Euthanasia Decisions Research Articles

Metabolic gene therapy in a canine with pulmonary hypertension secondary to degenerative mitral valve disease.

Myxomatous mitral valve disease (MMVD) stands out as the most prevalent acquired canine heart disease. Its occurrence can reach up to 40% in small breed dogs and escalates in geriatric canine populations. MMVD leads to thickening and incomplete coaptation of valve leaflets during systole, resulting in secondary mitral valve regurgitation. Serious complications may arise concurrently with the worsening of mitral valve regurgitation, including left-and right-sided congestive heart failure, and pulmonary hypertension (PH). Ultimately, the PH progression might contribute to the patient's demise or to the owner's decision of euthanasia. Most currently available FDA-approved therapies for PH are costly and aim to address the imbalance between vasoconstriction and vasodilation to restore endothelial cell function. However, none of these medications impact the molecular dysfunction of cells or impede the advancement of pulmonary vascular and right ventricular remodeling. Recent evidence has showcased successful gene therapy approaches in laboratory animal models of PH. In this manuscript, we summarize the latest advancements in gene therapy for the treatment of PH in animals. The manuscript incorporates original data showcasing sample presentations, along with non-invasive hemodynamic assessments. Our findings demonstrate that the use of metabolic gene therapy, combining synthetic adeno-associated virus with acid ceramidase, has the potential to significantly reduce the need for drug treatment and improve spontaneously occurring PH in dogs.

Increased incidence of weight-loss-associated humane endpoints in rats administered buprenorphine slow-release LAB formulation following traumatic brain injury: a retrospective study.

Traumatic brain injury (TBI) remains a significant global public health epidemic with adverse health and cost implications. Due to its complex, heterogeneous nature and wide-ranging impacts, definitive TBI treatments remain elusive. As such, continued laboratory research using animal models is warranted. In accordance with guidelines set forth for the humane treatment of research animals, TBI animal models are often administered analgesics for pain management. The choice of drug, timing, dose, and formulation of analgesic can vary depending on the study's unique needs and can potentially and unintentionally influence experimental results. In TBI studies utilizing rats as animal models, buprenorphine is a common analgesic administered. In addition to pain management in such studies, investigators must also monitor the research animals post-operatively and make the decision for humane euthanasia before intended experimental survival timepoint if the animals are assessed to be excessively suffering. This study investigated the differences in adult, male Sprague Dawley rats used for various TBI studies that reached weight-loss-induced humane endpoints following a single administration of buprenorphine slow-release LAB (bup-SR-LAB) or buprenorphine slow-release HCl (bup-SR-HCl). Our findings indicate that TBI-induced rats receiving bup-SR-LAB in conjunction with a secondary surgical insult such as artificial intracranial pressure elevation and/or osmotic pump implantation reach a weight-loss-induced humane euthanasia endpoint more often compared to sham-injured rats. When stratifying into the same groups, we did not find this pattern to hold true for rats administered bup-SR-HCl. Overall, this study contributes to the limited body of literature addressing different analgesic formulations' effects on laboratory animals.

Influences on the Decision to Euthanize a Compromised Pig.

The decision to euthanize a compromised pig can be challenging for pig farmers and veterinarians. To understand more about the challenges in Germany, a cross-sectional online survey was conducted. Based on a hybrid design, the responses of 39 veterinarians and 62 pig farmers were analyzed to generate a list of common clinical signs associated with the euthanasia of sows, fatteners, and piglets. Moreover, a set of influences on the farm, due to economic and personal considerations, were found to shape the decision-making process. The two most salient reasons outlined for the delay of timely euthanasia were uncertainty and misinterpretation of the chance for healing. The lack of valid clinical signs or a sound justification was most frequently mentioned as a challenge to the general decision-making process. In summation, this study highlights the need to generate a valid taxonomy for clinical signs that includes their development in a compromised pig over time. Future studies should elaborate on the justification of euthanasia decisions to facilitate the resolution of ethical dilemmas among the involved pig farmers and veterinarians. Lastly, the results suggest that clinical reasoning and consultation skills should be included when decision-making behavior is to be trained.

