As much as we hate to think about it, at some point almost every horse owner has to face some pretty tough decisions regarding a horse's health and well being. Although no one can be fully prepared for the inevitable life-or-death decisions, some thinking and planning ahead can make things a bit easier. Rationally assessing the possibilities, and making difficult decisions, is easier done before the need arises. Waiting until your horse is severely ill or injured makes the decision a lot tougher.

The decision to end the suffering of a horse with a badly broken leg, or in severe and constant pain due to founder, is emotionally trying. But in such circumstances the right decision will probably be clear.

What about a horse that becomes ill and requires intensive care or surgery? We all like to do everything possible for our horses, but the reality is that such care can become prolonged and agonizing for the horse, heart-wrenching for you and, let's face it, expensive. You need to weigh many factors, including the horse's pain and suffering, its likelihood of recovery, your finances, your barn setup, and your lifestyle. Your veterinarian will do his or her best to help you make the right decision, but ultimately the decision is yours.

When a horse becomes ill, extensive testing may be needed to determine the cause. Equine medicine is particularly vexing, as it is so difficult to see inside a horse to know what's wrong. Starting with a summary of the horse's history and a physical examination, your veterinarian will try to home in on the source of the problem.

If the problem is in the chest or abdomen, listening from the outside, or feeling through the wall of the rectum during a rectal examination, give only some idea of what might be going on. An analysis of fluid tapped from the chest or abdomen, and the testing of blood, urine, and manure may provide additional answers. But until horses learn to talk, veterinarians have to use all other available information to try to come to some conclusions. If the problem is severe or particularly perplexing, your veterinarian's best advice may be to bring the horse to an equine referral center.

Such facilities vary in their charges for hospitalization, but none is free. After-hours emergency fees add to the bill. Medical treatment costs for a draft horse can be quite high. With the exception of sedatives, the amount of medication needed to treat a draft is far greater than is needed for a light horse. Even something as simple and basic as intravenous fluid therapy can run into hundreds of dollars per day for a big horse. If your horse needs surgery, such as for colic, the cost can run into thousands of dollars.

I'm not trying to sound cold-hearted, just realistic. Your veterinarian will quote you the likely costs for diagnosis and treatment, and will offer as many options as possible. Costs may change as more information is gathered, as well as when/if your horse responds to therapy. Your veterinarian will try to give you as accurate a prognosis (from the Greek, meaning "to see into the future") for recovery as is possible.

If your horse will likely survive an injury or medical condition, but will be in continuous pain, you must weigh your emotional needs against the horse's needs. If your horse will likely survive, but will no longer be able to perform, you must decide if you or someone you know is willing and able to take on a pasture ornament. You will likely think harder about subjecting an elderly horse to the stress of abdominal surgery and recovery than you would for a promising 3-year-old.

Thinking ahead can make some of these decisions easier. Try to decide beforehand what your financial limit is. Assess your situation critically. You may be able to afford the cost of abdominal surgery, but are you set up to create a hospital-like situation in your barn during the recovery period? Are you, or is someone you know, able to administer the necessary after care?

The decision to go ahead or to give up may depend on your horse's will to live, outlook for recovery, anticipated quality of life, your financial situation, or any combination of these factors, all of which are equally valid. When it comes time to make a tough decision, listen to your heart, your pocketbook, your family and friends, your veterinarian and, sometimes most of all, your horse.

Beth A. Valentine, DVM, PhD, is a veterinary pathologist at the Oregon State University College of Veterinary Medicine in Corvallis, this site's virtual vet, and co-author of Draft Horses, an Owner's Manual. This article appeared in the Winter 2004 issue of Rural Heritage.