A service animal is individually trained to assist a person in relation to a disability. For example, the animal could be trained to alert a diabetic person about low blood sugar levels; protect a person suffering from epilepsy during a seizure; or calm a person on the autistic spectrum.
A guide dog is a type of service animal, and refers to a dog that is trained as a guide for a person with visual impairment.
An emotional support animal provides emotional support to individuals with a mental health condition. They are generally not trained to perform specific tasks in relation to a disability, but their presence provides comfort and emotional support.
Legislation generally requires that individuals accompanied by service animals (including guide dogs) be provided access to any place to which the public is admitted. Emotional support animals do not necessarily benefit from the same legislative protection. However, 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.
If a patient presents with an emotional support animal that is not a service animal or guide dog, do I need to let the patient attend with their animal?
If a patient presents at your clinic with an emotional support animal, they probably consider themselves to have a disability requiring the assistance of the animal. In this situation, you should consider doing your best to accommodate the patient up to the point of undue hardship.
Accommodating a person with an emotional support animal may require offering a virtual appointment or an end of day appointment. 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.
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.
However, it is the responsibility of the patient to maintain control of their animal at all times. If the emotional support animal displays behaviours that are aggressive, damaging to property, or disruptive to others, the animal and patient may be asked to leave.
Undue hardship and specific animals
Physicians may feel discomfort with certain types of animals, or certain large breeds of dogs. Whether the threshold for undue hardship is met will depend on the specific circumstances of each case. For example, undue hardship may be found if the animal poses a substantial risk of harm to others based on a reasonable assessment. On the other hand, a physician or staff member’s subjective discomfort with certain types of animals may not be a valid reason to restrict access or services to a person with an emotional support animal.
Can I ask to see a letter from a mental health professional supporting the patient’s use of an emotional support animal, especially if the animal just seems like a pet?
If you are wondering whether an animal is an emotional support animal, you might consider sensitively asking the patient whether the animal is needed for support. You may also ask to see a letter from a mental health professional.
However, even if there is no letter supporting the animal’s use, you should generally do your best to accommodate the patient and let them attend with their animal.
Do I have to provide a letter in support of a patient using an emotional support animal?
Physicians have an obligation to provide patients with information about their medical condition. If a patient asks you for a letter supporting their use of an emotional support animal, 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.
In your letter, you should avoid endorsing any specific animal by breed or name. It is also important that you practise within your scope, and avoid making recommendations you do not have the necessary skills and judgment to make.
For example, you should not recommend that the patient have an emotional support animal with them unless you are qualified to make that recommendation. It is sufficient to say that the patient believes the emotional support animal to be helpful to them or you believe the animal provides a general benefit to the patient.
Be sure to discuss with your patient the amount of personal health information they are comfortable including in the letter, which may be as general or detailed as the patient wishes it to be. More information about writing these sorts of letters can be found in Writing with care.