a quality of life score at the end, while others stick to a simple yes-or-no format, before calculating the number of affirmative (or negative) answers to arrive at a recommendation. 

What Kinds of Things Do Quality of Life Scales Cover?

Though they differ in a handful of ways, quality of life scales generally discuss the same aspects of canine life, including:

Comfort 

Is your dog in pain?

Can he breathe normally without laboring? Is he confused and scared by the world around him? Can these symptoms be managed consistently with medication? 

If neither medication nor general comforting measures can relieve your dog’s pain or frightening symptoms, he may be suffering needlessly. 

Eating 

Does your dog eat regularly? Does he eat with the same gusto as always? Would he gobble down a tasty steak if offered? 

A healthy appetite is usually considered one potential sign of wellness, though geriatric canines may see a reduced need for food as they slow down. Weight loss is common in older dogs, so it isn’t always a worrying sign, though it does always warrant a conversation with your vet.

Nevertheless, consistently refusing food (including the tastiest of options) over time is unfortunately a fairly reliable sign that your dog is dying.

Drinking

Is your dog drinking water regularly? Does trying dog-friendly water alternatives help? 

Some dogs are lifelong water haters, but enticing them with salt-free broth usually helps. When dogs are near the end-of-life stage, they may start refusing to drink even the tastiest of liquid concoctions.

Mobility 

Can your pup get around without pain or significant difficulty?

Is any pain beyond the usual aches of arthritis? Do mobility aids like slings help, or is his strength waning? Do medication and indoor assistance such as area rugs and runners for traction help? 

Struggling to get around causes obvious pain in your pup, but it can also lead to mental distress as your dog attempts to tackle day-to-day needs like eating, drinking, and using the bathroom with increasing difficulty. 

Hygiene

Are bathroom breaks regularly a messy event for your pup? Squatting to potty is particularly difficult for dogs with severe joint issues, sometimes resulting in accidental falls into waste. 

Indoor accidents are also a significant concern, with senior pups occasionally soiling beds when straining to stand or even having accidents and peeing during sleep as they lose control of their bowels or bladder.

Not only does this make a mess of your four-footer, but it can also cause increased mental distress for many dogs.

Happiness

Does your pup wag his tail and participate in pup-pleasing activities like walks and fetch? Do treats still rock his world? Does he seem happy? 

Pain and illness can deeply impact your canine’s excitement for everyday pleasures. So, most quality of life scales investigate your dog’s capability of feeling joy – pups who never or rarely feel happiness may be suffering from a poor quality of life. 

Engagement

Is your dog interested in the world around him? Does he interact with you or others in the household, including pets? Does he sit around blankly staring and failing to react to stimuli?

Toward the end of life, dogs of advanced age or suffering from chronic illness may stop engaging and spend significant time sleeping. 

Your dog may also stop doing things like greeting you when you come home or cease playing with you and other pets.This is heartbreaking, as it’s not only sad to know your pup isn’t doing the things that used to make you smile; he’s not doing them because the end is likely approaching. 

Life Balance

Does your dog have good days and bad ones, or are they all generally trending downward? Is he struggling with basic activities everyday or does he still have days in which he seems to be enjoying life?

Canine aches and pains are commonplace in seniorhood and during chronic illness, but dogs may have good days where these issues are less prevalent. At the same time, your pup may also have bad days that leave him bedbound and uncomfortable. Good days may become more scarce as time progresses, leaving your dog in pain more often than not.

What Are Some of the Best Quality of Life Scales?

Several quality-of-life scales are floating around nowadays, with most branching off the original quality of life scale developed by Dr. Villalobos, but with their own formats and scoring systems. 

Here are a few of the best and most commonly used canine quality of life scales:

H5M2 Scale (HHHHHMM Scale)

The HHHHHMM Scale was created by Dr. Villalobos and is often shortened to the H5M2 Scale for easy pronunciation. It’s the best-known quality of life scale and one of the easiest to remember and navigate for a clear-cut answer.

