Caring for Horses Through Life and Death
Considering end-of-life decisions for your horse ahead of time will help minimize the unpleasantness inherent in these events and serve to provide optimal care for your horse.
Reprinted from The Horse Report (October 2013) with permission from the Center for Equine Health, School of Veterinary Medicine, University of California, Davis (UC Davis).
Medical advances and an ever-increasing knowledge base about health and disease over the last century have resulted in longer lives for humans and animals. There is no question that these advances have saved lives, but not all applications have been desirable.
As the survival time for people with incurable conditions (including aging) has improved, we have come to realize that prolonging life does not always equal quality of life. With this in mind, people are now more willing than before to talk about the end of life for themselves and their families. They are giving thought to whether they want their lives prolonged by technology—drugs, feeding tubes, respirators, dialysis—and expressing these health care preferences in legal documents called advance directives in the event they cannot be expressed later.
How to Prepare an Advance Directive for your Horse
- Create a written document that states the horse’s name, age, and physical description. If possible, include a photograph.
- If the horse is insured, include the name of your insurance company, the policy number, and contact information of the agent, as well as type of policy (i.e., major medical vs. mortality).
- Designate an emergency contact person and provide multiple contact numbers.
- Designate your primary care veterinarian with contact information, including a backup DVM if one is available.
- Clearly state your intentions for your horse should it be injured or become ill and efforts to reach you fail. Include details regarding referral for intensive care and a financial cap if relevant.
- Designate your emergency contact and your veterinarian as agents to authorize humane euthanasia in the event that you are unreachable and your horse is suffering and stabilization or transportation to a referral center are not possible or humane. This wording is personal and will depend on your circumstances. Standard protocols for insured horses will be followed.
- Indicate your aftercare preferences: private cremation vs. transport to rendering, etc.
- Indicate if you wish to keep a memento such as a shoe or piece of mane or tail.
- If you board your horse, provide your barn manager with a copy of this information.
- In an emergency, make every effort to keep the horse calm and consult with your veterinarian on management while waiting for medical help to arrive. Safety is always a paramount concern.
- In elected euthanasia for a geriatric horse, select a quiet time of day and offer a last meal or favorite part of the daily routine. This is a personal decision and can serve as a final bonding moment.
- Select a location that is relatively soft and free of debris.
- Consider light sedation as an option to minimize stress. Your veterinarian will guide you in this decision based on the circumstances of the horse.
- It is important for herdmates to understand that their friend has passed and not just disappeared. This is especially true for mares with foals, and most veterinarians will leave a deceased foal with a mare after euthanasia to allow her to adjust and recognize the finality of the situation. Instinct runs strong in mares and they will often wander away or back to food within 30 to 40 minutes. In the wild, death draws predators and the instinct is to move away.
- Schedule some time with your veterinarian or talk with him or her at a routine visit about your plans for your horse. Provide them with a copy of your advance directive so that they can retain it in their records. They will help to walk you through the process and answer any questions or concerns that you might have. Make a note to update the document yearly.
This Horse Report is about giving similar consideration to end-of-life assessments and decisions for your horse.
In an essay entitled Gift to a Friend, Gregory Ferraro, DVM, wrote about his views on euthanasia. He acknowledges that one of the unfortunate aspects of life is that we usually outlive the animals with whom we share intimate friendships. Frequently, their death comes dramatically and with certainty. Severe illness or tragic accident provides no alternative to the end of life decision.
More commonly, these matters are not so clear-cut. Increased longevity due to better care, as for humans, has resulted in increased populations of older horses in their twenties and beyond who will one day begin a decline. Illness and debilitation might come gradually over an extended period, accompanied by a subtle rise in suffering. During this period of time, we might be so caught up in saving the life of our beloved friend that we find it difficult to recognize the intersection of progressive medical treatment and the relief of suffering.
Euthanasia, or the humane termination of an animal’s life, is a gift that we give to our suffering animals. When properly chosen and applied, it is one of the most humane acts a person can accomplish. Unfortunately, there is no one who can give you a precise answer as to when such a gift should be given. It is a personal decision that each of us under difficult circumstances has to make based on our own values and experiences.
