Credit: Dusty PerinMost veterinarians agree that euthanasia is not a treatment option, but rather an option after reasonable treatment is unsuccessful in specific circumstances. They also agree that it is their responsibility to provide euthanasia for horses that cannot be treated, and that it is one of the most important services their practices provide.
“Euthanasia is a gift, and it is a privilege to offer dignity and kindness in death,” said Colleen Best, DVM, PhD, Department of Population Medicine, Ontario Veterinary College.
A compassionate, caring euthanasia that is gentle for all parties takes time and thoughtful communication. Done well, it is a highly valued service, especially for the owners who view their horses as pets or family members.
Respondents to our previous surveys said that one of the topics they wanted to know more about was euthanasia. Therefore, we decided to undertake a survey to ask you, our readers, some basic questions about euthanasia services.
Our questions centered on the euthanasia services offered at your practices. While the results are small (58 respondents) compared to the entire equine veterinary industry, these answers might give you some information about how some of your colleagues replied.
We also reached out to individual practitioners for their opinions about some of these questions and the concerns surrounding euthanasia. We found that 96.6% of responding vets provided euthanasia services. We then asked them to estimate the number of horses they euthanized each year. The most common response was 11-20 cases per year (32.8%).
Estimate how many horses per year you euthanize.
Zero…………………………………………………. 3.4%
1-10…………………………………………………..20.7%
11-20…………………………………………………32.8%
21-30…………………………………………………12.1%
More than 30…………………………………….31.0%
The frequency of euthanasia requests varies throughout the year. “I am asked about once a week at this time of the year (late summer), but there are times when there is higher demand and times when we go months without a request,” said Steve Reed, DVM, DACVIM, of Rood and Riddle Equine Hospital in Kentucky.
What is your average charge per euthanasia?
$0…………………………………………………….. 5.2%
$100-$250…………………………………………81.0%
$251-$500…………………………………………13.8%
More than $500……………………………….. 0.0%
One of the most commonly discussed topics related to euthanasia is what to charge. The survey found that $100-$200 (81%) is the most common fee for euthanasia among our respondents.
Those being surveyed also had an opportunity to share their perspectives on pricing these services. Here’s what a couple of respondents had to say:
• “The charge at my practice includes supplies, drugs and disposal by a rendering company. I do not have a service charge for euthanasia … I do charge for an exam if I am solely coming in for euthanasia, but I do not have an additional charge if subsequent to colic work-up.”
• “I have a personal philosophy that I do not charge for euthanasia on my clients’ horses that have generally been under my care most of their lives. They have supported me well during their lifetimes.”
• “Typically, at Rood and Riddle Equine Hospital, we don’t charge for euthanasia, but again, every case is unique,” said Jose J. Bras, DVM, MS, DACVS, Rood and Riddle Equine Hospital. If we do charge, it’s typically $40 for the administration of barbiturates. Other charges are added if the owner requests that we transport and dispose of the horse.” In addition to standard euthanasia services, Rood and Riddle Equine Hospital also offers neurological necropsy. “That is about $300,” said Reed.
What are the most typical reasons you euthanize a horse? (Multiple answers were allowed.)
Physical problem (i.e., colic, catastrophic injury)……….. 98.3%
Mental problem (i.e., dangerous horse)………………………..10.3%
Financial problem (owner can’t afford horse)……………… 27.6%
Other (please specify)………………………………………………. 24.1%
Another frequently discussed topic is the reason for euthanasia. The majority of respondents said the typical reason for euthanasia was related to a physical problem, such as colic or catastrophic injury (98.3%).
“The most common reason I believe euthanasia is necessary is when a horse is suffering from a disease or injury that diminishes their quality of life, but every case is unique and the decision to euthanize is highly individual,” said Bras.
For respondents who indicated “other,” some of the reasons written in included old age, terminal illness or a combination of extreme old age as winter weather approaches.
One respondent indicated that his practice performs the service on referral from other practices in the area.
The AAEP provides guidelines that take in a wide range of circumstances when euthanasia is reasonable. Among the most common reasons are:
• Incurable, progressive and/or transmittable disease
• Chronic, severe lameness
• Inoperable colic
• Foals born with severe birth defects
• Old age debilitation
• Severe traumatic injury
• Dangerous behavioral traits
Do you make a profit on equine euthanasia?
Yes…………………………………………………… 34.5%
No…………………………………………………… 25.9%
Sometimes………………………………………. 39.7%
Other………………………………………………. 0.0%
Respondents had differing opinions about making a profit on euthanasia services. Here are a few comments that were offered.
• “Not an area of practice that I believe has a profit motive.”
• “Very small profit with the current cost of drugs and time.”
• “In Wisconsin, veterinarians are required to charge ‘sales tax’ on euthanasia services, but not medical services like vaccines, dentals or surgery.”
“I set our prices for euthanasia about a year ago, and haven’t given it a lot of thought since,” said Richard Vetter, DVM, of Foothills Veterinary Hospital in Buckley, Washington. “The cost of medication is not that inexpensive, but I prefer to use more than necessary to make sure the procedure goes as smooth as possible.”