Each letter of the H5M2 Scale stands for an aspect of canine life, including:

• Hurt: Can your dog breathe OK? Is he in any pain? Can medication control any such issues?
• Hunger: How is your dog’s appetite? Is he eating regularly or shunning food entirely?
• Hydration: Is your dog drinking an adequate amount of water? Do flavor-boosters encourage him to drink more? Is he refusing all liquids?
• Hygiene: Can your dog potty on his own without stumbling into excrement? Does he suffer indoor accidents at random times?
• Happiness: Does your dog seem to enjoy his daily routine? Does he still greet you with a tail wag? Does he enjoy doing things he always has?
• Mobility: Can your dog walk around on his own? Can he go outside to potty without pain? Are simple walks too much for him?
• More Good Days Than Bad: Are most of your dog’s days pleasant and pain-free, or are more days now full of pain, sleeping, or uncertainty?

These areas are individually graded from 1 to 10, with 10 being the best score, meaning your dog is OK in that category. Scores are tallied at the end, with dogs receiving a score above 35 seen as having acceptable life quality.

The H5M2 Scale assigns scores to key areas of daily life, so it helps gauge your dog’s overall well-being. That said, it also requires honesty about the nitty-gritty details of a beloved family member’s daily routine, and some owners may inflate scores to hang on a little longer. 

Given the difficulty in scoring, some owners find a quality of life scale using a yes-or-no format to be easier to use. 

Ohio State University Quality of Life Assessment

Ohio State University adapted the H5M2 Scale with permission from Dr. Villalobos and formed this chart covering the same principles in easy-to-digest terms. 

Like the original H5M2 Scale, this version of the test assigns points to various topics but uses statements rather than categories for pet parents to review. It also ranks each from 1 to 5, with 1 being strongly agreeing with the statement and 5 being strongly disagreeing with the statement.

Ohio State University’s Quality of Life Assessment is longer than the H5M2 Scale, with the following statements for owners and vets to navigate:

• My pet does not want to play.
• My pet does not respond to my presence or does not interact with me in the same way as before.
• My pet does not enjoy the same activities as before.
• My pet is hiding.
• My pet’s demeanor/behavior is not the same as it was before diagnosis/illness.
• My pet does not seem to enjoy life.
• My pet has more bad days than good days.
• My pet is sleeping more than usual.
• My pet seems dull and depressed.
• My pet seems to be or is experiencing pain.
• My pet is panting (even while resting.)
• My pet is trembling or shaking.
• My pet is vomiting or seems nauseous.
• My pet is not eating well.
• My pet is not drinking well.
• My pet is losing weight.
• My pet often has diarrhea.
• My pet is not urinating well.
• My pet is not moving normally.
• My pet is not as active as normal.
• My pet does not move around as needed.
• My pet needs my help to move around normally.
• My pet is unable to keep himself clean after soiling.
• My pet has a coat that is greasy, matted, or rough-looking.
• How is my pet’s overall health compared to the initial diagnosis/illness? (1 being worse, 5 being better)
• Rank your pet’s current quality of life. (Select a number from 1 to 5, with 1 being bad and 5 being good.)

This chart doesn’t require users to add points at the end for a score like the H5M2 Scale. Instead, it aims to help owners and vets establish a dog’s overall wellness and discuss each statement to determine if a pup patient is enjoying life without needless suffering. 

While this chart takes longer to navigate, it leaves less wiggle room for artificially fluffing scores, as there’s no predetermined score to “beat.” It also gives real-life scenarios that may be overlooked with other dog quality of life scales. 

On the flip side, this chart ultimately requires you to decide without a scoring guideline to help.

Journeys Quality of Life Scale Calculator

Veterinarian Dr. Katie Hilst developed Journeys Quality of Life Scale Calculator. Specializing in comfortable, at-home euthanasia, Dr. Hilst’s scale covers daily parts of you and your dog’s life and requires users to score each using a number between 1 and 10. 

When using this scale, 10 is the best score (meaning the area isn’t of concern), and 1 is the worst (meaning your dog struggles greatly with said aspect.)

