Topics in Stroke Rehabilitation

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Ethical Issues with Service Animals

Nora Wenthold & Teresa A. Savage

To cite this article: Nora Wenthold & Teresa A. Savage (2007) Ethical Issues with Service
Animals, Topics in Stroke Rehabilitation, 14:2, 68-74, DOI: 10.1310/tsr1402-68

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 Ethics in Practice
Kristi L. Kirschner, MD, Editor

Ethical Issues with Service Animals

Nora Wenthold and Teresa A. Savage

The beneficial aspects of canines who provide services to people with disabilities have resulted in an explosion of a category
of dogs that are bred and/or trained just for service purposes. Over the past 30 years, the role of most service dogs has
become more prominent and more demanding. There are also concerns as to the well-being of these animals and questions
regarding realistic expectations of them. The purpose of this article is to explore the utilization of service dogs in a
rehabilitation health care setting. More specifically, ethical issues that are pertinent to the service dogs role will be identified
and resolutions recommended. Key words: ethics, service animals, service dogs
Downloaded by [University of California, San Diego] at 13:56 29 June 2016

H
umans have used animals since the
beginning of timefor food, clothing,
and shelter, as beasts of burden and
transportation, for amusement, for medical
experimentation, and for companionship.
Although their moral status is debated and some
philosophers advocate for elevating nonhuman
animals to a higher moral status than they
currently occupy, animals are treated as
property.1,2 The role of service animal touches on a
mutual need of both humans and animals,
especially dogs, and that is the need for
companionship. Although there are tasks and
duties required of the service animal in
rehabilitation health care, the service animal
brings an acceptance and devotion to their human
partners that can surpass a species difference. The
bond is as strong as a family bond. Service animals
display behaviors often interpreted as caring and
loving, but it must be remembered that they are
not there by their own volition; they are trained
and carefully monitored for any deviations from
their trained behavior. They are subject to stresses
in their environment and can be harmed or can
harm others if not properly managed and cared
for. This article will address the ethical issues with
service animals.
dogs in the United States.3 A rough estimate is that
there are 17,000 assistance dogs currently working
in the United States.4 It is unknown when a dog
was used the first time to assist someone with a
disability. However, there is evidence such as
records of dogs being kept at healing temples in
ancient Greece or an illustration on a wooden
plaque from medieval times depicting a dog on a
leash leading a blind man to suggest that we are
simply rediscovering an ancient practice in our use
of dogs in rehabilitation. However, more recent
records can be found at Les Quinze-Bingts, a Paris
hospital for the blind, that has dated records from
1780 describing systematic attempts to train dogs
to aid blind people. From 1788, there are records
of a blind sieve-maker from Vienna who trained
his spitz (a breed of dog like the husky, malamute,
or chow chow) so well that many doubted his
disability. A couple decades later, the founder of
Nora Wenthold, is Research Administrator, Rehabilitation
Institute of Chicago; and Certified Canine Facilitator, Canine
Companions for Independence, Chicago, Illinois.
Teresa A. Savage, PhD, RN, is Associate Director, Donnelley
Family Disability Ethics Program, Rehabilitation Institute of
Chicago; and Adjunct Assistant Professor, Physical Medicine and
Rehabilitation, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois.

