The nature of laminitis - its unpredictable course, the severe pain and disability it causes, the lengthy convalescence it requires even when cured - poses challenging ethical quandaries for the clinicians who treat it and the owners whose horses suffer from it. Unique among equine ailments, this disease places owners and clinicians in the untenable position of trying to balance considerations that are very difficult to weigh against each other: the animal's pain, the unknown disease trajectory, the questionable possibility of full recovery, the limited usefulness of the animal post-laminitis, the financial drain of treatment, the financial loss of a formerly productive horse, the expense of maintaining a "pasture potato," the animal's frustration or distress during convalescence, etc. The pressing question in every case of laminitis is: where should we draw the line? The answer to this question will not only be different in every individual case of laminitis, but different owners and clinicians will often have divergent views even regarding the same case. In an ethical terrain that is so clearly "gray," absolutes are unlikely to be found. Instead, our essay hopes to clarify the ethical considerations involved in treating a horse with laminitis to facilitate the decision-making process regarding the specific cases encountered by clinicians in the field.