Persistent pain that cannot be controlled with medication or other treatment
Severe difficulty breathing
Inability to stand, walk, or move without significant distress
Loss of control of bladder or bowel with no realistic improvement
Refusal to eat or drink for an extended period
Rapid, unexplained weight loss and severe weakness
Repeated vomiting, diarrhea, or dehydration that cannot be managed
Advanced cancer or other terminal illness with poor prognosis
Frequent seizures that are severe or not controllable
Loss of interest in all favorite activities and interactions
Constant confusion, disorientation, or anxiety
Inability to rest comfortably or sleep due to distress
Open wounds, infections, or sores that do not heal
Significant decline in mobility with no quality of life
Vet confirms there are no effective treatment options left
More bad days than good days over time
Dog no longer responds to comfort, affection, or care
Veterinary recommendation based on suffering and prognosis