The way people think about animals is constantly evolving. In recent years, simply meeting the basic needs of production animals and minimizing their suffering are increasingly seen as inadequate. Many now view animals, regardless of species, as sentient beings with emotions, often treating them as members of the family. As a result, expectations for veterinary care have grown, including for species traditionally regarded as livestock, such as sheep, pigs, and cows. This change is paralleled by an increasing number of animal sanctuaries, which provide lifelong care for formerly farmed or neglected animals, regardless of their productivity.

In response to this growing population of rescued animals living out their post-production years in sanctuary settings, the study’s authors explore the evolving landscape of large animal veterinary medicine. While a positive change, this shift also presents ethical, practical, and psychological challenges for veterinary professionals, who often lack the training, infrastructure, and resources necessary to provide intensive care.

Veterinarians are typically trained under welfare models where humane euthanasia is considered the best course of action for animals with a poor prognosis. However, they’re becoming increasingly confronted with clients who don’t consider euthanasia to be the most humane option, often seeking to prolong life as much as possible — sometimes against veterinarians’ professional judgment. This fundamental mismatch in expectations can lead to moral distress among veterinary staff, especially when treatments seem futile.

The authors conducted an exploratory study at a large academic veterinary hospital to assess the extent of ethical and moral distress experienced by staff caring for rescued large animal patients. A total of 130 participants, including veterinarians, veterinary nurses, clinical-year students, and support staff, completed the survey.

All respondents reported encountering at least one ethically troubling case, and 87% identified rescued or sanctuary patients as a source of ethical or moral concern. Over half (55%) found caring for these patients more stressful than for other animals. The most common causes of distress included:

• Prolonging life despite suffering (90%)
• Withholding euthanasia, leading to prolonged suffering (88%)
• Inadequate staffing (88%) or facilities (55%)
• Client demands for inappropriate or non-beneficial treatments (63%)

Interestingly, 51% of respondents reported experiencing ethical or moral concerns related to clients who withheld appropriate treatment, even when the patient had a good prognosis. This appears somewhat contradictory to the more commonly reported concern where clients pursued treatment whether beneficial, effective, or not. However, the reasons behind client decisions to withhold treatment in these cases remain unclear.

The authors identify several factors that contribute to distress in veterinary teams when caring for rescued large animals. To address these challenges, the authors propose actionable strategies:

1. Lack of hospice and palliative care guidelines for large animals. Unlike in small animal practice, structured end-of-life care options for large animals are scarce due to logistical, financial, and safety constraints — highlighting the need for formal guidelines tailored specifically to large animal species to support ethical and compassionate end-of-life decision-making.

2. Insufficient training and literature for advanced interventions. Veterinary professionals are often unprepared to manage the complex medical needs of aged or chronically ill farmed animals in sanctuary settings. Addressing this gap requires expanded education and continuing professional development focused on advanced care for non-traditional patients, including rescued and sanctuary animals.

3. Limited referral options for complex or ethically challenging cases. Specialized hospitals are often the only facilities equipped to manage such patients, placing a disproportionate burden on clinicians at these specialized clinics. Strengthening hospital networks and establishing clear referral pathways for ethically or medically complex large animal cases can help alleviate this burden.

4. Prevalence of futile medicine. Many clinicians experience distress when asked to perform interventions they consider medically inappropriate or unlikely to benefit the patient. Developing and adopting a veterinary-specific measure of moral distress would better capture and address the ethical complexities unique to veterinary medicine.

5. Regulatory constraints related to food animal designation. Under United States Department of Agriculture regulations, animals such as pigs and cows, even when housed in sanctuaries, are classified as food-producing species. This classification restricts treatment options due to strict drug-use limitations for animals who may be intended for human consumption. Addressing this issue will require long-term legislative changes in public health policy, alongside the development of a dedicated database or registration system to identify rescued animals permanently removed from the food chain.

The rising demand for veterinary care of rescued large animals reflects broader societal shifts in how animals are perceived and valued. While these developments create meaningful opportunities to expand compassion and care, they also introduce complex ethical tensions that may compromise the well-being of veterinary professionals. The authors advocate for a proactive, systemic response encompassing research, policy reform, and enhanced education to support career longevity and retention of veterinary staff, and to ensure high-quality care for large animals who’ve been lucky enough to be granted a second chance at life.