As canine cognitive dysfunction progresses, quality of life assessment becomes increasingly important and challenging, requiring owners and veterinarians to navigate difficult end-of-life decisions with welfare at the centre.
Advanced canine cognitive dysfunction presents some of the most difficult welfare and ethical challenges in companion animal medicine. Dogs in late-stage CDS may experience continuous confusion, spatial disorientation, failure to recognise familiar people and places, and profound sleep disruption — all genuine welfare-significant experiences — while appearing physically healthy and maintaining appetite. This creates a decision-making challenge for owners who associate poor quality of life with physical signs of illness. Welfare-centred end-of-life decision-making for CDS requires explicit assessment of cognitive and emotional quality of life alongside physical condition. Palliative care can improve quality of life for some dogs, but when distress becomes a consistent feature of the dog's daily experience despite optimal management, euthanasia is the most welfare-positive decision available. Veterinarians and owners who can have these conversations openly and early achieve the best welfare outcomes.