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Enrolling in animal-assisted therapy programmes
  1. Simon Coghlan

Abstract

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.

In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month’s dilemma, ‘Enrolling in animal-assisted therapy programmes’, was submitted and is discussed by Simon Coghlan. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.

The series is being coordinated by Steven McCulloch, senior lecturer in human animal studies at the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.

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Simon Coghlan is a veterinarian and has a PhD in philosophy. He currently works in the School of Computing and Information Systems at the University of Melbourne, Australia. He writes on veterinary ethics, animal ethics and applied ethics.

Enrolling in animal-assisted therapy programmes

A long-standing client wishes to enrol her dog in an animal-assisted therapy (AAT) programme for children with autism spectrum disorder. The AAT psychologist has requested a veterinary assessment before the dog (Imogen) takes part in the programme. Imogen is a very calm, well-trained 18-month-old Labrador. She has recently been diagnosed with unilateral elbow dysplasia. Her owner reports that Imogen dislikes having her nails trimmed. Given this, you wonder if you have an ethical responsibility to recommend against the dog entering AAT. However, your client is very upbeat. ‘Imogen loves children and will be a wonderful help to them,’ she enthuses. What should you do?

Issues to consider

Animal-assisted therapy (AAT) is becoming increasingly popular, with dogs and horses being most commonly used. AAT is a goal-oriented, structured intervention aimed at providing therapeutic benefits for people (IAHAIO 2014). AAT may be deployed by professionals, such as speech therapists, physiotherapists, social workers and psychologists.

Evidence that AAT benefits people is mixed (Fine 2015), and more rigorous scientific research is required to solidly establish AAT as a treatment option. Nevertheless, research suggests that AAT may produce physical, mental and social benefits. For example, AAT may encourage social interaction and reduce anxiety in children with autism spectrum disorder (ASD) (O’Haire 2013).

Any thoughts?

Readers with views to contribute on ‘Enrolling in animal-assisted therapy programmes’ should e-mail them to vet.inpractice@bmj.com so that they can be considered for publication in the next issue. The deadline for receipt of comments is April 15, 2019. Please limit contributions to 200 words.

AAT personnel include human health professionals and animal owners or ‘handlers’. These personnel have responsibilities to the welfare of both animals and human patients (Ng and others 2015). Animals must be carefully selected and their temperament checked before they are enrolled in a programme. Some authors recommend that dogs should be at least one to two years old before they are selected for AAT (Writing Panel of Working Group and others 2008). Animals with aggression or anxiety disorders clearly pose a risk to healthcare staff and patients. Animals with zoonotic diseases pose a risk too, especially to debilitated or immunocompromised human patients (Writing Panel of Working Group and others 2008).

Possible way forward

Veterinarians have ethical responsibilities towards animals put forward for AAT. Veterinarians may be regarded as strong animal advocates who have primary loyalty to their patients (Coghlan 2018). If an unwell, very old, immature or anxious animal will likely be harmed by AAT, veterinarians should advise against their entry into these programmes. Animals who simply do not enjoy the experience should not be forced to participate, even when AAT practitioners and clients enthusiastically push for it.

Veterinarians also have responsibilities to human healthcare workers and their patients. Animals should be up-to-date with vaccinations, have comprehensive parasite control and be free of zoonotic disease. Suitable temperaments and adequate training of animals for AAT is essential.

Children can behave unpredictably. Here, Imogen’s friendly personality is an asset. However, legitimate questions arise over her elbow dysplasia and her dislike of nail clipping. Painful conditions can make calm animals less tolerant. A risk of ‘out-of-character’ aggression is heightened if Imogen is already nervous when her feet or legs are touched. On the other hand, Imogen’s dislike of nail clipping may not represent genuine anxiety. Furthermore, the elbow condition may, if it is mild, not be painful. Perhaps suitable interventions will reduce any risk of soreness. Of course, elbow dysplasia causes progressive joint problems that may render Imogen unsuitable for AAT.

With these factors in mind, the veterinarian should perform a thorough medical and behavioural assessment of the dog, including careful testing for soreness and anxiety when her legs and feet are manipulated. If the veterinarian lacks expertise or is unsure, a referral to a specialist animal behaviourist is advisable. It may be upsetting to Imogen’s owner if she proves unsuitable for AAT. However, the dog’s welfare, and the welfare of the healthcare staff and the children with ASD are more important.

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