End-of-life decisions for companion animals involve complex welfare, ethical, and emotional dimensions. Quality-of-life (QoL) assessment frameworks — including the HHHHHMM scale, the Global QoL scale, and VetMetrica — provide structured tools for owners and veterinarians. Palliative care for companion animals has grown significantly, offering pain management, hospice support, and comfort-focused care without curative intent. Euthanasia, when indicated, is considered the most compassionate intervention to prevent prolonged suffering. Research shows owner grief is substantial and prolonged, warranting bereavement support. Ethical frameworks address timing decisions, financial constraints, and the balance between owner attachment and animal welfare. Hospice-assisted natural death (HAND) is emerging as an alternative for owners with religious or personal objections to euthanasia.