Assessing Equine Quality of Life (QoL): Guide to End of Life Decision-Making

Quality of Life
Factors
QoL Assessment
Decision Making
End of Life

Horses are cherished companions to humans, often playing many roles throughout their lives, from work and sport to providing emotional support. Ensuring the wellbeing and quality of life of our horses is a priority, even during challenging times such as end-of-life.

Quality of Life (QoL) assessments provide an objective evaluation to guide end-of-life decisions. These assessments include a thorough examination of the horse’s physical, mental, and social well-being.

Veterinarians and horse owners can use these assessments to track how a horse’s wellbeing changes over time, particularly in cases of untreatable chronic disease, severe injury, or age-related decline.

By identifying these changes early, the caretaking team can implement treatment or management changes to improve quality of life, or make the ultimate end-of-life decision to preserve horse welfare.

Read on to learn more about equine quality of life, assessment factors, and making decisions about humane euthanasia so you are equipped to provide your beloved horses with the best standard of care in their senior years.

Quality of Life for Horses

Quality of Life (QoL) is an important concept in veterinary medicine, animal welfare, and animal ownership. The way we manage and care for our animals directly impacts their welfare and wellness.

Animal scientists define QoL as the individual animal’s sense of well-being as they perceive it at any point in time. ^[1] This includes factors such as: ^[1]

Health
Social needs
Environmental needs
Basic species-specific needs

Determining adequate quality of life for animals is challenging, as they cannot tell us what they are experiencing directly. ^[2] Additionally, individual needs often vary depending on the animal’s health status, mental state, environment, and other factors. ^[2]

Setting a minimum standard for quality of life is difficult, as there is little consensus regarding what adequate QoL entails. ^[2] For example, many experts argue that adequate QoL should go beyond simply coping and meeting basic needs, and should also include aspects of play, exploration, and social engagement that allow an animal to enjoy their life and flourish. ^[2]

Five Freedoms of Equine Welfare

At a minimum, all animals should have the Five Freedoms met in their day-to-day life: ^[2]

Freedom from hunger and thirst
Freedom from discomfort
Freedom from pain, injury, and disease
Freedom to express normal behavior
Freedom from fear and distress

What Factors Affect a Horse’s Quality of Life?

Quality of Life is fundamentally an assessment of the positive and negative experiences in a horse’s life. Most of these experiences can be categorized as impactful to the horse’s physical or mental wellbeing. During Quality of Life assessment, it is also important to consider the effect of the horse’s health on the owner’s QoL.

Physical Wellbeing

Physical wellbeing encompasses both the horse’s physical health and their ability to meet their biological needs. Factors to consider regarding physical wellbeing include: ^[3]^[4]

Degree of pain and discomfort
Presence of any health conditions
Level of energy
Sleep patterns
Ability to move around, stand, and get up from lying down
Ability to chew food
Appetite and water intake
Ability to maintain normal body temperature (thermoregulate)
Body weight and ability to maintain weight
Ability to defecate and urinate
Ability to breathe without excessive effort

Mental Wellbeing

Although challenging to interpret, the horse’s mental wellbeing is an important part of their overall quality of life and is part of a robust QoL assessment. Factors to consider when evaluating mental wellbeing include: ^[3]^[5]

Indications of fear or stress
Changes in behavior, including aggression
Level of interest in their surroundings, handlers, and other horses
Level of participation in herd activities
Positive or negative interactions with other horses and their handlers
Expressions of playfulness and curiosity
Signs of boredom or frustration, including stereotypies such as cribbing or weaving

Human-Animal Bond in Quality of Life

Although the human-animal bond does not directly impact the horse’s Quality of Life, it is an important consideration when making end-of-life decisions.

Owners of horses with significant health concerns are susceptible to developing caregiver burden, characterized by increased stress related to the demands of caregiving. ^[6] This can include treatment-related demands, such as physical demands, time spent, or financial concerns, as well as emotional experiences such as frustration or guilt related to ongoing care. ^[6]

Caregiver burden can directly impact the owner’s quality of life by affecting their ability to meet their own mental and physical needs. ^[6] This can also affect the human-animal bond by leading to feelings of resentment, burden, or stress surrounding interactions with the horse. ^[6]

Factors regarding the human-animal bond to consider include: ^[6]

Feelings of guilt, frustration, anger, stress, or anxiety
Financial burden associated with ongoing care
Time spent on care for the animal
Effect on family and personal relationships
Effect on personal health and wellbeing
Ability of the caretaker to care for the animal

Assessing Quality of Life

Veterinarians, other animal health professionals, and owners typically perform QoL assessments when making end of life decisions for all kinds of domesticated animals, including horses. ^[2] These assessments can help owners make objective decisions by providing a clear perspective unclouded by the love, care, and attachment they have for their animal. ^[2]

QoL assessments are also an important part of making treatment decisions for health problems, as the effect of treatment, recovery, and long-term outcomes on quality of life may change the owner’s decision to pursue treatment. ^[2]

Currently, there is no single QoL assessment method that is widely used for horses. ^[1]^[5]^[7] Researchers suggest that developing a standardized method would be beneficial for the equine industry as a whole. ^[5]

Quality of Life Assessment Chart

The following QoL assessment method is adapted from several sources. ^[1]^[3]^[4]^[5] In the absence of a more widely available tool, this checklist may be helpful for owners to assess their horse’s QoL. Work with your veterinarian if you have specific questions about using this method or are unsure how to interpret your horse’s cues.

When evaluating QoL, it is important to remain as objective as possible, as personal biases can cloud interpretation of the horse’s wellbeing. ^[5]

If you check “Yes” for any of the parameters on the list, seek veterinary advice.