The decision is rarely made easily but often comes less painfully to those who have thought about it ahead of time. Veterinarians with experience in this area will tell you that animal owners who have contemplated the question of euthanasia and settled upon a plan well in advance of the need to act lessen their trauma in making the decision.
We recommend that animal owners, especially those with older animals, establish a close working relationship with their attending veterinarians. They should discuss the subject of euthanasia with those caregivers and come to an understanding of how the events surrounding the loss of their animals should be handled—not just if, when and how euthanasia should be performed, but who should be present, where it should occur, and what is to be done with the animal afterward. Preplanning for these circumstances will minimize the unpleasantness inherent in these events and serve to provide optimal care for your horse.
Life for all living creatures comes to an end. While it is easier to avoid thinking about the subject, we have the ability to make that end lovingly easy for our beloved animals.
Reasons for Euthanasia
There is a wide range of reasons to consider euthanasia of a horse, but usually the horse is considered old and debilitated, sick, injured, dangerous, or unwanted. Some decisions are based on an acute emergency situation, while others are related to chronic and progressive conditions that worsen over time. Catastrophic accidents are usually an emergency, such as those caused by natural disasters, as are accidents that occur during transportation, breeding and foaling, riding, training, and other equine activities.
As horses age, there might be a progressive compromise in the function of their vital systems, behavior, or ability to move about, all of which can cause the horse to suffer. Illnesses in horses of any age that have a poor prognosis, treatment that is cost-prohibitive, or associated pain that cannot be controlled or alleviated should be considerations for euthanasia. Common examples of this are progressive laminitis, advanced neurologic disease, and unresolving colic.
Safety factors could warrant consideration of euthanasia with a horse that is dangerous to itself, to its handlers, or even other herd mates. Personal situations of the horse owner or management of the horse might also be a reason for requesting or electing euthanasia. Situations can include the physical inability to treat or care for a horse or financial impairment such as loss of a job. When financial constraints are present, every effort should be made to rehome a healthy horse.
In summary, justification for euthanizing a horse for humane reasons should be based on both medical considerations as well as quality of life issues for the horse. Although not a replacement for consultation with a veterinarian, the following guidelines for euthanasia developed by the American Association of Equine Practitioners (AAEP) and the United States Humane Society should be considered:
- Is the horse’s condition chronic, incurable, and resulting in unnecessary pain and suffering?
- Does the horse’s condition present a hopeless prognosis for life?
- Is the horse a hazard to itself, other horses, or humans?
- Will the horse require continuous medication for the relief of pain and suffering for the remainder of its life?
- If the horse is suffering but treatable, is proper and recommended care of the horse within the means of the rescue/retirement facility, such that the health and safety of the other horses are not compromised?
- Is the horse constantly and in the foreseeable future unable to move unassisted, unable to interact with other horses or unable to show behaviors that may be considered essential for a decent quality of life?
Your veterinarian would be able to guide you in making this determination, especially regarding the degree to which the horse is suffering. Each case should be addressed on its own merits, as individual horses differ from each other as much as human beings differ from each other.
Decision-Making Techniques: When Is It Time?
Carolyn Stull, MS, PhD, a UC Davis Cooperative Extension Specialist and lecturer on animal welfare issues, has authored numerous articles on the welfare of horses and has been a major contributor to this Horse Report. In a 2013 article published in the Journal of Equine Veterinary Science, she describes the general humane endpoints for horses that could be considered by their owner, including the development of conditions that result in untreatable excruciating pain, a 20% decrease in their normal body weight, or the inability to reach food and water. The endpoints should be recognizable to the owner and can be monitored over time to establish their significance.
For example, a horse with a catastrophic injury that is not treatable could exhibit painful behavior and not be ambulatory enough to reach food and water. An old horse might slowly lose weight over time, even though all efforts have been made to provide it with appropriate feed and water. These horses can be monitored for weight loss and behavioral changes in order to set a humane endpoint. Establishing the endpoints will help evaluate the progression of the disease or injury and assist in the decision-making process.
Some endpoints using the MEDW criteria include the constant struggling of a horse to perform simple movement activities (M), or a deteriorated body condition with a loss of 20% or more of body weight (W).