Euthanasia decisions in a 23‐year‐old horse with comorbidities

Euthanasia decisions in a 23‐year‐old horse with comorbidities

Treatment considerations for bluetongue virus serotype‐3 cases in sheep

Background: Bluetongue virus (BTV) serotype‐3 (BTV‐3) has been circulating in the Netherlands since September 2023 and was first reported in Kent in the UK in November 2023, picked up via the annual bluetongue surveillance programme. It is a highly pathogenic strain in sheep with limited preventive measures once virus is circulating in the biting midge population. At the time of publication there is no BTV‐3 vaccine available and no cross‐protection from other BTV vaccine strains. There are no specific antiviral medicines available, and therapy focuses on nursing care and anti‐inflammatory medicines to reduce clinical signs, although early euthanasia decisions need to be considered on the grounds of animal welfare.Aim of the article: This article takes the experiences of vets from the Netherlands and describes what practitioners might be able to do to treat clinical cases of BTV‐3, with thanks to Schapendokter (2023) for sharing their practice protocols.

Factors associated with behavioral euthanasia in pet dogs.

When pet dogs demonstrate certain serious problem behaviors, this may lead owners to choose behavioral euthanasia. However, research on behavioral euthanasia of pet dogs is sparse and previously published papers have not specifically sampled owners who made the decision to euthanize for behavior. The Behavioral Euthanasia in Pet Dogs Questionnaire was created to collect a wide range of information from dog owners who made behavioral euthanasia decisions. Using this survey, we explored the types of behaviors associated with behavioral euthanasia. Human-directed aggression, especially toward adults living in the household, was the most frequently reported reason for choosing behavioral euthanasia; followed by aggression toward other animals, especially other dogs living in the same household. The majority of dogs displaying human-directed or other animal-directed aggression were reported to have bitten and broken skin, and many of these had bitten in multiple or severe incidents. Most dogs had lived in their homes and displayed problem behaviors for over a year prior to behavioral euthanasia, and the euthanasia occurred at a variety of ages, from less than 1 year old to 18 years old. Additional research is required to understand environmental or nonbehavioral factors contributing to the behavioral euthanasia of companion animals, as well as the psychosocial and emotional impact of behavioral euthanasia on the human experience. Understanding the behavioral factors associated with behavioral euthanasia can direct resources toward problem behavior interventions, improve public education about animal behavior, and strengthen the human-animal bond.

Prognostic indicators of outcome in nonambulatory beef cattle presented to 2 referral hospitals: A retrospective study of 63 cases.

Down cow syndrome is commonly described in dairy cattle. The diagnosis and treatment of nonambulatory cattle is challenging and prognostic indicators of this condition in beef cattle have not been determined. Evaluate records of beef cattle (≥2 years of age) presented to 2 referral hospitals for inability to stand and identify prognostic indicators for survival to discharge. Sixty-three adult beef cattle treated for inability to stand at 2 referral hospitals. Medical records of 63 beef cattle presented for inability to stand between January 2010 and December 2022 were retrospectively analyzed. Continuous and categorical variables were included in univariate and multivariate regression models to evaluate their association with outcome. Of 63 animals included in the study, 19% (12/63) were discharged, and the remaining 81% (n = 51) either died (11.1%) or were euthanized (69.8%). The odds of being discharged increased with each additional day of hospitalization (odds ratio [OR], 2.66; 95% confidence interval [CI], 1.39-6.89) and with each additional flotation therapy session (OR, 2.108; 95% CI, 1.209-4.219). Down beef cattle with a diagnosis of calving peripheral nerve paralysis and capable of walking out the tank after the first flotation session were 6.66 (95% CI, 1.58-35.51) and 30 (95% CI, 4.4-614.98) times more likely to be discharged compared with cattle that had other diagnoses and those that were unable to walk out the tank, respectively. Treatment of nonambulatory beef cattle carries a poor prognosis. Practitioners can use information from our study as a guide for treatment or euthanasia decisions of nonambulatory beef cattle.

Reason for euthanasia in dogs with urothelial carcinoma treated with chemotherapy or radiation therapy or both: A retrospective observational study.

Clients want to know the ultimate cause of death in their pet after cancer treatment. The cause of euthanasia and investigation of urinary obstruction in treated dogs with urothelial carcinoma (UC) has not been specifically reported in veterinary literature. Our hypothesis was that the majority of treated dogs with UC are euthanized secondary to primary tumor factors, such as urinary obstruction. Fifty-nine client-owned dogs diagnosed with UC. Retrospective observational study on clinical signs and disease at euthanasia of dogs with UC treated by radiation therapy or chemotherapy or both. The median overall survival time (OST) of all dogs was 339 days (range, 17-1996; 95% confidence interval [CI], 185-392; interquartile range [IQR], 112-505). Of dogs deemed to have been euthanized because of UC (50/59, 85%), the primary cause was considered to be local progression in 31/50 (62%), most often because of perceived complete or partial urinary obstruction (24/31, 77%). No variables were found to be predictive of urinary obstruction. The overall documented metastatic rate was 56%. In dogs euthanized because of UC, metastasis was deemed to be the cause in 19/50 (38%) dogs. Regardless of the type of treatment, UC in dogs has a poor prognosis and there is a continuing need to improve treatments that focus on local control of the primary tumor, given its high contribution to the decision for euthanasia. Proactive management to avoid the high frequency of urinary obstruction may be worthy of future investigation.

