How to know when to put your cat down: signs, a scored scale and what to ask

You are reading this because you are worried about your cat. That is hard. This guide gives you a way to look at the question with a clear head. It does not decide for you. Your vet can examine your cat and talk it through with you.

This page gives general information. It is not veterinary advice. If your cat is in distress right now, call your vet or an emergency clinic.

Call a vet now if

Do not wait to read the rest of this page if your cat:

• struggles to breathe,
• has collapsed or cannot stand,
• has been hit by a car or badly hurt,
• cries out in pain that you cannot ease, or
• passes little or no urine. VCA calls this a life-threatening emergency.

Ask the clinic what to do on the way.

Why this is hard with cats

Cats hide pain. VCA says cats have evolved to hide signs of illness and pain. A cat can be very sick before you notice. Early signs may be only a quiet, withdrawn cat.

So do not wait for your cat to cry out. Look for small changes. Compare today with last month.

Signs that quality of life is poor

Cats Protection says you may need to ask whether your cat:

• can no longer eat or drink normally,
• cannot stand or move normally,
• has trouble breathing,
• is badly hurt in an accident,
• is incontinent,
• has a behaviour problem that cannot be treated and leaves the cat very unhappy, or
• has any condition that causes pain that cannot be controlled.

Lap of Love adds other signs. These include limping or a hunched posture, restlessness, refusing food or water, falls, trouble keeping clean, hiding, no wish for contact, and more calling or agitation at night. It says a steady fall in daily life can mean it is time for further assessment.

Lap of Love also says age alone is not a reason. A cat that is old but comfortable and enjoying life does not need this decision.

Use a scale

A scale turns a feeling into numbers. You can see a trend. You can share it with your vet.

The HHHHHMM scale

The letters stand for hurt, hunger, hydration, hygiene, happiness, mobility, and more good days than bad. Lap of Love says it was first designed by a veterinary oncologist. It tells you to use the scale regularly and to go over the results with your vet. It also says you may try more than one scale to find the one that suits you.

The Lap of Love scale

Lap of Love publishes a free scale with four groups: social functions, mental health, health and natural functions. You score each statement:

• 0 means the statement describes your pet.
• 1 means you see some changes.
• 2 means it does not describe your pet.

Examples are “enjoys normal play”, “appetite has stayed the same”, “drinking has stayed the same”, “nighttime activity is normal” and “no outward signs of pain”. You add up the scores. The scale then gives three bands:

• 0 to 8: quality of life is most likely adequate. No medical action is needed yet. Your vet can help you know what to watch for.
• 9 to 16: quality of life is questionable. The scale suggests medical help.
• 17 to 32: quality of life is a definite concern. The scale says changes will probably get worse soon. Vet guidance can help you choose between hospice care and a peaceful end.

The scale does not make the choice. It gives you and your vet something to look at. The bands are a guide, not a rule. Your vet helps you read them.

Keep a good day and bad day record

Write one line each evening:

• Did my cat eat? Drink? Use the litter tray?
• Did my cat groom, play or seek me out?
• Did my cat move without pain?
• Was today a good day, a mixed day or a bad day?

Do this for at least a week. Bring the page to the vet. The Cat End-of-Life and Memory Book has a page for this. Our free vet visit summary tool also helps you write down what you have seen.

What to ask your vet

Cornell lists these questions to ask the vet:

• Is my cat suffering?
• What treatments are available, and what would they cost?
• What might treatment achieve: a full recovery, pain relief or more time?
• What home care will I need to give?

It also lists questions to ask yourself:

• What is my cat’s quality of life?
• Is my cat comfortable, and will treatment make that better or worse?
• How much longer can I reasonably expect my cat to live?

Cornell says reasons to consider euthanasia include a long-term disease with no treatment left, end-stage organ failure, a nerve condition that makes care very hard, and an injury that cannot be repaired. A vet may say a condition justifies it. The owner must always authorise it.

Cats Protection says treatment to reduce pain or distress may not be possible or may no longer work. It then calls ending suffering “the most loving and courageous way” to care. It also says you should do what feels best for you and your cat.

Before the day

Cats Protection and Cornell list things to settle early:

• Whether you want to be with your cat. Both say this is your choice.
• Cost and options, and whether to pay in advance. Cats Protection says you may be upset on the day.
• Whether the vet will arrange cremation. Cats Protection says you must ask at the time.
• Aftercare. Cornell lists taking the body home for cremation or burial, or letting the clinic arrange it.
• Children. Cornell says to avoid words such as “put to sleep” with young children, and to explain clearly.

Our guide to signs of kidney disease in cats and our post on when a cat is a senior may help you talk to your vet about changes you have seen. If you have a dog, see how to know when to put your dog down.

What happens at the end

Cats Protection says you sign a consent form. Some vets give a sedative first. The vet then gives an injection that causes unconsciousness or deeper sedation and then stops the heart. The page says it should cause no pain beyond a brief pinprick. The vet checks for a heartbeat.

Cats Protection also says your cat’s eyes will not close. Your cat may take a deep breath, twitch, or empty the bladder or bowels. These are reflexes. Cornell says that in virtually all cases the cat loses consciousness and passes within seconds. Cornell also says many vets prefer a quiet time of day, so you can stay as long as you need.

Grief

Cats Protection says there is no normal way to grieve and no time limit. It says grief can start before your cat has died. It lists a free, private support line called Paws to Listen. Cornell says to allow yourself time to grieve.

A place to keep it all

The Cat End-of-Life and Memory Book has a good and hard days diary, questions for your vet, aftercare planned ahead, help with grief and children, and a memory book. It is a fillable PDF. You can use it now, with your vet, or keep it for later.

When the time comes, read cat euthanasia: what to expect, step by step.

This guide is one step in our complete guide on how to cope with losing a pet: the decision, the day, aftercare and grief, in order.