The MEDW criteria can be used in daily monitoring of the stages of disability of a horse, such as a geriatric horse, to evaluate normal ambulatory movement (M), eating (E), drinking (D), and body weight (W). The horse should also be evaluated for its ability to rise from a recumbent position. Horses that can no longer rise on their own will be susceptible to colic. Unlike dogs and cats, horses cannot tolerate being down for more than a few hours due to their propensity to compromise gut function while down.
Some endpoints using the MEDW criteria include the constant struggling of a horse to perform simple movement activities (M), a compromised eating desire or dental function (E), a failure to consume adequate amounts of water (D), or a deteriorated body condition with a loss of 20% or more of body weight (W). These simple observations can be recorded daily over time and reviewed in making an informed decision for euthanasia of an individual horse.
Assessing the horse’s quality of life is another technique to assist owners and veterinarians with decision-making. This method assesses the horse at regular intervals using criteria such as the impacts or deficiencies of its environment, nutrition, behavior, and biological and pathological measures, as well as the owner’s evaluations. In many instances, palliative care can be instituted that provides quality of life over quantity.
The scientific literature contains a number of studies on assessing the quality of life in horses. Several studies point out that while health is an important aspect of defining quality of life for a horse, any judgment about quality of life should include discomforts of emotional/psychological origin such as fear, anxiety, boredom, frustration, loneliness, separation distress, and depression, some of which may be husbandry-related. Conversely, pleasure derived from physical contact, eating, social companionship and mental stimulation should also be included in the overall assessment. Quality of life is a uniquely individual experience and should be measured from the perspective of the individual horse.
Owners often fear they will not know when it is time and worry that they are holding on to meet their own needs. Ultimately, most horse owners have a threshold or line that exists, and when the horse crosses it, the decision becomes more obvious.
Acceptable Methods for Euthanasia
Acceptable euthanasia methods result in a rapid loss of consciousness, followed by respiratory and cardiac arrest, and finally the loss of brain function. The American Veterinary Medical Association (AVMA) has specified acceptable methods of euthanasia as including an overdose of barbiturate drugs, gunshot, or application of a captive bolt device.
Both gunshot and captive bolt are humane only if applied to the appropriate site on the skull and should be performed by a skilled person. The benefit of these forms of euthanasia is that the drug pentobarbital is not involved, which renders the body safe for the food chain. Gunshot is sometimes the only humane means to euthanize a gravely injured horse when a veterinarian is not available. For more information on appropriate administration of these techniques, we refer the reader to the 2011 AAEP Euthanasia Guidelines and the AVMA Guidelines for the Euthanasia of Animals: 2013 Edition.
Considerations in the selection of the most appropriate euthanasia method include human safety, such as the falling or thrashing of the horse, horse welfare in ensuring a quick and painless death, the amount of restraint necessary for each method, cost, and environmental effects. Selection of the location of the euthanasia procedure should consider the comfort of the horse and safety of the handlers, but also the subsequent removal of the body. The location of euthanasia must allow enough room to accommodate the unpredictable direction of the horse falling.
Pentobarbital combination is the most commonly administered form of acceptable euthanasia of companion horses in this country. Claudia Sonder, DVM (director of the Center for Equine Health), a practicing equine veterinarian for the past 17 years, offers the following perspective: Light sedation prior to euthanasia is advisable to minimize any anxiety associated with the event. A local anesthetic is often used to place an intravenous catheter once the horse has been sedated. Taking the time to perform these steps helps to ensure as peaceful a passing as possible. Such preparation is not always possible, and procedural decisions should be based on safety for the horse and handler.
When the euthanasia solution is administered intravenously, the horse loses consciousness rapidly and no longer perceives its environment or feels pain or anxiety. In human medicine, the vein to brain effect is very rapid, and most patients cannot count to 10 before they are fully unconscious. There is moderate variability in drug tolerance in all species, and time to loss of consciousness can vary from horse to horse. Circumstances that have created lower blood pressure—such as severe colic, infection, shock, and moderate sedation—can prolong the onset of loss of consciousness.
