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How to Know When It’s Time

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Sometimes when cats have terminal illnesses such as cancer or advanced kidney disease, we face the dilemma of when to say goodbye. We don’t want to say goodbye too soon and miss out on precious time, but we don’t want our kitty to suffer. How do we know when a cat is not experiencing enough good times to outweigh the bad? Without a sudden decline, it is harder to know exactly when the tipping point towards too much discomfort is. What if the kitty is sleeping all day but still eats most of their food? What if our feline family member isn’t eating much, but still wants pets and snuggles?

The nature of cats makes knowing when it is time to say goodbye more challenging. At least initially, cats will hide pain and discomfort, showing only mild changes in their routine. A cat in pain does not always meow, hiss, or growl, but will move around less and may be more irritable with people and other animals. They may hide or lie in one spot for a long time or have a decreased appetite. Depending on the location of their pain, they may show alterations in their sleeping and relaxing positions. They may no longer accept pets from their people, or they may protest when being picked up. They may hiss or swat at their animal housemates. The feline grimace scale is a tool to help evaluate a cat’s pain level: https://www.felinegrimacescale.com/. Alternatively, a cat who is not feeling well may want the comfort of being on or near their person and become clingier.

A cat may also be uncomfortable for reasons other than pain. A cat that has a queasy stomach may still feel hungry, but will only sniff at their food and walk away. Some cats may stop eating their regular food and will only eat treats. Other cats will like a new food for a few days, then turn up their nose. If the cat is queasy enough, they will vomit. A cat may feel weak, and you may notice they have a wobbly gait. They may not want to walk as far or jump as high. It may be too far for them to walk to their litter box, and they will eliminate outside their litter box. They may eat and drink less, not due to nausea, but because their food and water bowls are too far away for them to get to in their weakened state.

For cats that have a slower decline, it may not be apparent exactly how much their routine has changed. People may wrestle with guilt at the idea of deciding to end their cat’s suffering. They may worry about saying goodbye too soon. One may have religious or philosophical concerns about deciding to end a cat’s life. These are very normal feelings. A quality-of-life scale modified to be specific to cats is available on this page to aid cat caregivers in evaluating changes in their cat’s behavior and their feelings. You can also schedule a quality-of-life assessment appointment at Nob Hill Cat Clinic.

Quality-of-Life Scale For Cats

Modified from the scale developed by Dani McVety, DVM Lap of Love Veterinary Hospice, Tampa, Florida

SUGGESTIONS ON USING THIS QUALITY-OF-LIFE SCALE

  • Complete this scale at different times of day to note fluctuations because most cats do better during theday and worse at night.
  • Ask multiple family members to complete the scale; compare their observations
  • Take periodic photos of the cat to help remember his or her physical appearance
a cat wearing a collar looking up at the vet clinic

Part 1: Cat’s Quality of Life

Score each subsection on a scale of 0-2
0 = I agree with the statement (describes my cat)
1 = I see some changes
2 = I disagree with the statement (does not describe my cat)

  1.  Sociability
    1. The desire to be with family has not changed
    2. Interacts normally with family or other pets (ie, no increased aggression or other changes
  2.  Natural Functions
    1. Appetite has stayed the same
    2. Drinking has stayed the same
    3. Urination has stayed the same (normal frequency, normal volume, using the litter box)
    4. Bowel movements have stayed the same (normal size, consistency, using the litter box)
    5. The ability to walk and move about the house has stayed the same
  3.  Mental Health
    1. Enjoys normal play activities appropriate for age
    2. Still dislikes the same things (i.e., “still hates to be picked up” = 0 “doesn’t care if picked up or handled” = 2)
    3. No outward signs of stress or anxiety
    4. Does not seem confused or apathetic
    5. Nighttime activity is normal with no changes seen
  4.  Physical Health
    1. Shows no changes in breathing rate or effort, no breathing with mouth open
    2. Shows no outward signs of pain https://www.felinegrimacescale.com/
    3. Does not pace around the house
    4. Overall Condition has not changed recently

Results

0-8 = Quality of life is most likely adequate. No medical intervention required yet, but guidance from your veterinarian may help identification of signs to look for in the future.

9-16 = Quality of life is questionable, and medical intervention is suggested. Your cat would benefit from veterinary oversight and guidance to evaluate his or her disease process.

17-36 = Quality of life is a definite concern. Changes will likely become more progressive and more severe.
Veterinary guidance will help you better understand the end stages of your cat’s disease process to make a more informed decision of whether to continue hospice care or elect peaceful euthanasia. 

Part 2: Family’s Concerns

Score each item on a scale of 0-2
0 = I am not concerned currently
1 = There is some concern
2 = I am concerned about this
I am concerned about the following things:

  • My cat’s suffering
  • My desire to perform nursing care for my cat
  • My ability to perform nursing care for my cat
  • My cat is dying alone
  • Not knowing the right time to euthanize
  • Coping with loss
  • Concern for other animals in my household
  • Concern for other family members (i.e., children)

Results

0-4 = Your concerns are minimal. You have either accepted the inevitable loss of your cat and understand what lies ahead, or you have not yet given it much thought. Now is the time to begin evaluating your concerns and limitations.

5-9 = Your concerns are mounting. Begin by educating yourself on your cat’s condition, which is the best way to ensure you are prepared for the emotional changes ahead

10-16 = Your concerns about your pet are valid. Now is the time to build a support system. Veterinary guidance will help you prepare for the medical changes in your pet, and other health professionals can begin helping you with anticipatory grief. 

ASK QUESTIONS

These open-ended questions will help to gauge the family’s time, emotional, and financial budgets:

  1. Have you ever been through the loss of a cat or other pet before? If so, what was your experience (good or bad, why)?
  2.  What do you hope the life expectancy of your cat will be? What do you think it will be?
  3. What is the ideal situation you wish for your pet’s end-of-life experience (i.e. at home, pass away in her sleep)?