Should you let that support peacock into your clinic? And other things to consider with therapy animals

Guide dogs and service animals have been around for a long time, dating centuries back in France and close to 100 years in Canada. With the emergence in recent years of support animals, other creatures besides dogs—including cats and non-domesticated animals such as livestock and wildlife—have been recognized for their ability to provide therapeutic benefits.Physicians may, at some point, be asked to write a letter confirming a patient’s need for a service dog or emotional support animal. Or they may encounter a patient who wants to come into the clinic with their support animal in tow. That’s why it’s important to understand the categories and rules around assistive animals.“Therapeutic animals can be of any species, including some wildlife and livestock (subject to applicable legislation),” the College of Physicians and Surgeons of Saskatchewan noted recently in its online newsletter. “It is important for healthcare providers to correctly identify these animals and provide care and advice consistent with each animal's role.”Not one but three kindsAn accompanying fact sheet posted by the college described the three types of assistive animals: service animals with specialized training to perform a specific task, therapy animals which are used for animal-assisted interventions or activities and are usually accompanied by a service provider, and support animals which are typically not trained to perform specific tasks to a disability but provide emotional support and comfort.A guide dog for people with visual impairments is an example of a service animal while dogs, cats, rabbits or other creatures brought occasionally into hospitals or long-term care residences are examples of therapy animals.Support animals are usually dogs or cats but can also be other less common pets or even livestock and wildlife. In a well-publicized case from 2018 where an airline barred an emotional support animal from boarding, the animal in question was a peacock.Duty to accommodateWhile there is a federal-level definition for service dogs, the rules around certification and accommodation of these animals fall under provincial and territorial legislation and vary across jurisdictions. In Saskatchewan, for example, the provincial Human Rights Code requires healthcare, housing, employment, education and public services settings to accommodate people who use service animals. The same right of access doesn’t extend to therapy and support animals.In addition to the Human Rights Code, other provinces—such as Alberta, British Columbia and Manitoba—have laws written specifically with provisions for service or guide animals.Care and handling of therapy animalsMost jurisdictions also have laws or guidelines that spell out who’s responsible for the care and handling of therapeutic animals. In general, the owner or handler is responsible for the care and oversight of the therapeutic animal, and for ensuring compliance with disease prevention measures such as vaccinations and health screening. When the animal is brought aboard commercial transport such as a plane or public transit, the owner or handler must also ensure the animal is restrained or contained.Read: Should we encourage dogs in healthcare settings?Therapy animals in your waiting room?In a post on its website, the Canadian Medical Protective Association (CMPA) points out that “legislation generally requires that individuals accompanied by service animals (including guide dogs) be provided access to any place to which the public is admitted.”While emotional support animals do not, in general, have the same legislative protection, the CMPA notes that the use of an emotional support animal by someone with a mental health condition may be protected under human rights legislation “if it is part of the person’s treatment or helps mitigate their condition.”For doctors faced with a patient who comes in with an emotional support animal, it may be advisable to “consider doing your best to accommodate the patient up to the point of undue hardship,” wrote the CMPA. “For example, undue hardship may be found if the animal poses a substantial risk of harm to others based on a reasonable assessment,” the association added. “To meet the threshold of causing undue hardship, you will generally need to show you could not have done anything more within reason to accommodate the patient.”So should you or shouldn’t you?Maybe you’re not sure if that ferret on your patient’s lap really is an emotional support animal or more of a pet. Maybe your office manager isn’t comfortable around ferrets. The CMPA suggests asking the patient, in a sensitive manner, if the animal is needed for support. You might also ask to see a letter from a mental health professional confirming the need for an emotional support animal.The CMPA also notes that a physician or staff member’s “subjective discomfort” with certain types of animals may not be a valid reason for barring a patient or the therapy animal from entering the clinic, or restricting access to services.“If you decline to see a patient with what they consider to be an emotional support animal, the patient may feel discriminated against on the basis of what they believe to be a disability, and could commence a college complaint, lawsuit, or human rights complaint,” the CMPA stated.Read: Human connections: 'Friendly Calls' program reaches out to lonely, isolated CanadiansPatient requests for therapy animal lettersOnly physicians qualified to recommend a therapy animal should make such a recommendation, said the CMPA, and any endorsement of a specific animal by breed or name should be avoided. On the other hand, even when a doctor is unsure about the need for a therapy animal, there is at minimum an obligation to provide patients with information about their medical condition.“You should at the very least agree to provide a treating physician’s letter, which would be a description of the patient’s medical concerns and treatment,” wrote the CMPA.In British Columbia, the medical form for confirming the need for a guide or service dog reminds doctors and nurse practitioners to consider the burden of care that patients take on when they get a guide or service dog. “It should be noted that, although a guide or service dog can assist a disabled person with independent living, having a guide or service dog will also place a burden on the patient,” reads the form guidelines. “Caring for a guide or service dog can also have a detrimental impact both on the health and wellbeing of the patient and/or the guide or service dog.”The guidelines also clarify that a guide or service dog is not a therapy dog taken by its owner on visits to people in institutions or in their homes, or an emotional support dog that provides comfort and companionship to the dog owner.“In neither case does the dog owner require a dog to assist him/her with day-to-day activities and to be present in all or most situations in order to lead as full and independent a life as possible.”Read: What does a psychiatrist do all day?

Should you let that support peacock into your clinic? And other things to consider with therapy animals

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