The Ethical Challenges of Treating Soft Palate Dysfunction

The ethics of using horses in sport is receiving intensifying attention and media scrutiny. There has been criticism from the public and media about welfare issues affecting racehorses, ill treatment, injury rates, falls, fatality rates and fate after retirement.

The ethics of equine or veterinary sports medicine is an area which also deserves distinct consideration. Sports medicine ethics is an important and well-established discipline within human medicine and biomedical ethics, which thus far has received very little attention within the equine veterinary field. Equine sports medicine brings together the ethical issues and complexity of veterinary practice with that of sports medicine, superimposed upon the much wider ethical issues of using horses in sport.

As a discipline, equine sports medicine has developed at a dramatic pace over recent decades. In this era of optimising peak athletic performance, an approach of marginal gains and proactive equine veterinary care has been established. This approach has undoubtedly been adopted with the best intention of optimising equine health to enable peak performance. However, some articles in the veterinary literature have suggested that the ’veterinary profession has created some of the [welfare] problems that now exist’ [1].

The ethics of some sports medicine veterinary practices have been criticised in mainstream newspapers. In an article in The Sunday Times last year [2], it was stated ‘There is also the disturbing question of wind operations. Many horses develop problems in their respiratory tracts that necessitate surgical procedures. It is widely accepted that the percentage of wind operations is ever rising and there are trainers and owners opting for pre-emptive surgeries. Think about this: you give a horse a general anaesthetic to perform an operation that the horse manifestly does not need. Welfare is like transparency: easy to put into sentences, not so easy to put into practice. As all wind operations must be reported, the authorities in the UK and Ireland have it within their power to stop the malpractice. So far, they have done nothing. Horse welfare presents a difficult, expensive and time-consuming challenge and those who govern the sport in this part of the world do not do enough.’

The concept of a social licence for equestrian sport has been widely discussed over the last couple of years. An opinion article in an American magazine stated that ‘The fate of racing will be decided by people who’ve never been to the races, know nothing about horses, have probably never even touched a racehorse’ [3].

Monitoring societal ethical changes and operating in accord with them is essential for all professions. Therefore, as the specialism of equine sports medicine continues to advance it is crucial for the veterinary profession to consider the ethical challenges that this can create. Within the veterinary literature it has been suggested that ‘it is necessary for the veterinary profession to stick its collective head above the parapet and to contribute to the development of practical methods for assessing which treatments of competitive animals are and are not ethical in the 21st century’ [4].

In a recent questionnaire of equine vets in the UK, ‘wind ops’ and ‘soft palate cautery’ were raised as important ethical concerns.

Palatal dysfunction comprises palatal instability (defined as dorsoventral billowing movements of the soft palate, with flattening of the epiglottis against the dorsal surface of the soft palate) and dorsal displacement of the soft palate (caudal border of the soft palate becomes displaced to a position above the epiglottis). Collectively palatal dysfunction is the most commonly observed upper airway dysfunction in Thoroughbred racehorses during exercise.

What is the experience of a horse afflicted with dorsal displacement of the soft palate? It is likely that these conditions give rise to unpleasant sensations of respiratory effort and air hunger [5]. Is continuing to train and race horses with these conditions untreated appropriate?

If we are to treat the condition what would be the experience of the horse? What is the experience of the horse during conservative treatments such as tongue bits, tight nosebands, and tongue ties? What is the evidence to support their use? Current data suggest that approximately 6% of National Hunt horses and approximately 3% of flat horses are raced with a tongue tie [6].

Are surgical treatments appropriate to consider? What are the most commonly performed surgeries? On average for the years 2018, 2019 and 2020, approximately 1800 ‘wind ops’ were declared per calendar year to the BHA [6]. The majority (60%) were in National Hunt horses, with 26% declared in flat horses, and 13% were dual purpose [6]. Soft palate cautery is the most commonly declared surgical treatment accounting for 63% of declarations [6]. What is the evidence to support soft palate cautery? What are the potential harms? What are the alternative surgical treatment options, how often are they performed and what evidence supports their use? Currently tie- forwards account for only 7.4% of declarations [6]. What are the concerns of alternative treatments such as laser cautery of the soft palate?

The veterinary industry needs to be able to support individual veterinary surgeons striving for the highest levels of professional conduct in equine sports medicine. The veterinary industry itself should be proactive around regulation and guidance to safeguard the integrity and reputation of veterinary surgeons and safeguard the health and welfare of the equine athlete. How should organisations consider what is optimal, permissible, and impermissible in equine veterinary sports medicine?

[...]