The HHHHHMM Scale was created by a veterinary oncologist and is a wonderful tool in helping to make an exceedingly difficult decision a little more objective.
As honestly and as objectively as possible, rate your animal's Quality of Life for these 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, with 1 being the WORST and 10 being the BEST. Some questions are included in each category to help you to think about their Quality of Life right now.
HURT: Adequate pain control is an important consideration, have you tried pain medication from your veterinarian, supplements and/or acupuncture? Is your pet comfortable? Discomfort can come from arthritic pain, back pain, breathing difficulty, discomfort secondly to large masses, etc. Is your pet's pain being successfully managed?
HUNGER: Is your pet eating enough? Do they have an appetite? Are they accepting of hand-feeding, and if so, are they getting enough nutrition this way? Do they seem excited to eat, but then turn away from the food (possibly because of nausea or oral pain, amongst other things)?
HYDRATION: Is your pet drinking enough? Are they drinking too much? If so, this can be evaluated by your veterinarian to determine if there is an obvious reason for it. Are they showing other signs of dehydration, such as difficulty having a bowel movement and small, hard stools?
HYGIENE: Can your pet be kept clean, particularly after elimination? Are there any signs of urine scald or irritation in the perianal area? Is the haricoat matted? Is your older cat still able to groom adequately? Are there pressure sores or wounds from immobility?
HAPPINESS: Does your pet still express joy and an interest in the surroundings? Is he or she responsive to things going on around them? Does your pet still enjoy greetings and attention from family members? Or are they starting to isolate themselves and not show an interest in getting attention? Is your aging cat still purring and enjoying sitting in your lap? Does your pet seem anxious, afraid, despondent, or lonely? Are there things that can be done to decrease their isolation (such as moving their bed to a central area)?
MOBILITY: Can your pet move around on its own to get to food and water and to eliminate? If they do have an accident, are they able to move away from it? Does your pet need human or mechanical assistance (like a cart)? Can your pet be taken outdoors or to the litter box for elimination fairly easily? Can modifications be made in your home to help with old age issues (like using puppy training pads around the litter box if your cat is missing OR putting yoga mats down on the slippery floor to help your old dog move around more easily)? Is your dog still excited to go on a walk, even a short one?
MORE GOOD DAYS THAN BAD DAYS: If there are too many bad days in a row or your pet seems to have "given up," then Quality of Life is compromised. Bad days are filled with undesirable experiences like vomiting/diarrhea, mental confusion, profound weakness, pain and discomfort, and lethargy. And sometimes a "good day" is just a day where nothing dramatic happened, but the animal is not actually engaging in life or enjoying any experiences.
NOW ADD UP ALL OF YOUR SCORES
IF THE SCORE is LESS THAN 35, then Qualify of Life is poor and humane euthanasia should be considered.
There is a "gray area," and each animal deserves individual, thoughtful, and kind consideration about where their life is at the moment. The Quality of Life Scale can be revisited on a regular basis as your pet approaches the end. If you need some veterinary guidance, we can help to make it a decision that is in the very best interest of your pet.
***Adapted by Villalobos, A.E., Quality fo Life Scale Helps Make Final Call, VPN, 9/2004, for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, released 2006***