‘Better a day early’: quality-of-life discussion could aid euthanasia decisions

Earlier discussions between vets and owners about equine quality of life could aid difficult euthanasia decisions, it has been agreed.

In May the Animal Welfare Foundation hosted the panel discussion Euthanasia: better a day too early than a day too late? to tackle the “complex difficulties” in euthanasia decision-making and how these affect the animal, owner and vet.

RSPCA head equine vet Roxane Kirton presented a case study of 25-year-old gelding Jay who had been taken into the charity’s care during a prosecution case. Jay was treated for poor body condition, musculoskeletal issues and dental problems, and had further treatment at a second and third veterinary intervention. His condition worsened and he was put down.

When the audience was asked at which stage Jay should have been put down, more than half voted for the second intervention.

Jay’s case generated discussions on quality-of-life tools, and Ms Kirton said there are validated and “good” tools for helping with euthanasia decisions for small animals such as cats – but although there are multiple published welfare assessment and quality-of-life protocols for equines, none are specifically designed and validated to help make decisions for horses who are chronically ill or geriatric.

“They still provide some useful assessment criteria and approaches, but the main limitations identified with most of them are their failure to sufficiently prioritise the subjective mental state of the horse over time, and a lack of appropriate integration of the assessment criteria into one overall grade to help with decision-making,” she said.

“Of the options available it’s been suggested that the five domains model likely provides one of the better conceptual frameworks for assessing quality of life. But there are still challenges in applying this framework as a quality-of-life assessment tool in practice.”

The panel discussed having a scale when it comes to euthanasia decisions; the bottom end “a poor life not worth living” to the upper end, “a good life” – and the question was raised about where vets should “draw the line” with chronic degenerative conditions.

Animal researcher Peter Sandøe said the problem is that it is “not an absolute scale”.

“It’s so difficult to draw that line because it looks like we have ‘poor’ and ‘good’, but in reality it’s a continuous scale where we ourselves have to decide what’s poor and good,” he said.

Vet Suzen Gregersen, who runs an at-home end-of-life service for cats and dogs, said drawing the line is a “grey area”.
“I always say there is no right time of euthanasia, but there is a best time. And the best time is when everybody agrees, and the animal is in what I call in its ‘window for opportunity’ for either more palliation or for euthanasia,” she said.

“But unless there is a partnership between the family and the vet, then it’s hard to say it’s the right time because it needs to be a two-way street.”

Mr Sandøe added that he believes that quality-of-life tools are “great if they are seen as decision support tools” – rather than something to make the decision for people.

“These tools are really good to alert people to aspects that they wouldn’t see otherwise, but at the end of the day I think giving the decision to a tool is in a way cheating yourself and pretending that there is an objective answer to something for which there will always only be a personal answer,” he said.

The session was concluded with the panel members discussing whether it is better to euthanise “a day too early or a day too late”. Largely the panel agreed it was better a day too early, but that quality of life needs to be talked about from an earlier stage.

You might also be interested in:

Better a week early than a day late: the hows and whens of equine euthanasia

There till the very end: owner of 33-year-old mare put down calls on others to do right by older horses – rather than rehoming

‘The kindest thing you ever do’: rider speaks out on the euthanasia of her ‘dearest friend’

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