	QoL Assessment Parameter
	Physical Wellbeing
	My horse requires assistance to stand after laying down or rolling
	My horse is losing weight
	My horse is not eating as much as before
	My horse is having difficulty eating
	My horse is not drinking as much as before
	My horse is not as active as normal, e.g. reluctant to walk, stiff gait, does not move voluntarily
	My horse has a dull coat
	My horse does not defecate or urinate normally, e.g. diarrhea, straining to urinate
	My horse is not breathing normally
	Mental Wellbeing
	My horse does not interact with me in the same way, e.g. does not come to the gate to greet you
	My horse does not interact with other horses in the same way, e.g. stays separate from the herd
	My horse seems dull, lethargic, or depressed
	My horse’s behaviour has changed significantly, e.g. increased aggression
	My horse is showing signs of stress or anxiety
	My horse does not show interest in their environment, e.g. no sense of exploration or play
	Human-Animal Bond
	I no longer have a satisfying human-animal bond with my horse
	My horse requires unsustainable levels of treatment, time, or money to stay comfortable
	Final Assessment
	My horse is having more “bad days” than “good days”
	I think my horse has a poor quality of life

After discussion with your veterinarian about treatment options, prognosis, and long-term quality of life, you can use this chart for identifying changes in QoL over time. QoL can be assessed daily, weekly, or monthly, based on the advice of your veterinarian. If you answer “Yes” to any new parameters, advise your veterinarian.

Other strategies include ranking quality of life factors on a scale from 1 – 10 each week. ^[3]^[8] Tracking how these rankings change over time can help owners identify declining QoL and provide them insight into their horse’s wellbeing. Similar rankings for caregiver QoL are also recommended.

Making End of Life Decisions

The decision to euthanize is a difficult one. Not only are there several choices to make surrounding the procedure, there is also significant emotional distress associated with making these decisions.

Consulting with your veterinarian and grief counsellors can help you work through these decisions to make the best choices for yourself and your horse.

Humane Euthanasia

There are several choices that owners must make surrounding the euthanasia process, including: ^[9]

Timing of the procedure
Method of euthanasia
Owner presence during the euthanasia procedure
Location for euthanasia
Memorializing the horse
Disposal of the horse’s remains

Many veterinarians and experts recommend scheduled euthanasia of horses facing end-of-life, rather than letting the horse die on its own. However, owners often struggle with scheduled euthanasia as they do not feel the timing is right. ^[9]

Ultimately, there is no “perfect time” for a euthanasia. Quality of life assessments can help owners identify changes in their horse’s QoL that can provide comfort in scheduling this procedure.

Scheduled Euthanasia

There are several benefits to scheduled euthanasia:

Painless, low stress procedure for the horse
Owner can be present during their horse’s last moments
Allows for a celebration of life prior to the procedure, providing closure for owners
Horse can go on a “good day”, rather than an emergency that can cause undue distress and pain
Can make disposal arrangements ahead of time

Scheduled euthanasia is usually performed chemically, where the veterinarian administers a lethal dose of medication into the bloodstream. ^[10] However, some owners choose alternative euthanasia methods such as gunshot. ^[10]

Handling Remains

The decision surrounding disposal of the horse’s remains is usually based on the accessibility of services and local legislations. For on-farm euthanasia, common disposal methods for horse remains include: ^[11]

Rendering
Burial
Landfill disposal
Composting

Most veterinary hospitals also offer cremation as a service for horses euthanized in hospital, or may have contacts with crematoriums who can pick up the horse after an on-farm euthanasia.

Equine cremation typically produces around 60 lb (30 kg) of ashes, requiring a sturdy receptacle to hold the ashes and a designated location to keep them long-term. Many owners opt to make memorial items out of the horse’s hair, halters, or hoofprints instead of cremation for this reason.

Emotional Distress

Many owners experience emotional distress surrounding the decision to euthanize, including feelings of guilt and anxiety. Common questions surrounding end of life decisions include: ^[8]

How will I know when it is time to euthanize?
What if I euthanize too soon?
What if I euthanize too late?
Should I let the animal die naturally, or euthanize?
Did I do enough?

Ultimately, the answers to these questions depend on the individual and how their horse’s quality of life changes over time.

While working through these questions, you will likely experience anticipatory grief, or grief prior to the actual loss. ^[6] Common feelings of anticipatory grief include: ^[6]^[8]

Overwhelming sadness when thinking about the horse
Longing for what was in the past
Feelings of emptiness or lack of meaning without the horse’s presence
Feeling like you cannot show sadness while the horse is still alive
Avoiding thinking about the upcoming loss
Difficulty accepting that the horse is suffering
Guilt that you have failed your horse

Seeking the advice of a grief counsellor may help owners answer these emotional questions surrounding euthanasia. ^[8] They can also provide assistance in managing anticipatory grief.

Dealing with Grief

The grief experienced by the loss of a beloved horse is similar to the grief experienced by losing a significant person in your life. ^[9] The grieving process follows a similar course of feelings, including feelings of numbness, disbelief, guilt, sadness, anger, and depression. ^[9]

Dealing with these emotions can be challenging, and seeking the advice of a grief counsellor is recommended. With appropriate time and support, owners can accept the loss of their beloved horse and may find themselves open to introducing another horse into their lives. ^[9]

Summary

Quality of life assessments are objective evaluations of a horse’s mental, physical, and social wellbeing.

Veterinarians and horse owners can use these assessments to make end-of-life decisions or identify necessary management changes
Regular assessment can help caretakers identify quality of life changes indicating the need for intervention
Most veterinarians recommend scheduled euthanasia to maximize horse wellbeing during end-of-life
Seeking professional advice surrounding euthanasia decisions and feelings of guilt is highly recommended