The HHHHHMM Scale
You should honestly and objectively rate your animal’s quality of Life on a scale for the following seven criteria—Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days than Bad Days.
Use a Scale from 1 to 10 for each category.
A score of 1 being the worst and of 10 being the best.
HURT: Adequate pain control is the first consideration. Is the animal comfortable? This includes arthritis pain, breathing ability, discomfort secondary to large masses, etc. Is the pet’s pain successfully managed? Have medications, supplements and/or acupuncture been attempted to alleviate pain?
HUNGER: Is the pet eating enough? Is there an appetite? Does the pet accept hand-feeding, and is the animal getting enough nutrition this way? In some situations, the patient may require a feeding tube to maintain caloric intake. A feeding tube may sound extreme to some pet owners; but quality of life can still be maintained with one in place and the tube can be fairly easily managed at home with the proper training and regular veterinary evaluation. In some cases, the feeding tube can be a temporary option until the animal is eating enough to sustain themselves on their own.
HYDRATION: Is the patient dehydrated? For patients who cannot keep or maintain hydration due to a disease process, subcutaneous fluids (given under the skin) can be used to supplement oral water intake. A pet owner can be taught how to administer the fluids at home, and most pets tolerate them reasonably well.
HYGIENE: Can the patient be kept clean, particularly after elimination? Is the haircoat matted? Are there pressure sores or wounds from immobility?
HAPPINESS: Does the pet express joy and interest in the surroundings? Is the pet responsive to things going on around him or her? Does the pet still enjoy greetings and attention from family members? Is the aging cat still purring and enjoying being in a lap? Is the pet depressed, lonely, anxious, bored, or afraid? Are there things that can be done to decrease the pet’s isolation (such as moving their bed to a central area)?
MOBILITY: Can the patient move around on its own to get to food and water or to eliminate? Does the pet need human or mechanical assistance (e.g., a cart)? Can the pet be easily taken outdoors or to the litterbox for elimination? Does the pet feel like going for a walk?
The answer to the mobility question has many confounding factors. For instance, cats and small-breed dogs can enjoy life with less mobility than a larger-breed dog. Also, some caregivers feel that euthanasia is preferable to limb amputation, but an animal that is alert and responsive with the altered mobility of an amputation can still have a great quality of life as long as the owners are committed to help! Since this isn’t always straight-forward, please feel free to discuss this with us or your veterinarian.
MORE GOOD DAYS THAN BAD DAYS: If there are too many bad days in a row or the pet seems to have “given up,” quality of life is compromised. Bad days are filled with undesirable experiences like vomiting/diarrhea, mental confusion, profound weakness and lethargy, pain and discomfort…
Now add up all of your scores. If the score is LESS THAN 35, then quality of life is poor and euthanasia is a humane choice.
There is a “gray area” and each animal deserves individual, thoughtful, and kind consideration. With some veterinary guidance, we can help to make it a decision that is in the best interest of the pet!
** Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 09/2004,for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006. **