Comfort At The Crossroads: Service, Therapy and Emotional Support Animals In The ICU And At The End-of-Life

AbstractThe US has witnessed a vast increase in animals in therapeutic roles. These roles include Service as defined by the American Disabilities Act (ADA) as well as other animal types that are not covered under the ADA provisions. Such animal roles are designated as Therapy animals and Emotional Support animals (ESA). Understanding the legal and regulatory requirements that govern how each animal type accesses healthcare facilities is essential in planning for their presence. Since only Service animals are required to be given access to facilities, individual institutions must plan for how to accommodate their presence throughout different phases of care. Additionally, plans to incorporate Therapy animals, if so desired, should be articulated including requirements for training, health and certification prior to patient space access. ESA are not required to be granted facility access but are increasingly prevalent in public spaces and should drive healthcare facility policy generation to address allowing or prohibiting access. Finally, anticipated conflict between individual rights that cross along animal presence lines should be anticipated and proactively addressed instead of responding to conflict only after it has arisen.Study TypeReviewLevel of EvidenceN/A The US has witnessed a vast increase in animals in therapeutic roles. These roles include Service as defined by the American Disabilities Act (ADA) as well as other animal types that are not covered under the ADA provisions. Such animal roles are designated as Therapy animals and Emotional Support animals (ESA). Understanding the legal and regulatory requirements that govern how each animal type accesses healthcare facilities is essential in planning for their presence. Since only Service animals are required to be given access to facilities, individual institutions must plan for how to accommodate their presence throughout different phases of care. Additionally, plans to incorporate Therapy animals, if so desired, should be articulated including requirements for training, health and certification prior to patient space access. ESA are not required to be granted facility access but are increasingly prevalent in public spaces and should drive healthcare facility policy generation to address allowing or prohibiting access. Finally, anticipated conflict between individual rights that cross along animal presence lines should be anticipated and proactively addressed instead of responding to conflict only after it has arisen. Study Type Review Level of Evidence N/A Address correspondence to: Lewis J. Kaplan, MD, FACS, FCCM, FCCP, Associate Professor of Surgery, Perelman School of Medicine, University of Pennsylvania, Division of Trauma, Surgical Critical Care and Emergency Surgery. Lewis.Kaplan@uphs.upenn.edu; Section Chief, Surgical Critical Care, Corporal Michael J Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104. (215) 823-6042; FAX: (215) 823-4309. Lewis.Kaplan@va.gov Conflict of Interest Disclosures: None for any author Funding: None © 2018 Lippincott Williams & Wilkins, Inc.

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