Home Senior Dog Care Quality of Life

Quality of Life and When to Say Goodbye

By the Dog Health Handbook team · Updated · Fact-checked against current veterinary references (see sources)

Key takeaways

  • Quality of life scales help you track how your dog is doing, but they are guides, not tests.
  • More bad days than good, or no longer enjoying favorite things, is a common signal to talk to your vet.
  • Most vets give a sedative first, so your dog is asleep before the final injection.
  • Home euthanasia avoids a car trip and lets your dog stay somewhere familiar.
  • Grief and second-guessing are normal; support is available.

Table of Contents

Research Quality of life scale Is it time? What happens Home or clinic Aftercare Grief FAQ Sources

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Deciding when to say goodbye is one of the hardest parts of loving a dog. A common guide is when bad days start to outnumber good days, or when your dog can no longer enjoy the things they love and pain, breathing trouble, not eating or not moving can't be fixed.1,2,3 Quality of life scales such as the HHHHHMM scale help you track this over time and talk it through with your vet.3,2 Most vets now give a sedative first so your dog is asleep before the final injection, and euthanasia can be done at the clinic or at home.4,5,6

Talk to your vet soon if your dog:

  • Has pain that medicine isn't controlling. For breathing trouble, call your vet or an emergency clinic right away.2,3,7
  • Has stopped eating, or can't keep food or water down2
  • Can no longer get up, move around or stay clean2,3
  • Is having more bad days than good, or several bad days in a row1,2

What the Research Says

  • No scale is fully validated. A 2022 review of quality of life tools for dogs and cats found none validated across all measures, and the widely used HHHHHMM scale has had minimal statistical testing.8,9
  • Most deaths are euthanasia. More than 8 in 10 dogs that die are euthanized.10,11,12
  • Nearly 1 in 4 euthanasias in one survey happened at home. In a US survey, 122 of 533 euthanasias took place at home.13
  • Doubt afterward is common. About half of owners question their decision after euthanasia.4

The HHHHHMM Quality of Life Scale

Developed by veterinarian Dr. Alice Villalobos, this scale scores seven areas from 0 to 10 (10 is best).3,2

AreaWhat to ask
HurtIs pain controlled? Is breathing comfortable?
HungerIs your dog eating enough, even with hand feeding?
HydrationIs your dog drinking enough? Fluids under the skin can help.
HygieneCan your dog stay clean, without sores or soiling?
HappinessDoes your dog still show interest and joy, and respond to family?
MobilityCan your dog get up and move, with help if needed?
More good days than badWhen bad days outnumber good, quality of life may be slipping.

A total above 35 out of 70 suggests life is still good, especially if no single area scores very low.3,2 The scale is a guide for talking with your vet, not a test.8,14 Limited mobility can still be compatible with a good life when a dog has help.3

Other simple tools

  • Favorite things list: write down 3 to 5 things your dog loves. When they can no longer enjoy them most days, it may be time to talk about euthanasia.1
  • Good day/bad day calendar: mark each day on a calendar or a tracking app.1,6
  • Each family member scores separately, then compare. Repeat on a schedule.1
  • Photos over time can show changes that are hard to see day to day.1

Is It Time? Signs to Discuss With Your Vet

  • Pain, breathing trouble, nausea, vomiting or seizures that can't be controlled2
  • Not eating, not moving or not staying clean, despite help2
  • Too many bad days in a row, or your dog seems "turned off" to life2
  • An illness that can't be improved, or care your family can no longer give6

In a US study, owners most often chose euthanasia because of pain or suffering, then poor quality of life, then a poor outlook.10 Ask your vet about the best and worst likely course, whether your dog is in pain, and how much time they think is left.1 Many families say afterward that they wish they had planned sooner, which is one reason to keep talking with your vet as things change.1

What Happens During Euthanasia

  1. Sedation: most vets now give a sedative first so your dog is calm and asleep. This is recommended by the AVMA and described as the gold standard, but practices differ, so ask your clinic.4,5,6
  2. The injection: often given through an IV catheter. As the solution is injected, your dog loses consciousness, and the heart and breathing stop within a few minutes.15,16
  3. Confirming death: the vet listens to the heart with a stethoscope.6,16

Afterward, the eyes usually stay open, the bladder or bowel may empty, and there may be a few reflex breaths or muscle twitches. Your dog is not aware of these.15,7,6 Your dog won't feel pain from the procedure.6

Whether to stay is a personal choice, and you shouldn't feel guilty either way.4,15 Your vet should explain every step.4 Planning ahead, such as who will be there, where it will happen and what you'd like for aftercare, helps reduce regret and fear of the unknown. Ask your clinic what they offer, including time alone with your dog before and after.5

At Home or at the Clinic

Home euthanasia avoids a car trip and lets your dog stay somewhere familiar.4 Some clinics and mobile services offer it.6 Approximate US costs in 2025 were about $100 to $250 at a clinic (around $120 to $130 is typical) and about $350 to $900 at home. Emergency clinics usually charge more.17

Aftercare

  • Options: home burial where allowed, or cremation. With communal cremation, usually no ashes are returned, or the ashes are mixed with other pets'; with private cremation you get back only your dog's ashes.6
  • Keepsakes: a paw print or a clip of fur.6
  • Other pets may seem tired or unsettled. Keep routines steady. A pet that stops eating or drinking needs a vet check, not just time to grieve.6,18

Grief and Guilt

Grief can start before your dog dies, and it rarely follows a straight path.4,18 Second-guessing the decision is very common.4 Owners' experiences were similar whether their dog was euthanized or died naturally.19

Support is available. The Cornell University Pet Loss Support Hotline is staffed by trained veterinary student volunteers at 607-218-7457. Pet loss support groups and grief counselors can help too.18,4 If you're struggling with thoughts of suicide or self-harm, call or text 988.18

See also signs your dog is dying and senior dog care.