When the horse starts to lose consciousness, it will usually take a deep breath and then start to buckle. The fall occurs because the brain is no longer aware of its surroundings and is no longer controlling the muscles and reflexes that maintain stance. The horse does not know it is falling and cannot control its actions or feel significant discomfort. Some horses simply sit down, others land with significant force. For the horse owner, this is a difficult image to process, and a very different experience from the small animal euthanasia, which allows for close contact as the pet passes. Many horse owners elect to stay for mild sedation but walk away before the euthanasia solution is administered. They do not want the lasting image of a fallen horse. Many will elect to come back after the horse has passed to spend some additional time before saying a final goodbye.
Helping a Child Cope with the Loss of Their Pet
Losing a pet can be a difficult time for a family, given that most pets are family members. They grow with us and eventually have to leave us. It’s no wonder that our first instinct is to protect our children and shield them from a broken heart. While it’s impossible to completely shelter a child from the loss of their pet, you can definitely help them cope through the grieving process.
Try not to assume that a child is too old or too young to grieve. Grieving is a process that will take time. It is natural for the child to cry; let them have and embrace their own feelings. If you are fortunate enough to have time to say goodbye or time to plan the euthanasia, discuss things ahead of time. Try to do this in a comfortable setting where the child feels safe and can focus on the words you are saying.
Children are innocent and they understand things in black and white. Be open and honest with them. If you don’t know an answer, it is okay to simply say, "I don’t know." Include them in everything that is going on, explain terms in the simplest way possible: "This is a kind way to take away our pet’s pain," and "Our pet will die in peace, without feeling scared." Explain the permanency of death and that their pet will not return. Because phrases such as "put to sleep" or "God took our pet" could be confusing and frightening to the child, I recommend using the terms dying, died, and death. Children can be very accepting of reality. Reassure children that nothing they have said or done has caused their pet’s death and that the pet was lucky to share its life with the family.
After your pet has passed, encourage your child to talk freely about their pet. It might help some children to draw pictures or to write a thank you letter to the animal. Sit down as a family and talk about all the good memories you shared, or make a scrapbook or photo album with your pet’s pictures. Have a memorial; let your child invite friends and family, say a few words, and then bury special items. You can create a tombstone or personalized stepping stones for the garden. You and your child can donate to or volunteer at a local animal shelter in your pet’s name.
No matter how your family decides to memorialize your pet, allowing your child to go through the grieving process can help them learn how to cope with losses in the years ahead. Be sure to let your child know that pain and sorrow will eventually go away, but the happy memories of their pet will stay forever.
Soli Redfield is a Client Service Coordinator for the Large Animal Clinic at the William R. Pritchard Veterinary Medical Teaching Hospital. She expects to complete her training as a Certified Pet Loss Grief Recovery Specialist through the American Institute of Health Care Professionals in December 2013.
Once the horse is down, there are several natural processes that occur as life energy passes out of the different body systems. Again, the horse is no longer aware, but these phenomena can confuse and startle an observer. It is not unusual for the horse to take a large, deep breath called an agonal breath. This is associated with nerve discharge to the diaphragm and breathing musculature. The horses can sometimes paddle their legs or show muscle tremoring. This, too, is associated with final nerve discharges that are not controlled by the brain, and this activity can go on for several seconds to minutes after death has occurred.
The attending veterinarian will listen to the heart to substantiate lack of contractions. Random electrical activity of the heart can persist for many minutes after the heart is no longer beating. The veterinarian will also check the horse’s corneal reflex by touching the eyeball and looking for the blink reflex to subside. The entire process of death can take several minutes after the horse has lost consciousness. With any euthanasia method, death must be verified and confirmed before leaving the animal.
The euthanasia solution is toxic to pets and wildlife, so any blood that remains at the site should be collected with a shovel and disposed of in a durable plastic bag. Aftercare of the body should be arranged in advance whenever possible. Most counties have a local service that is available to pick up a deceased horse and transport him to a rendering plant or to a crematorium. It is not legal to bury horses in most counties because of the environmental implications. Horses euthanized by means other than lethal injection do not pose a risk to wildlife unless they had an infectious disease process. The process of loading the horse into the transport truck is upsetting for many, and most horse owners elect not to witness that portion of the process.
There is a fee associated with aftercare that varies from county to county and can range up to several hundred dollars. Planning ahead for these expenses minimizes the stress associated with the end of a life.
