4/25/2010 Euthanasia Part III: Making the Decision

 Vet tip of the Day: When is it the right time for euthanasia?

In this final entry concerning the difficult topic of euthanasia, I would like to share with you my views as a veterinarian on the hardest part of the decision for euthanasia: when is the appropriate time?

First and foremost, I respect the right of a horse's owner to use their own judgement in deciding what they believe is best for their horse.  Horses legally are considered property, they do not have legal rights.  There are governing bodies in every state to respond to situations of animal cruelty to protect horses from abuse situations, but elective euthanasia is not considered abuse. I do not agree with every decision for euthansia, and I have refused to perform euthansia in rare cases.  However, the vast majority of owners who come to the decision to end their horse's life do so after careful and painful deliberation, and are acting in the best interest of their cherished animal.

I am frequently asked by clients to help them in making the decision to end a horse's life.  Usually this is in the case of geriatric horses, or chronically lame horses.  I would love to be able to tell you that it is always clear to me when a horse is suffering inhumanely, but it isn't.  The question of quality of life is engulfed in a huge grey cloud. Two things that I offer as factors to consider when you are trying to determine the quality of a debilitated or geriatric horse's life are: 1) progressive weight loss in the face of an excellent plane of nutrition and 2) prolonged periods of recumbency (lying down) to the point that pressure points such as hips develop non-healing sores, and the horse has pronounced difficulty rising.

The subject of euthanasia for practical reasons is really problematic.  Horses live a long time and they are very expensive to care for.  As horses age they typically require more calories and special dietary considerations, as well as nutritional supplements and sometimes medication (such as pergolide for Cushings horses, or anti-inflammtories for musculoskeletal problems) which increase the cost of upkeep for an animal that may no longer be rideable.  I stick very firmly to my respect for each horse owner's individual right to make decisions for such horses.

On the other end of the spectrum are owners who simply do not believe in euthanasia, and feel very strongly that all living beings should die a natural death.  Again, I respect this perspective, as long as the owner is able to provide adequate nursing care and pain medication to support their horse through the process of dying.  I always remember a foal I treated back at the University of Georgia when I was a resident.  The owner had lost a son to a long battle with cancer and absolutely would not consider euthanasia an option for this foal.  The foal suffered from neonatal septicemia, a bacterial infection that circulated throughout the body, seeding infections in multiple sites.  The foal had bacterial endocarditis (a vegetative bacterial growth on a heart valve), pneumonia, an infected umbilical cord, and an infection of the growth plate adjacent to one of the hind fetlock joints.  The bacteria responsible for all these infections was resistant to virtually every antibiotic available.  Statistically the foal's chance of survival was way below 10%, he was extremely lame, had dramatically reduced exercise capacity due to his enlarged heart and leaky mitral valve, as well as the severe pnuemonia.

Despite my repeated explanations of the foal's condition and poor quality of life, the owner refused to consider euthanasia, and instructed me to continue treating the foal, regardless of cost or prognosis.  Well guess what?  That foal lived to race as a 3 year old - he only raced once, and not very well, but he managed to overcome his heart infection, and although he never was sound, he was retired after his one race and lived out his life in a beautiful pasture. It is not our place to judge the decisions of others regarding their horses, unless cruelty or neglect are evident.

So when is it appropriate to choose euthanasia for your horse?  Only you can make that decision.  Listen to your veterinarian's assessment of your horse's condition and prognosis, then search your heart and mind and make your decision based on your own personal ethical code.  It is never easy, and it never gets easier, but it is part of the responsibility of horse ownership. 
















I believe that education is the key to evolution. 
I believe that animals are the key to compassion.
I believe the learning never stops.

4/21/2010 Euthanasia

 Vet tip of the Day: Thinking about Euthanasia

I would like to introduce the topic of euthanasia with a few stories.  The first is one about an experience I had as a resident, and the second is about PipSqueak, a wonderful patient of mine

I completed a large animal internal medicine residency at the University of Georgia School of Veterinary Medicine.  I was on call to receive emergency patients into the hospital every 3rd weeknight and every other weekend for 5 consecutive years.  That's a lot of emergency admissions.  The sad reality of referral equine medicine is that we see a lot of very sick horses and many of them don't make it out of the hospital.