Other Topics of Concern
We asked respondents to offer their comments about euthanasia services. Here are some of the things they had to say:
• ???Disposal is becoming a problem.”
• “The average prices stated above do not include disposal fee.”
• “It can be done badly by some practitioners. I have heard horror stories from clients.”
• “It sucks your soul dry, although when it is an act of mercy, I am appreciative to have the ability to put a horse out of its misery.”
• “The process of euthanasia is not sufficiently taught or discussed in veterinary schools.”
• “There is a significant emotional toll on the providers of this service. This issue is seldom addressed by our profession.”
Compassion Fatigue
Even when performed for ethical and sound reasons, administering euthanasia services can take its toll. “Some of this stress can lead to increased rates of suicide,” Best noted. “The rate of death by suicide is higher among veterinarians than average. If we are struggling and need help, we need to recognize it.”
Best suggested that veterinarians develop relationships, whether professional or personal, that can help them cope. “It can be challenging for solo practitioners, but mentors offer an outlet of support,” she said. “Most importantly, don’t be afraid to seek out help if you are concerned about having compassion fatigue.”
She offered several suggestions for both solo and multi-doctor practices to consider implementing to help offset compassion fatigue. Every individual responds differently to stress and might find some of these strategies more helpful than others. (An article about compassion fatigue can be found on our website, where you can also find an article about burnout.)
1) Have policies in place that make euthanasia as easy as possible.
Require a consultation and/or exam prior to euthanizing a horse. An exam offers the opportunity to confirm the service is necessary and is being performed for the right reasons. It can also be helpful to require the owner be present for a conversation about the decision. This reduces situations where you might be called to show up to a field to put the horse down on your own and alleviates doubt about the reasons behind the decision.
Preparing for how the procedure will occur can also be beneficial. “I always bring a tech with me to hold the horse so that I’m safer and more comfortable performing the procedure,” Best noted.
2) Schedule the service strategically.
The emotional and mental strain is different for every veterinarian. Knowing yourself and how you respond to situations can help you plan your day to make the best of a difficult situation.
Do you prefer to perform a euthanasia procedure in the morning so you have a full day of cases to look forward to as a reminder of all the good you do throughout the day? Or do you prefer to schedule euthanasia cases for later in the day so you can go home, spend time with your family, friends or pets, and decompress?
Make sure the support staff knows your preference for scheduling euthanasias.
3) Offer payment plans or offer assistance for rehoming.
In some situations, a horse owner chooses euthanasia when the expenses of providing treatment for serious illnesses or significant injuries exceeds the owner’s budget. If that’s a difficult reason for you to accept for performing the service, create a structure so that clients have access to pay over time. Offering to help re-home or place the horse in a rescue can be another option if the owner simply can’t afford the care and you don’t feel euthanasia is necessary.
4) Secure disposal and/or transportation options.
After euthanasia is performed, disposal is an important part of the process. Find a company you’re comfortable working with.
5) Exercise your option to decline to provide euthanasia.
Choosing to perform euthanasia is a choice each and every veterinarian has the opportunity to accept or deny. Any veterinarian uncomfortable with performing the service in general or in a specific circumstance has the authority to decline to perform the service. “It’s our choice,” Best emphasized.
Who Responded?
We wanted to know more about the people who answered the survey. The overwhelming majority was female (70.7%). We found that the group of respondents by age was fairly equal. Respondents 25-34 years old comprised 22.4% of the participants. Those 35-44 years responded at a rate of 24.1%, followed by those 45-54 years old (20.7%) and 55-64 (25.9%). Not surprisingly, veterinarians 65+ were the smallest group offering euthanasia services (6.9%).
For those who answered the question, the largest group had a household income of $50,000-$99,999 (31%), followed by $100,000-$149,999 (20.7%) and $150,000-$199,999 (17.2%). The two smallest groups reported having a household income less than $50,000 (8.6%) and $200,000 more (6.9%). We also asked the geographic area they serve based on total population.
Following are the demographic results:
Geographic Location Percentage
Suburban metropolitan area (1+ million population) 10.3%
Mid-size city (100,000 – 999,999 population) 17.2%
Small city (25,000- 99,999 population) 31.0%
Town (5,000-24,999 population) 13.8%
Small Town (1,000-4,999 population) 17.2%
Village/rural community (under 1,000 population) 10.3%
Take-Home Message
Clear, compassionate communication with the client is an important element in euthanasia cases. “I let them know how much I care, and I explain the gravity of the disease process, along with the risks to them and their family, if that is appropriate,” Reed said. “I make sure they understand when and to what extent the horse is suffering.”
This small survey is a good start toward understanding how different practices charge and perform euthanasia services. Answers also provided a look at the importance of communication with the client and the reality of compassion fatigue.
There are some questions that still need to be answered. “The decision to euthanize a horse is never an easy one for owners. It is our ethical and moral duty as their veterinarians to provide them with the best medical advice and to help them fully understand the implications for their horses’ future,” Bras concluded.
