Act boldly: Important life decisions, courage, and the motivated pursuit of risk.

A key welfare concern for the equine population in the U.K. has been identified as delayed death, leading to prolonged suffering of horses. Reasons why some horse owners fail to have their horses euthanised include financial cost, emotional attachment, peer pressure, negative attitudes towards killing and poor recognition of behavioural indicators of equine pain and stress. The Five Freedoms framework of welfare was used to build a Likert-style survey to investigate the factors underlying attitudes of horse owners towards welfare measures in an end-of-life decision. Participants were asked to respond to hypothetical welfare scenarios and to give details of any horses they had had euthanised. The survey was conducted predominantly via equestrian Facebook groups and obtained 160 participant responses. Reliability of the scale was acceptable, with Cronbach’s α=0.89. Principal Component Analysis was used to load the hypothetical scenarios onto seven factors containing 62.2% of the variance. The first four factors could be categorized according to “Ethology-informed Management”, “Traditional Horse Management”, “Emotional Issues” and “Physical Issues”. Participants were more likely to consider euthanasia for physical issues, compared with issues relating to affective state and/or ethology, although it was not clear whether this was due to disregard for welfare issues relating to mental health or failure to recognise them as such. A large number of responses stated that the scenario had no bearing on whether a horse should be euthanised, again suggesting a lack of recognition of welfare issues and their implications. When asked to state their reasons for euthanising their horses, participants cited almost exclusively physical reasons, with the exception of those citing dangerous behaviour. Only a small number of responses also included consideration of affective and/or ethological factors, suggesting that welfare issues concerning affective state and/or behaviour are at risk of omission from end-of-life decisions.

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Moral distress in end-of-life decisions: A qualitative study of intensive care physicians

Journal of Critical Care ◽

10.1016/j.jcrc.2020.12.019 ◽

2021 ◽

Vol 62 ◽

pp. 185-189

Author(s):

Una St Ledger ◽

Joanne Reid ◽

Ann Begley ◽

Peter Dodek ◽

Daniel F. McAuley ◽

...

Keyword(s):

Intensive Care ◽

Qualitative Study ◽

End Of Life ◽

Moral Distress ◽

End Of Life Decisions ◽

Life Decisions

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European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions

Resuscitation ◽

10.1016/j.resuscitation.2021.02.017 ◽

2021 ◽

Author(s):

Spyros D. Mentzelopoulos ◽

Keith Couper ◽

Patrick Van de Voorde ◽

Patrick Druwé ◽

Marieke Blom ◽

...

Keyword(s):

End Of Life ◽

European Resuscitation Council ◽

End Of Life Decisions ◽

Life Decisions

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“What Would You Do?”: How Cat Owners Make End-of-Life Decisions and Implications for Veterinary-Client Interactions

Animals ◽

10.3390/ani11041114 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1114

Author(s):

Katherine Littlewood ◽

Ngaio Beausoleil ◽

Kevin Stafford ◽

Christine Stephens

Keyword(s):

Decision Making ◽

New Zealand ◽

End Of Life ◽

Companion Animals ◽

Chronically Ill ◽

Future Research ◽

End Of Life Decisions ◽

Life Decisions ◽

End Of Life Decision ◽

Life Decision

Cats are the most common companion animals in New Zealand. Advances in veterinary care means that cats are living longer and there are many older cats. End-of-life decisions about cats are complicated by owner–cat relationships and other psychosocial factors. Our study explored the ways in which end-of-life decisions were being made by owners of older and chronically ill cats in New Zealand and the role of their veterinarian in the process. Qualitative data were gathered via retrospective semi-structured interviews with 14 cat owners using open-ended questions. Transcripts of these interviews were explored for themes using template analysis and nine themes were identified. Four were animal-centered themes: cat behavior change, pain was a bad sign, signs of ageing are not good, and the benefits of having other people see what owners often could not. Five were human-centered themes: veterinarians understanding owners’ relationships with their cat, normalizing death, the need for a good veterinarian to manage end of life, veterinary validation that owners were doing the right thing, and a strong desire to predict the time course and outcome for their cat. End-of-life decision making is complex, and the veterinarian’s role is often poorly defined. Our owners appreciated the expertise and validation that their veterinarian provided but continuity of care was important. Future research aimed at exploring the veterinarian’s perspective during end-of-life decision making for cats would be a valuable addition to the topic.

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End-of-Life Decisions Among Cancer Patients Compared With Noncancer Patients in Flanders, Belgium

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.7531 ◽

2006 ◽

Vol 24 (18) ◽

pp. 2842-2848 ◽

Cited By ~ 20

Author(s):

Lieve Van den Block ◽

Johan Bilsen ◽

Reginald Deschepper ◽

Greta Van Der Kelen ◽

Jan L. Bernheim ◽

...

Keyword(s):

End Of Life ◽

Cancer Patients ◽

Response Rate ◽

Decision Making Process ◽

End Of Life Decisions ◽

Symptom Alleviation ◽

Incidence Studies ◽

Life Decisions ◽

End Of Life Decision ◽

Life Decision

Purpose Incidence studies reported more end-of-life decisions with possible/certain life-shortening effect (ELDs) among cancer patients than among noncancer patients. These studies did not correct for the different proportions of sudden/unexpected deaths of cancer versus noncancer patients, which could have biased the results. We investigated incidences and characteristics of ELDs among nonsudden cancer and noncancer deaths. Methods We sampled 5,005 certificates of all deaths in 2001 (Flanders, Belgium) stratified for ELD likelihood. Questionnaires were mailed to the certifying physicians. Data were corrected for stratification and nonresponse. Results The response rate was 59%. Among 2,128 nonsudden deaths included, ELDs occurred in 74% of cancer versus 50% of noncancer patients (P < .001). Symptom alleviation with possible life-shortening effect occurred more frequently among cancer patients (P < .001); nontreatment decisions occurred less frequently (P < .001). The higher incidence of lethal drug use among cancer patients did not hold after correcting for patient age. Half of the cancer patients who died after an ELD were incompetent to make decisions compared with 76% of noncancer patients (P < .001). Discussion with patients and relatives was similar in both groups. In one fifth of all patients the ELD was not discussed. Conclusion ELDs are common in nonsudden deaths. The different incidences for symptom alleviation with possible life-shortening effect and nontreatment decisions among cancer versus noncancer patients may be related to differences in dying trajectories and in timely recognition of patient needs. The end-of-life decision-making process is similar for both groups: consultation of patients and relatives can be improved in a significant minority of patients.

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