When humans appropriate any species of animal for human wellbeing, it is the responsibility of the human to provide the best possible care for that animal. Asking an animal to work in a human healthcare profession is much like asking a human to do the same. Just like humans, animals need time off, exercise, social interactions, and good healthcare, and they need space and distance from their patients and their handlers. Unfortunately, since there are no nationally established competency requirements to provide equine-assisted therapy, professionals with little or no formal training and education related to equitation science, ethology, or equine behavior may incorporate horses in their clinical practices. This raises serious ethical and safety concerns that have broad-reaching implications for horses and patients alike. This chapter explores common misconceptions about horse behaviors and communication, and best practices for animal care, and delves into the ethics of including horses in human healthcare.