History Top Stroke Rehabil 2007;14(2):6874

2007 Thomas Land Publishers, Inc.
According to the Humane Society of the United www.thomasland.com

States, there are approximately 66 million owned doi: 10.1310/tsr1402-68

68

the Institute for the Education for the Blind in
Vienna, Johann Wilhelm Klein, published a book
that described his methods on training guide dogs
for people with blindness. Unfortunately, there is
no evidence of his ideas being realized.
The modern history of the assistance-dog move-
ment began in 1929, with the first guide dog
school, The Seeing Eye. This school was inspired
by a partnership created between Dorothy
Harrison Eustis and Morris Frank. While living in
Switzerland, Ms. Eustis observed trained dogs
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guiding blind veterans. This inspired Ms. Eustis to
write an article for the Saturday Evening Post de-
scribing what she had witnessed and offering to
work with an interested blind American. Morris
Frank, a young blind man living in Nashville,
wrote to Ms. Eustis asking her to train a dog for
him and, in return, he would teach others who
were blind so that they too could become indepen-
dent. Morris Frank became the first American to
use a dog guide, and Buddy, a female German
shepherd, became the pioneer dog guide in
America. Morris Frank returned home to Nashville
and honored his promise. With $10,000 from Ms.
Eustis, he worked to establish the first dog guide
school in America.
In contrast to the population of people with
visual impairments, Americans with physical dis-
abilities and members of the deaf community have
had about 30 years of working with service and
hearing dogs in a formalized setting. In the mid-
1970s, Bonnie Bergin pioneered the service dog
movement and founded Canine Companions for
Independence. Agnes McGrath, her contempo-
rary, also pioneered a program to train dogs to
assist the hearing impaired and inspired the devel-
opment of a number of hearing impaired dog
training centers.
Assistant Animal Terminology
Although the Americans with Disabilities Act
(ADA) defines a service animal, there are many
terms for assistant animals. There are three major
categories: service animals, therapy animals, and
companion animals. The ADA defines a service
animal as any animal that has been individually
trained to perform tasks for people with disabili-
Ethical Issues with Service Animals 69
ties such as guiding people who are blind, alerting
people who are deaf, pulling wheelchairs, alerting
and protecting a person who is having a seizure, or
performing other special tasks.5 This article will
focus primarily on the service group. Therapy ani-
mals are animals that are used in the course of
improving a persons quality of life or in helping
the person achieve some therapeutic goal. The
Delta Society describes the use of therapy animals
in animal-assisted activities, which are opportuni-
ties for motivational, educational, recreational,
and/or therapeutic benefits to enhance a persons
quality of life.6 Animal-assisted therapy is goal di-
rected in which the animal meeting specific criteria
is an integral part of the treatment process.6 Com-
panion animal is another term for a pet, and this
animal is usually owned by the person.
Service animals are primarily dogs, so the term
service dog will be used. Sometimes service dogs
are also called assistance dogs. In one particular
organization, Paws With a Cause, dogs are rescued
from animal shelters, rigorously evaluated for
physical attributes and temperament consistent
with the duties of a service animal, and then un-
dergo extensive training. The cost of preparing and
placing a service or hearing dog with a client ex-
ceeds $18,000.6 The agency will acquire and train
the dog to suit the needs of a particular client. A
client must be over 14 to get a service dog and over
18 to get a hearing dog.
Hearing dogs are trained to bring their owner (the
client) to the source of a noise, such as a ringing
doorbell, phone, or smoke alarm. Guide dogs, often
bred for the purposes of being service animals, assist
persons with blindness to navigate in their home
and community.7 Service dogs perform multiple
tasks, such as opening doors, retrieving dropped
objects, or turning switches off/on.
There have been studies demonstrating the use-
fulness of service dogsthe positive economic im-
pact and the positive psychosocial aspects, both to
adults and children with disabilities, in using ser-
vice dogs.811 Little has been written on the ethical
issues with service animals. Managing expecta-
tions and the workload of the service dog, attend-