Equine common variable immunodeficiency: Lessons from 100 clinical cases

SummaryThe clinical manifestation of recurrent fevers and infections alerts the clinician to the possibility of an underlying immunodeficiency. Common variable immunodeficiency (CVID) in the horse is a rare late‐onset, nonfamilial immunological disorder of B cell depletion and/or dysfunction with resultant inadequate antibody production. The most common clinical presentations in horses with CVID are recurrent upper and/or lower respiratory infections, meningitis and/or ataxia, cholangiohepatitis, infectious colitis, infectious dermatitis and severe gastrointestinal parasitism. Immune‐mediated and lymphoproliferative conditions are additional clinical features. The diagnosis of CVID in horses is based on a persistent hypogammaglobulinaemia primarily caused by a serum IgG concentration below 10.00 g/L in at least two different measurements, often accompanied by a serum IgM concentration below 0.50 g/L. Most horses with CVID show a persistent peripheral blood B cell distribution below 6% of total circulating lymphocytes, indicating severe B cell paucity or depletion, but the B cell distribution can be within the normal reference interval. Post‐mortem findings add diagnostic information about the distribution of B and T cells in lymphoid tissues. Clinical management of horses with immunodeficiency is intense and expensive, and these factors weigh on the difficult decision of elective euthanasia. To date, no genetic mutation has been identified in horse patients with CVID, and the large number of breeds of single‐affected individuals in a same herd or immediate lineage from various parts of the United States and the world do not point at an obvious inheritable mechanism of disease or environmental risk factors. This article describes the clinical and immunological findings in 100 equine cases, and comparisons with the disease in human patients.

Cross-Sectional Survey of Public Perception of Commercial Greyhound Racing in New Zealand.

The commercial greyhound racing industry in New Zealand is struggling with an eroding social license and 'on-notice' status. Multiple independent reviews of the industry have identified ongoing issues of animal welfare during and between races, euthanasia decisions, poor data tracking, a lack of transparency and problems with rehoming dogs, resulting in New Zealand animal advocacy agencies and the general public questioning the continuation of greyhound racing. The current paper assessed the New Zealand public's awareness and familiarity with commercial greyhound racing, identified current levels of public support or opposition for racing, and provided context in terms of engagement with greyhound racing using a comprehensive survey of a robust sample of New Zealanders. The results confirm that the social license of the greyhound industry is under challenge with most respondents expressing disagreement with or lack of knowledge of current industry practices and indicating they would vote in support of a ban. There is scope for increasing public acceptability by addressing welfare issues, increasing awareness of positive industry practices, and encouraging transparency of the greyhound racing agency. However, as greyhound racing is on the decline worldwide, calls are likely to continue for a phase-out of commercial greyhound racing.

Legitimation of Euthanasia Decisions: A Philosophical Assessment of the Assisted Life Termination

The purpose of this article is to find out whether philosophical and anthropological studies of human nature affect the legitimization of decisions about human life and death, using the example of a philosophical analysis of the problem of euthanasia. Theoretical basis. Philosophically and anthropologically based situational analysis in bioethics is chosen as the research methodology, which reveals the legitimation of euthanasia as a complex and highly responsible moral decision, which should be based on both the consideration of all the patient’s special circumstances and the competent and adequate application of fundamental knowledge about the human being. Originality. From a philosophical point of view, it would be correct to legalize euthanasia, but under the condition of significantly limiting the cases of its application, clearly defining the conditions for its provision and strict control over its implementation. It is morally unacceptable to justify either murder or torture, so euthanasia appears as an attempt to avoid both at the same time. Conclusions. Specific solutions to practical problems often indicate the necessary direction for solving theoretical difficulties. Thus, making proper moral decisions about euthanasia requires reliance on fundamental knowledge about human beings, but at the same time it provides arguments "for" and "against" artificial termination of life. The basic principles of bioethics – autonomy, nonmaleficence, beneficence and respect for the dignity of human life – serve as criteria for making balanced ethical decisions both in theory and in practice. These principles should be complemented by a coherent ethical, legal and philosophical position on euthanasia, which is achieved through legitimation procedures. Decisive for making a decision on euthanasia should be the strong desire of the patient himself.