Journeys Quality of Life Scale Calculator includes: 

• Jumping or mobility: How well does your dog get around? Can he jump and play as normal? If he’s slowed down with age, does he still seem comfortable moving from point A to B?
• Ouch or pain: Is your dog in pain or pain-free? Can the pain be controlled with medication? Is the pain constant (even at rest) or only during motion?
• Uncertainty or understanding: Is your dog’s condition unpredictable and volatile? Can he quickly nosedive in condition without explanation, or is his illness stable and predictable?
• Respiration or breathing: Does your dog struggle to breathe? Does he have bouts of uncontrolled coughing or panting? Does he suffer from exercise intolerance?
• Neatness or hygiene: Does your dog have control over his bladder and bowels? Does he have open sores or tumors? Can he still groom himself if needed?
• Eating or drinking: Does your canine take in food and water normally? Is he somewhat pickier than usual but eating with encouragement, or does he refuse food entirely?
• You: Are you constantly worried about your dog’s condition? Do you feel overwhelmed with daily canine care, or can you meet most of your dog’s needs without feeling emotionally and physically drained?
• Social: Does your dog spend time with the family? Is he hiding or reluctant to interact? Does he still greet you and enjoy petting and attention, or is he growling and happier being left alone?

This scale asks direct questions of pet parents and inquires about your well-being. Overall scores hovering near 80 are seen as healthy and happy dogs, while those scoring 8 or in that range are clearly suffering.

While thorough, the calculator does leave some gray areas like other scales. How, for example, do you evaluate a dog who scores a 20? What about a dog scoring a 30? 

There are no easy answers for intermediate scores, and this highlights the need to consider such calculators with your vet to determine the best course of action for your dog’s unique case.

Other Factors to Consider When Contemplating Pet Euthanasia 

Euthanasia is a complex issue with many factors at play. Coming to a decision isn’t always as easy as running down a canine quality of life chart. You may need to weigh other pieces of the puzzle.

More things to discuss surrounding dog euthanasia include: 

Your Well-Being

Caring for a senior dog or a dog with chronic illness isn’t easy.

Constantly dispensing medications, cleaning up accidents, and aiding in your dog’s mobility can be hard on your body, while seeing your beloved companion in pain and slowing is emotionally taxing.

Prolonging the experience when it is not in your dog’s best interest may lead to unnecessary suffering on your part too.

Future Decline

Euthanasia offers your dog a peaceful passage, relieving him of pain. Delaying euthanasia means watching your canine companion decline in condition. 

While you are technically getting more time with your dog, it may not be quality time with pleasant memories. It may be full of uncertainty, pain, and physically watching your dog fade away.

This isn’t something every pet parent wants to subject their dog (or themselves) to.

Grief and Stress

Providing end-of-life care for your most trusted companion is incredibly difficult, as it weighs heavily on your mind and heart. Knowing you’re on the precipice of making one of the hardest decisions you’ll ever have to make for your dog can affect your day-to-day mental health and lead to bouts of anxiety and depression.

Not everyone wants to prolong this emotional anguish.

Dealing with pet loss begins before euthanasia, so allow yourself time and space to grieve. It’s normal to cry and feel upset, even when your pup is still with you. Don’t be ashamed or embarrassed about your feelings.

Talk to a trusted friend or counselor about how you’re feeling. Let it out. Don’t bottle it in.

Finances

We wish no one had to think about money at a time like this, but it’s an unfortunate factor when contemplating euthanasia.

We all know vet care can get pricey, especially when dealing with complicated health issues and potential life-saving efforts.

There’s no shame in declining to spend thousands of dollars to extend your pet’s life — especially when they are suffering and not maintaining a good quality of life.

Reality

As a dog parent, your first instinct is to do whatever it takes to protect your pup.

You may find yourself chasing down cures and procedures to lengthen your time with your dog. While such interventions may stabilize your dog’s condition in some cases, they may only be moving the euthanasia goalpost and delaying the inevitable.

They may cause unnecessary pain, too, with surgeries, needles, and more that only temporarily benefit your fur friend.

Bring any concerns about euthanasia to your vet’s attention. Talk through your feelings if you’re feeling conflicted or don’t know what to do. Your vet has loved your dog right along with you and can help you make the best choice for your best fur friend.

Dog Quality of Life Scale: FAQ

Dog quality of life scales were developed to rate your dog’s overall wellness, but they can still leave questions for many pet parents. Let’s explore some of the most common questions together.

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Saying goodbye to your dog is never easy, particularly when tasked to make the most selfless of decisions for your best four-footed friend. We hope this article provides the information you need to make the best decision for you and your pup.