ing to the physical and psychological needs of the
dog, and anticipating separation through retire-
ment or death are all ethical issues to be addressed
 70 TOPICS IN STROKE REHABILITATION/MAR-APR 2007
in this article. Before tackling the ethical issues,
certain terminology needs explanation. There are
many humans involved with a single service ani-
mal. There is the owner of the animal, the leader or
handler, the human partner, and patients. Many
service animals are trained and owned by an
agency that provides the dog to an institution,
such as a rehabilitation hospital, through a con-
tractual arrangement. One or two people who un-
dergo special training are designated as the service
dogs facilitators. The service dog lives with them,
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is brought to work by them, and they are respon-
sible for the dogs well-being. The facilitators also
act as the service dogs advocate and are pivotal in
facilitating communication between the agency
that owns the dog, the dog handlers, and the insti-
tution where the dog works. Facilitators may or
may not be directly involved in the service dogs
daily work activities, such as working with the dog
during a therapy session, but they are available to
the dog or dogs handlers during the day and
communicate with dog handlers daily to address
pertinent issues. Facilitators provide the constant
behind-the-scenes care, so the service dog is
physically and psychologically ready for work.
There are other humans, therapists or other clini-
cians, who also undergo special training to work
with the dog during the day. These are the service
dogs handlers. There is oversight of the dogs well-
being by the agency owning the service dog. The
owner of a service dog assumes ultimate responsi-
bility for the dog. This is done by setting standard
guidelines regarding care of the dog that the insti-
tute has agreed to uphold, such as the frequency of
veterinary visits, the types of toys that the service
dog can have, and the equipment that the dog is
allowed to wear. This information is communi-
cated to the service dogs owners through site vis-
its, completion of annual progress reports, submis-
sion of medical records, and correspondence with
the facilitators.
Guide dogs for people who are blind or hearing
dogs for people with hearing impairment may be
owned by the person with the disability or a ser-
vice animal agency. Service dogs working in facili-
ties are typically owned by an agency, live with one
or two facilitators, and are led by a variety of
trained handlers. Inconsistency between humans
interacting with the service dog can be a source of
ethical problems.
Ethical Issues
The primary ethical issue with service animals is
the tension between using the dog to achieve pa-
tient or client goals (beneficence) and monitoring
the welfare of the dog (nonmaleficence). As an
animal, the dog does not have autonomy to choose
to be a service animal, but the dogs temperament
and response to situations belie the dogs choice.
Clarity about who is representing and advocating
for the dogs interests is also at issue.
Managing expectations and the workload
The role for a service dog in a health care setting
is usually defined by patients needs within the
health care institution. This may include game
playing, visiting, walking, or grooming activities.
Typically, the service dog is asked to participate in
activities that he/she enjoys. A select group of han-
dlers, people within an institution who are spe-
cially trained to work with a specific service animal
within specific guidelines, are the only ones who
should direct the service dogs activities. Dogs, like
most pack animals, rely on consistency and trust to
complete requests made by people. The irregular
dynamics of a health care environment can make a
seemingly easy request a challenge for the dog. A
service dogs performance is strongly impacted by
an overstimulating health care environment, so to
be successful it is vital that the service dog has
complete confidence in his or her dog handler or is
known to the dog as the leader. It is critical to have
consistency in the people trained to handle the
service dog and in the behaviors and signals used
to communicate with the dog. Mixed messages,
new untrained people, and general confusion can
be very stressful for the dog and result in unreli-
able responses from the dog. The facilitators and
handlers must communicate with each other so
they know what can be expected from the dog,
how to lead and respond to the dog, how to assess
the dog for signs of stress, and how to manage the
dogs stress.
One of the reasons that dogs have always