Disposition of the Body
There are often local regulations regarding disposal procedure options of an equine carcass. Rendering is the most common method of disposal, but burial and cremation are other methods frequently used for horses. A rendering facility processes (renders) animal waste materials from supermarkets, butcher shops, restaurants, feedlots, ranches, and dairies. These materials are then recycled and used for the manufacturing of soap, paints, cosmetics, lubricants, candles, animal feed, and biofuel. State and local county laws will specify whether burial is allowed in a given area of the country, along with requirements for soil depth. Composting and depositing the carcass in a landfill could be an option in some states but may require special regulatory permits or approvals.
If your horse is euthanized at a veterinary hospital, disposition of the body is usually arranged through the veterinarian. At the UC Davis Veterinary Medical Teaching Hospital, clients sometimes elect to have their horse undergo a necropsy to reveal the cause of death and contribute to science and the education of veterinary students. The information gained from a necropsy could also serve to help other horses in the future or provide information for the horse owner on their management practices. For example, the discovery of parasites or enteroliths (stones in the gut) can affect the subsequent care of herd mates.
Some horse owners elect to have their horses cremated. Since the average cost of cremation is approximately $1.00/pound in UC Davis' region and does not include transport to the facility, planning ahead for the cost and logistics of cremation is recommended for those who prefer this option for their horse. Several family owned crematories exist in the region near UC Davis and can be contacted for information: www.preciouspawsandclaws.com/8.html and www.koefran.com/services.html.
Human Emotions and the Grieving Process
The deep love and strong bonds we have with our animals can evoke profound grief and mourning when they die. It is important to honor the emotions experienced during this time and allow time to grieve.
Stull has found that although horses are often categorized as “livestock,” the relationship between people and horses is similar to the human-animal bond described for companion animals such as dogs and cats. Interviews with horse owners revealed strong feelings of attachment toward their horse, deeper levels of communicating, emotional solace with their horse, and physical displays of affection. The severity of response to the death of a horse often correlates to the duration and intensity of this relationship.
The partnership of horse and rider as an athletic team adds to the sense of loss. The years of trust and experience that go into a successful team cannot easily be duplicated and the loss of a teammate can signify the end of the road in achieving a specific athletic goal. Grief and coping mechanisms from the loss of a horse can be experienced not only by the owner or rider of the horse, but also by care providers, grooms, trainers, or even the horse’s veterinarian.
It is expected that the different stages of grief associated with human loss are also experienced following the loss of a horse, including denial, anger, bargaining, depression, and acceptance. These stages might not occur for all owners but should be recognized as part of the grieving process. Some owners might also have other emotional reactions following the death of their horse, such as guilt or relief, depending on the specific circumstances and the role of the horse for the owner. Owners could also experience isolation, withdrawal and loneliness or fear a lack of recognition without their horse. A pet loss program offered in some areas by the local hospice organization or veterinary hospital can offer support, counseling, or other outreach education for the grieving horse owner.
There are many things that barn members can do to support their fellow horse enthusiast through their time of grief, such as setting up a stall-side memorial like this one at the Kentucky Horse Park after John Henry's death in 2007.
Photo: Erica Larson
In many cases, the barn environment creates a strong social support network that is separate from work and family life. There are many things that barn members can do to support their fellow horse enthusiast through their time of grief, including:
- Sharing photographs, poems, or plant memorials;
- Making a donation to a charity as a memorial to the horse and owner; and
- Reaching out to talk and share stories and listening.
Soli Redfield, Large Animal Client Service Coordinator at the William R. Pritchard Veterinary Medical Teaching Hospital, has found that clients are grateful for the mementos she prepares after a horse has been put down, such as commemorative horse shoes and reminders made using bits of mane or tail.
We are grateful to the following individuals for their insightful contributions to this article:
- Carolyn Stull, MS, PhD;
- Gregory Ferraro, DVM;
- Gary Magdesian, DVM, Dipl. ACVIM, ACVECC, ACVCP;
- Monica Aleman, DVM, PhD, Dipl. ACVIM;
- Jeannine Berger, DVM, Dipl. ACVB; and
- Ms. Soli Redfield.
POLL: Colic Surgery