Prospective case study of critical decision making for horses referred for treatment of colic.

There is limited evidence on factors affecting critical decision making for horses with colic. This study's aim was to describe the assessment and decision making involved in horses referred for management of colic. An in-depth case analysis was used to document case presentation, decision making and outcomes for horses referred for colic to two UK equine veterinary practices over a 12-month period. The data recorded included previous history, presenting signs, response to treatment, case outcome and factors affecting decisions for further treatment or euthanasia. Data were available for 60 cases: 55 were hospitalised for medical or surgical treatment and five horses were euthanased following initial assessment. The main factors affecting treatment decisions were severity of clinical signs (80%, 47/59), financial concerns (10%, 6/59) and ongoing health issues or previous history of colic (5%, 3/59). Factors associated with euthanasia decisions were postoperative complications (5/18), poor prognosis (4/18), deteriorating clinical signs (3/18) and financial concerns (3/18). The limited study population may affect the extent to which the findings can be generalised. The severity of clinical signs was the key factor in treatment decision making. The main factors affecting euthanasia decisions were clinical deterioration, poor prognosis and financial constraints. These findings should be incorporated into clinical case recording to capture the multifactorial nature of decision making.

Respiratory compromise in French bulldogs presented with intervertebral disc extrusion.

French bulldogs hospitalised for the management of intervertebral disc extrusion (IVDE) are frequently affected by respiratory compromise, typically brachycephalic-associated upper respiratory obstruction and/or aspiration events. We evaluated the occurrence of such respiratory compromise events in French bulldogs presented to two referral hospitals. Clinical data for French bulldogs diagnosed with IVDE were retrospectively collated, including severity of neurological deficits, neuroanatomical localisation, diagnosis, details of respiratory compromise, treatment and outcome. A total of 306 dogs diagnosed with IVDE were included. Sixty dogs (19.6%) experienced respiratory compromise, of which 31 dogs (10.1%) progressed to cyanosis, collapse or respiratory arrest. The study was limited by its retrospective nature. Furthermore, the duration of hospitalisation was not evaluated and the decision for euthanasia was often multifactorial. One in five French bulldogs presented with IVDE experienced respiratory compromise. The detrimental welfare effects of this warrant further discussion.

End-of-life decisions in the intensive care unit-exploring the knowledge and attitude of nurses and doctors: a national survey

Aim: In our country, there is a growing awareness regarding end-of-life practices. It has become evident that treatments in intensive care to end-stage patients, instead of honoring their previously made end-of-life decisions, significantly diminishes patients’ overall quality of life. The aim of study is drawing attention to end-of-life decision practices and to evaluate the knowledge and attitudes of intensive care physicians and nurses, who are decisive in end-of-life decision-making practices. Methods: The study was planned as a multi-center, cross-sectional, descriptive questionnaire. There were 21 questions about demographic data, definitions, and end-of-life decisions. 259 of 760 intensive care physicians and nurses who filled out the questionnaire were included. Results: Two hundred and fifty-nine participants were included. The rate of decision for terminal sedation and euthanasia was differentiating according to intensive care experience. Participants’ knowledge was insufficient regarding withholding and withdrawal approaches. Intensive care physicians, and patients at the terminal stage of chronic disease were recommended as decision makers with the highest rate. Conclusion: In this study, it was determined that the participants' knowledge about end-of-life decision concepts was not sufficient, and their approaches were differentiating due to experience. It is considered that there is a need for education and standardization about end-of-life decision-making process.

Cultural awareness for veterinarians working with LatinX livestock caretakers

Work done by Colorado State University researchers has high­lighted the human-animal bond that exists on dairy and other livestock operations, and the perceptions of animal caretakers regarding animal health and euthanasia decisions. There is a clear need for culturally responsive training to better prepare animal caretakers to make end-of-life decisions in a timely manner while reducing the emotional burden associated with euthanasia decision making. While veterinarians are well po­sitioned to provide leadership in health management and end-of-life decision-making processes, they are seldom involved in the creation and facilitation of training programs for livestock caretakers. Cultural differences that may limit effective com­munication and training can be overcome by engaging live­stock caretakers with approaches proven effective in both re­search and practice settings.