Frequently Asked Questions

How do I know when it's time to put my dog down?

When bad days outnumber good, your dog can't enjoy favorite things, or pain, breathing trouble or not eating can't be controlled. Your vet can help you decide.

What is the HHHHHMM scale?

A quality of life score covering Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad. Above 35 out of 70 suggests acceptable quality of life.

Is euthanasia painful for dogs?

No. With sedation first, your dog falls asleep, then loses consciousness as the final injection is given.

Should I stay with my dog during euthanasia?

It's a personal choice. Many owners stay, and you shouldn't feel guilty if you can't.

How much does dog euthanasia cost?

Approximate US costs in 2025: about $100 to $250 at a clinic and about $350 to $900 at home.

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Sources and further reading

This article was rewritten and fact-checked on October 28, 2026 against current veterinary references and specialist guidelines:

  1. Honoring the Bond Program. How Will I Know? Assessing Quality of Life and Making Difficult Decisions for Your Pet. The Ohio State University Veterinary Medical Center, undated.
  2. Hunter T, Downing R. Quality of Life at the End of Life for Your Dog. VCA Animal Hospitals, updated August 2024.
  3. Villalobos A. Quality of Life Scale (HHHHHMM). Veterinary Practice News, November 2009.
  4. American Animal Hospital Association, International Association for Animal Hospice and Palliative Care. 2016 AAHA/IAAHPC End-of-Life Care Guidelines. AAHA, 2016.
  5. Cooney K. How I approach... a meaningful euthanasia appointment. Veterinary Focus 2023;33(3) (IVIS).
  6. Bryan L. Euthanasia: Why, When, and How to Say Goodbye to a Pet. University of Illinois College of Veterinary Medicine, February 2024.
  7. Lap of Love. Agonal Breathing in Pets: What It Is, What It Means, and What To Do. Lap of Love, accessed October 2026.
  8. Fulmer AE, Laven LJ, Hill KE. Quality of Life Measurement in Dogs and Cats: A Scoping Review of Generic Tools. Animals, 2022.
  9. Dhaliwal R, et al. 2023 AAHA senior care guidelines for dogs and cats. Journal of the American Animal Hospital Association, 2023.
  10. Pearson EB, Hoffman JM, Melvin RL, McNulty KE, Creevy KE, Ruple A. Analysis of 2,570 responses to Dog Aging Project End of Life Survey demonstrates that euthanasia is associated with cause of death but not age. Journal of the American Veterinary Medical Association, 2023.
  11. Dog Aging Project (summarizing McNulty KE, Creevy KE, Fitzpatrick A, et al., JAVMA 2023). Development and validation of a novel instrument to capture companion dog mortality data: the Dog Aging Project End of Life Survey. Dog Aging Project.
  12. Pegram C, Gray C, Packer RMA, Richards Y, Church DB, Brodbelt DC, O'Neill DG. Proportion and risk factors for death by euthanasia in dogs in the UK. Scientific Reports, 2021 (VetCompass study).
  13. dvm360 (reporting McNulty KE, Ruple A, Fitzpatrick A, et al., JAVMA 2026). Survey identifies client education gaps in canine end-of-life care. dvm360, June 2026.
  14. Merck Veterinary Manual. The HHHHHMM Scale. Merck Veterinary Manual (after Villalobos AE, 2004).
  15. Eirmann L. Facts About Euthanasia (Small Animals). Cornell University College of Veterinary Medicine, accessed October 2026.
  16. Gillette L; reviewed by Morrison BJ. 7 Signs a Dog Is Dying and What To Do. PetMD, updated October 2024.
  17. Koehler R. Pet Euthanasia: How Much Does It Cost? PetMD, July 2025.
  18. Cornell University College of Veterinary Medicine. Pet Loss Support Hotline. Accessed October 2026.
  19. Ryave J, Kutrybala I, O'Brien J, Ruple A, Wilkins V, Schmid SM, et al. Owner-reported experiences are similar for dogs experiencing euthanasia or unassisted death: evaluation of the Dog Aging Project's End of Life Survey free-text responses. Journal of the American Veterinary Medical Association, 2026.

About this article

Last updated : written using the 2016 AAHA/IAAHPC End-of-Life Care Guidelines, the 2023 AAHA Senior Care Guidelines, Ohio State University, the University of Illinois, Cornell University, VCA, Dog Aging Project studies, IVIS-hosted material and a 2022 scoping review.

This page is for general information and is not a substitute for an exam by your veterinarian.