It is fortunate if a pet is able to die at home in a painless and peaceful state. This is ideal, and is most predictable when using veterinary supervision that includes proper pain control and home euthanasia services. But not all terminal animals receive needed professional help, nor are they able to pass away peacefully and naturally at home. Some dying pets suffer greatly and go into terrible respiratory distress and thrash about and become agonal before death. This is truly not natural. In the wild, debilitated animals naturally become prey. Sick animals in the wild do not survive long enough in decline to endure the angst of suffering to death.

Witnessing a house pet’s traumatic death can be a horrible experience for loving family members who did not want their beloved pet to suffer this pointless indignity, without having the option of humane euthanasia. Family members feel guilty and are haunted for years with these harsh memories. The right thing to do for pet owners who prefer a natural death is to: provide adequate pain medication, be instructed to use the Quality Of Life scale, and always have a backup plan in case their pet goes into a distressful crisis and needs professional help to change worlds. Caregivers should know where to go 24/7 for immediate assistance for the gift of euthanasia, to avoid a beloved pet’s futile and unnecessary “suffering to death.”

The original concept of ‘Pawspice’ embraces expert pain management and standard care while providing palliative medicine and home care giving instructions for families to maintain quality of life for their terminal pets. When a dearly beloved pet’s serious illness can’t be successfully treated due to other conditions or advanced age or the owner’s financial constraints or a logistical problem; veterinarians can help pet owners by compassionately providing end of life care. When a treated pet’s cancer has recurred, if that cancer is resistant to further treatment or if the pet is in the terminal stages of cancer; in home hospice care is a wonderful next step. Since physicians confuse palliative medicine with hospice, and hospice excludes euthanasia, a new term, “Pawspice” which rhymes with hospice, was created by this author, Dr. Alice Villalobos. Pawspice keeps the pet and its family comfortably close to their nest. A well conceptualized, creative, palliative pet hospice (Pawspice) for pet owners may be the very best care that veterinary medicine can offer to support the human-animal bond. Veterinarians and their staff can kindly and respectfully help pet owners sustain a quality of life for geriatric and terminal pets during their last months, weeks and days of life.

My Quality of Life Scale (on the APLB website: helps all caregivers determine if they are successful in maintaining a good Pawspice. It also helps decision makers feel justified when they need to make the final call for the gift of euthanasia to relieve their pet of pointless pain and distress, and assure a peaceful and painless passing.

The Association for Pet Loss and Bereavement

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Quality of Life Scale


When we decide to have a pet we take on a complex responsibility and covenant to protect and be there for it — in every way. The time may come when he or she grows sick or infirm, and it is our unavoidable duty to do what is best for the pet, despite the heartbreak that may bring to us, personally. In doing that, euthanasia is our last and most profound act of love and stewardship. In making that terrible moral decision we must step beyond our own feelings, and do what is best for the pet. And it now all comes down to quality of life.

The death of a beloved pet can be so tragic for us. That is such a hard concept. But if they outlived us who would care for and love them when they die? Maybe somehow, this is the best way.

Nobody wants to live forever. And when we can also somehow put that into perspective for our dear animal companions, it makes a lot of new sense. They have their own strong sense of dignity, too. Unfortunately, that is too often overlooked.

One of the most common complaints we hear is that people fear they may have waited too long — or not long enough — before having their beloved companion animals euthanized. If it is feasible, we suggest filling this scale out three times, on three successive days, to get a more accurate appraisal.

We can be too emotionally involved and subjective to easily make a clear decision. The following Quality of Life Assessment System is a means designed to help you make a more objective evaluation.

It is strongly suggested that you confer with your veterinarian, in deciding on that last accommodation.


Pet caregivers can use this Quality of Life Scale to determine the success of Pawspice care. Score patients using a scale of: 0 to 10 (10 being ideal).

Score Criterion
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 eliminations. 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 *A total over 35 points represents acceptable life quality to continue with pet hospice (Pawspice).

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. Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell.

Alice Villalobos, DVM, DPNAP, a renowned veterinary oncologist, introduced “Pawspice”, a quality of life program for terminally ill pets. Pawspice starts at diagnosis and includes symptom management, gentle standard care and transitions into hospice as the pet nears death. Dr. Villalobos developed this scoring system to help family members and veterinary teams assess a pet’s life quality.