Animal instincts: Service animals vs. emotional support animals in the practice

What would you do if a patient arrived for an appointment at your optometric practice with a service animal? What if the animal is there for emotional support?

Your answer may depend on appreciating the difference legally between the two. In a new case study on the Ethics Forum, the AOA Ethics and Values Committee (EVC) addresses those questions and urges doctors of optometry to put some bite into their practice policies.

The Ethics Forum provides an opportunity to review a hypothetical case study containing potential ethical challenges and includes suggestions on how one might handle the situation based on the AOA Standards of Professional Conduct and Code of Ethics.

"By establishing office policies for service and emotional support animals and training staff, doctor's offices diminish the risk for ethical concerns or legal consequences," the authors of the new case study write.

"If the situation encountered in an optometrist's office is not handled effectively, there may be hard feelings, bitterness, ill will or emotional anguish," the authors add. "Taking active steps to address this subject serves to remind doctors of the commitment to the human aspects of care that often bring meaning to the practice of optometry."

Considerations: legal, clinical and ethical

Public accommodation of people with animals has become a hot topic. In June 2019, for instance, The New York Times reported that Americans were increasingly leaning on emotional support animals, from dogs to ducks, resulting in legal frays and state legislative action. And in August 2019, the Department of Transportation waded into the subject, setting enforcement priorities regarding service animals on planes.

Doctors of optometry should know where they stand, says Hilary Hawthorne, O.D., a member of the EVC who co-authored the case study. Among subjects covered in the case study are the definition of a service animal, the tasks they are trained to perform and how they are viewed as a medical resource, which means they are protected by federal law.

Further, the case study covers therapy animals and emotional support animals, which are not considered service animals under the Americans with Disabilities Act.

"As doctors of optometry, we really need to educate ourselves," Dr. Hawthorne says. "There's a proper way and an improper way to view the legal issue. But we have to look at it from all sides. We're providing this as a case study. Ultimately, the decision to allow animals other than service animals belongs to the practitioner."

Says co-author Audrey Seaton-Bacon, Ph.D.: "As a clinical psychologist, I have come to appreciate the supportive role that animals can play in the therapeutic process. Service providers must understand that there are indeed individuals with real and varied conditions that are assisted, mitigated or alleviated through a service, ESA or therapy animal. However, due to the potential for abuse, providers must educate themselves about the applicable laws and begin to formulate a plan of action should the issue present itself."

Have ethical questions?

If you have any questions on ethics, please submit them to EthicsQuestion@aoa.org. The AOA Ethics and Values Committee will respond to your questions as soon as possible.

If you have an ethical challenge you wish to share, please submit a case description to ethics@aoa.org. The case description will be reviewed by the AOA Ethics and Values Committee and may be featured in a future Ethics Forum.