One weekend early in the first year of my residency I didn't sleep for 48 hours.  During that time I received 8 emergency patients.  Four of them were critically ill and over the course of two days I administered a lethal dose of sodium pentobarbital (euthanasia) to all four when it became clear that they had no hope of survival. Right there you come up against one of the more difficult concepts in the decision for euthanasia: no hope.  We all know that there always is hope, we just choose under certain circumstances to consider that hope too small to warrant the continued suffering of the really sick or the really old.  And let's face it, economic concerns and practical concerns influence the decision to end animal's lives as well.

That particular weekend in 1989 when I was a resident was very difficult for me. In the five subsequent years I never had to face the death of some many horses in such a short period of time.  I was exhausted, I was a new resident and I didn't have a lot of experience coping with the grief, guilt and confusion often experienced by owners when making the decision for euthanasia of an animal they love. At that stage of my career I also didn't have a lot of experience pushing the plunger on the syringe of "blue juice" that ends an animal's life.  I don't really remember all the details of that weekend.  I do remember that moment, just before performing each injection, when I wondered if perhaps there was hope, if perhaps I had misinformed the clients, if in fact the horse might survive if I could just do one more thing to turn its condition around, if I was making a terrible mistake.  None of these things was true, but the thoughts ran through my head nevertheless.  And I remember on Sunday afternoon, after I had humanely destroyed the fourth horse, sitting on the floor of the recovery stall outside the equine surgery suite and thinking, if one more horse comes in and requires euthanasia before tomorrow morning, someone else is going to have to push the plunger, I just can't take any more life today.

The second story is about PipSqueak.  PipSqueak was a grey arabian gelding who I took care of for 13 years, from the time he was 14 until his death.  Over these years PipSqueak belonged to 4 different owners, all of whom he taught the skill of riding after hounds, or foxhunting.  PipSqueak was a remarkable horse, an outstanding athlete, and a very wise soul.  Toward the last years of his life he was retired and turned out to pasture by his then owner.  His care was not adequate and he lost weight and began to have trouble getting up.  One of his previous owners, who by now was a teenage girl, saw PipSqueak's condition and reclaimed him.  She had owned PipSqueak when she was 8-12 years old and had ridden him all over the desert of Northern Nevada.  Now 15 years old, she brought PipSqueak home and fattened him up and took great care of him for another 9 months.

Although he was back in great body condition, PipSqueak's degenerative joint disease progressed to the point that he sometimes struggled for as long as 20 minutes attempting to rise, raising himself on his front legs but unable to lift his hind end to a standing position.  He was treated with joint supplements and anti-inflammatories, his hocks were injected, he was put on special footing and had special foot care, but his condition continued to deteriorate.  Finally his owner's grandmother called me one day to schedule an appointment for PipSqueak's elective euthanasia.

I arrived at the appointed time to find the entire family waiting with PipSqueak.  The horse had been bathed, his mane and tail brushed to a shimmering white, hoof dressing applied to all four feet, and he wore a beautiful new halter.  We all walked out with PipSqueak to the area where he was to be buried.  PipSqueak walked comfortably because his owner had given him one last whopping dose of bute that morning along with a bucket of grain so that he would be comfortable and feel especially spoiled in his final hours.  As we walked we shared stories of PipSqeak's many exploits over the years.

PipSqueak stood patiently while everyone said their goodbyes.  As I injected the sodium pentobarbital PipSqueak's family stood close by, speaking to him gently.  As soon as he fell to the ground we followed his descent, everyone keeping a hand somewhere on his neck or head.  We were very quiet,  his young owner began to cry and arms encircled her in her grief.  PipSqueak passed from life to death very swiftly, in the company of humans who loved and respected him, and who took the responsibility of ending his life squarely on their own shoulders, with compassion and grace.

I find the topic of euthanasia very complex, and will discuss it in more theoretical, and practical terms, over the next few days.  Please feel free to comment on this blog entry with your own thoughts and experiences concerning this topic.


I believe that education is the key to evolution.
I believe that learning never stops.