"Living is not always better than not living": British researchers urge vets to discuss euthanasia rather than airway surgery with owners of pugs and bulldogs

What happened

Dan O'Neill, associate professor in companion animal epidemiology at the Royal Veterinary College (RVC) in London, made a statement on the Vet Times Podcast that surprised many. In his view, vets should consider euthanasia rather than surgery for brachycephalic obstructive airway syndrome (BOAS).

He urged vets to remove clients' "feeling of heroism" around BOAS surgery and to focus on their pets' long-term welfare. His colleague Rowena Packer supported this position.

What brachycephalic syndrome is

Brachycephalic breeds have shortened muzzles: pugs, French and English bulldogs, shih tzus, Boston terriers, Pekingese and others. Because the skull is so short, the soft tissues of the nose and throat do not fit. The nostrils are narrow, the soft palate is too long, and the larynx and windpipe may be narrowed. All of this makes it hard for the dog to breathe.

How BOAS shows

Dogs with the syndrome snore, breathe noisily even at rest, tire quickly on walks and cope badly with heat. Some cannot sleep lying down normally and sleep sitting up or with a toy in their mouth to keep their airway open. In severe cases dogs collapse, and overheating can kill them.

How severity is assessed

In the UK, breathing in brachycephalic dogs is assessed using a grading scheme with several levels of severity. The vet listens to the dog's breathing at rest and then after a short exercise test, such as three minutes of brisk walking, and watches how quickly it recovers. Noise, breathlessness and laboured inhalation after exercise point to a more severe grade.

What surgery involves

In surgery, the vet widens the nostrils, shortens the overlong soft palate and sometimes removes everted laryngeal saccules. This makes it easier for air to flow. Many dogs breathe noticeably better afterwards, but the shape of the skull stays the same, and some problems remain.

What Dan O'Neill said

According to O'Neill, BOAS surgery "never solves the problem": these dogs go on to have a lifetime of respiratory compromise, and surgery only lessens it a little. When such invasive surgery is needed and the operation itself adds to the dog's welfare problems, it may often be better from a welfare point of view for the animal to be euthanised kindly.

Not always better to live

O'Neill put it this way: it is not always the case that living is better than not living. If, even with surgery, a dog is going to continue to have a life not worth living, vets need to consider euthanasia. The remark sparked debate, because many owners and vets see surgery as a chance for the dog.

What Rowena Packer said

Rowena Packer, senior lecturer in companion animal behaviour and welfare science at the RVC, agreed with her colleague. She said the key is raising the bar for what counts as acceptable welfare for dogs with extreme conformation. In her view there is a mistaken belief that if you love them enough and have the money for treatment, everything will be fine.

Why love is not enough

Packer explained that for many brachycephalic dogs, even with the most devoted owner and expensive treatment, an underlying burden of suffering remains. Treatment often only palliates the harm. We have to accept, she said, that for some dogs this is not enough for an acceptable quality of life.

Which questions to ask

Packer suggested that vets ask themselves and owners: are we aiming high enough for this individual dog, or are we just accepting that its welfare will never be great? Accepting that, she said, does these animals a real disservice, especially when their lives are short and full of suffering.

What the IHA tool is

O'Neill suggested that the Innate Health Assessment (IHA), launched in November, could help with such conversations. It is a 10-point checklist that helps owners judge whether their dog can perform all the natural functions and behaviours normally expected of its species: breathing normally, eating, sleeping, running, playing, coping with heat and so on.

How the checklist works

The owner answers simple questions: can the dog walk and play without difficulty, sleep in a comfortable position, eat and drink without problems, see, give birth naturally and tolerate warm weather? If many of the answers are no, that is a reason to talk to the vet about how to help the dog and what to expect in future.

Before and after buying

O'Neill noted that a conversation with someone thinking of buying a brachycephalic dog differs from one with an owner who already has one. With prospective owners, vets need to talk about the suffering such a dog may experience. With existing owners, the focus is on the actual welfare of their pet rather than the wider heroic idea of extending life at any cost.

Why it is hard for owners

Packer pointed out that earlier research shows owners of brachycephalic dogs are often extremely attached to them. That makes a conversation about euthanasia especially hard. Vets must make clear that they are supportive, she said, but also be honest that difficult decisions do need to be made.

Why this view is controversial

Many veterinary surgeons believe BOAS surgery significantly improves dogs' lives, especially when carried out early, in young dogs. For them euthanasia is a last resort. The position taken by O'Neill and Packer is more a call not to see surgery as a fix for everything and to assess each dog's quality of life honestly.

When surgery helps most

According to veterinary surgeons, surgery usually gives the best results in young dogs, before the airway has changed significantly. The earlier the nostrils are widened and the palate shortened, the fewer secondary changes develop in the larynx. That is why vets recommend assessing the breathing of brachycephalic puppies in their first year of life.

Why the issue is so pressing in the UK

French bulldogs and pugs have been among the most popular breeds in the UK for years. They are often bought for their looks and because of social media and advertising, without buyers knowing about their health problems. British veterinary organisations, including the BVA, have campaigned for such dogs not to be used in advertising and for people to choose healthier breeds.

Why breeding matters

The main cause of BOAS is the shape of the head, which is fixed by breeding. That is why many veterinary organisations in Europe urge people not to buy dogs with extremely short muzzles and to choose lines with longer noses. Some breed clubs already run breathing tests on dogs used for breeding, such as the Kennel Club and University of Cambridge Respiratory Function Grading Scheme in the UK.

What other countries are doing

In the Netherlands, breeding dogs with overly short muzzles is restricted. In Norway, a court banned the breeding of Cavalier King Charles spaniels and English bulldogs under the previous rules. In Germany, the law prohibits breeding animals with hereditary suffering. The UK has so far relied on educating buyers and voluntary testing.

What prospective owners should do

1. Consider another breed if you like small companion dogs.
2. If you choose a brachycephalic breed, look for dogs with longer muzzles and wide nostrils.
3. Ask the breeder about the parents' breathing test results.
4. Watch how the parents breathe at rest and after play.
5. Do not buy puppies from random sellers online.

What current owners should do

If you have a pug, bulldog or another short-muzzled dog, keep an eye on its breathing and weight. Excess weight makes breathing much worse. Avoid heat and long exertion, and use a harness rather than a collar. Talk to your vet about whether surgery is needed, and assess your dog's quality of life honestly together.

Why weight matters

In brachycephalic dogs extra weight is particularly dangerous: fat is also deposited around the airway, narrowing it further. Even a small weight loss can make breathing noticeably easier. Your vet can help work out the right amount of food and suggest safe levels of exercise.

Warning signs

See a vet immediately if your dog is struggling for breath, its tongue and gums turn blue, it collapses or cannot settle after exertion. Vomiting and regurgitation during a breathing crisis are also dangerous. Brachycephalic dogs overheat quickly in hot weather, and heatstroke can be fatal.

What this means for Europe

The debate in the UK reflects a Europe-wide discussion about dogs with extreme conformation. The Netherlands, Germany and Scandinavian countries already restrict breeding of such dogs. Current and future owners of pugs and bulldogs across Europe should assess their dog's health honestly and choose animals with longer muzzles.

When to see a vet

Take your dog to a vet if it snores loudly, breathes noisily at rest, tires quickly, copes badly with heat, sleeps sitting up or regurgitates. Go immediately if its tongue turns blue, it collapses or it is severely short of breath. Discuss with your vet whether surgery would help and how to give your dog a decent quality of life.