On-farm euthanasia – providing a good death

Decisions involving compromised cattle include treatment, slaughter or euthanasia. The American Association of Bovine Practitioners (AABP) Guidelines for the Humane Euthanasia of Cattle contain a helpful list of considerations to aid decision making.1 Rather than repeat what you can easily find yourself in the aforementioned guidelines, I will outline some ideas to consider to support euthanasia decisions and make the process go as smoothly as possible.

Circumstances affecting patients’ euthanasia or medically assisted suicide decisions from the perspectives of patients, relatives, and healthcare professionals: A qualitative systematic review

This study aims to explore circumstances affecting patients’ euthanasia and medically assisted suicide (MAS) decisions from the perspectives of patients, relatives, and healthcare professionals. A qualitative systematic review was performed following PRISMA recommendations. The review protocol is registered in PROSPERO (CRD42022303034). Literature searches were conducted in MEDLINE, EMBASE, CINAHL Complete, Eric, PsycInfo, and citation pearl search in Scopus from 2012 to 2022. In total, 6840 publications were initially retrieved. The analysis included a descriptive numerical summary analysis and a qualitative thematic analysis of 27 publications, resulting in two main themes—Contexts and factors influencing actions and interactions, and Finding support while dealing with resistance in euthanasia and MAS decisions—and related sub-themes. The results illuminated the dynamics in (inter)actions between patients and involved parties that might both impede and facilitate patients’ decisions related to euthanasia/MAS, potentially influencing patients’ decision-making experiences, and the roles and experiences of involved parties.

Cushing’s syndrome in Flanders and the Netherlands: an owner survey

Cushing’s syndrome is a common chronic condition, with daily impact on the owner’s and dog’s life. The owners’ perception and quality of life are essential, as any negative impact could lead to cessation of medical care or decision of euthanasia. The present survey aimed at collecting the perception of Flemish and Dutch owners of dogs affected by Cushing’s syndrome on medical, practical, financial and emotional aspects. In total, the questionnaires of 218 respondents were available for analysis, highlighting owners’ expectations, quality of life, understanding of the disease and encountered difficulties, and identifying weak and strong points regarding ownerveterinary interactions, together with providing several demographic data related to canine Cushing’s syndrome in Flanders and the Netherlands.

Development of a Nomogram to Estimate the 60-Day Probability of Death or Culling Due to Severe Clinical Mastitis in Dairy Cows at First Veterinary Clinical Evaluation

Severe clinical mastitis is a frequent disease of dairy cattle. An effective mean of predicting survival despite treatment would be helpful for making euthanasia decisions in poor prognosis cases. The objective was to develop a nomogram for prediction of death or culling in the 60 days following a severe mastitis episode in dairy cows at first veterinary visit in farm settings. A total of 224 dairy cows presenting severe clinical mastitis and examined for the first time by a veterinarian were included in a prospective study. Clinical and laboratory (complete blood cell count, L-lactate, cardiac troponin I, milk culture) variables were recorded. Animals were followed for 60 days. A nomogram was built with an adaptive elastic-net Cox proportional hazards model. Performances and relevance were evaluated by area under the receiver operating characteristic curve (AUC), Harrell's concordance index (C-index), calibration curve, decision curve analysis (DCA) and misclassification cost term (MCT). The nomogram included: lactation number, recumbency, depression intensity, capillary refilling time, ruminal motility rate, dehydration level, lactates concentration, hematocrit, band neutrophils count, monocyte count, and milk bacteriology. The AUC and C-index showed a good calibration and ability to discriminate. The DCA suggested that the nomogram was clinically relevant. Euthanizing animals having less than 25% probability of survival is economically optimal. It could be used for early euthanasia decisions in animals that would not survive despite treatment. To facilitate the use of this nomogram by veterinarians, a web-based app was developed.

Ethical and Practical Considerations Associated with Companion Animal Euthanasia.

The reality that euthanasia in veterinary practice can end animal suffering but can also be used in circumstances that do not serve an animal's interest, can be a benefit for animals, and a burden for veterinary professionals, respectively. This essay addresses ethical and practical concerns associated with companion animal euthanasia, including defining euthanasia, why and when euthanasia should be performed, applying euthanasia in practice, contemporary methods, aftercare of deceased animals, and the consequences of euthanasia and dysthanasia for animals, animal owners, and veterinary professionals. We contend that an intention-based definition of euthanasia should be strictly applied in veterinary practice and that practitioners view euthanasia decisions as requests that can (and in some cases should) be declined, rather than as mandates.