worked so well with people is that both humans
and dogs share a common fundamental need of
companionship. However, the companionship that
service dogs receive when they are off-duty is
vastly different from the companionship they re-
ceive while working. Both types of companion-
ship are important to the dog as most service dogs
are selected from working breeds that enjoy engag-
ing in task-related duties. However, clear communi-
cation is required by the facilitator or handler to
ensure the dog reacts appropriately in a given situa-
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tion. An example of this is how service dogs are
trained to greet people in different ways to accom-
modate various settings. People are always in-
structed to ask a dog handler if they may pet the dog
or many people will ask the question, Is your dog
off duty? If the dogs facilitator or handler is able to
comply, they may look at the dog and give a com-
mand such as release or play and at that point
the dog will stand from the seated position to greet
the individual in a similar way that a dog may greet
someone walking through the front door. Usually,
this greeting includes a wagging tail, kisses, and
maybe a small run. A much different reaction is seen
from a service dog when the dog is working and the
dog handler asks the dog to visit or greet a
patient. When the dog is working, the dog will walk
up quietly to a patient, gently rest his/her head on a
patients lap, and wait to receive a pet.
It is crucial that all demands made of a service
dog are considered reasonable and appropriate.
Failure to do so can result in injury to the dog or to
people near the dog. For example, even though a
service dog working in a health care setting may be
physically able to and enjoy pulling people in a
wheelchair, it may not always be appropriate. The
tile floors can cause the dog and wheelchair to gain
speed quickly and newly waxed floors can prove to
be slippery, which can lead to accidents. There are
service dogs that pull their human companions in
wheelchairs. Typically, these dogs have been
trained and conditioned for this specific task and
wear proper equipment such as a harness to ac-
complish this task safely. Most important, these
dogs have developed a long-term relationship and
trust with the individual using the wheelchair.
Other tasks may be physically appropriate for a
service dog but may cause psychological stress.
Ethical Issues with Service Animals 71
The best way to eliminate psychological stress on a
service dog is to provide consistent leadership.
Because service dogs are expected to ignore spe-
cific survival instincts such their flight-or-fight
response, trust in their facilitators and handlers is
crucial. Most service dogs only have one or two
people that they look to for leadership, and most
service dogs have only one home with one set of
family dynamics to interpret. However, service
dogs working in large facilities may have as many
as seven leaders at any given time. In addition,
they may live in multiple homes, which require
them to adapt to various family dynamics. How
can a service dog adapt to this lifestyle successfully
and fulfill countless requests from dozens of indi-
viduals daily?
The key is consistent leadership. All individuals
who handle the service dog must be trained, certi-
fied, and have adequate bonding time with the
dog. The training and certification process edu-
cates the facilitators and handlers on the dogs
basic physical and psychological needs. Facilita-
tors and handlers also learn the meaning of all the
commands and how to help the service dog to be
successful. They learn to interpret the dogs body
language and how to lead the dog during situa-
tions of unpredictability. All of the facilitators and
handlers for the same dog need to work together to
mimic each others behavior. The more similar the
leaders interactions and expectations, the easier
the requested tasks are for the dog to understand
and perform.
The most important requirement that each facili-
tator or handler must undergo is to spend bonding
time with the service dog. This can be done through
the practice of commands, grooming, and spending
time off-duty together. This helps to build trust
between a facilitator or handler and a service dog. If
a service dog does not trust his or her facilitator/
handler, then it is a set-up for disaster; it will cause
psychological stress in the dog, which may lead to
injury of the dog or a person.
Addressing the physical and psychological needs of
the dog
Whether a service dog works in a large or small
facility, there always needs to be coordination be-
 72 TOPICS IN STROKE REHABILITATION/MAR-APR 2007
tween units and staff to ensure that a dog is not
overtaxed. This can be done by setting a schedule
for the dog allowing for ample times for breaks
between activities and recognizing what a dog
would consider a break as opposed to what a
person considers a break. For example, being told
to sit in a corner of a room while a therapist
finishes working with a patient is not a break to a
dog as the dog is still on command and watching
his or her leader for the next command. However,
having a dog go into a crate for 15 to 30 minutes in
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a quiet office gives the dog a clear signal that they
are not being expected to respond to commands at
the moment and can relax.
In addition to short breaks between tasks at
work, service dogs also need breaks on a larger
scale. This may include weekend hikes or long
walks or breaks from being on a leash. Many ser-
vice dogs spend a lot of their time active on a leash
and following commands; even though they enjoy
their work and love being around people, all dogs
benefit from time off leash and interacting with
other dogs. Some service dogs may not be able to
fully enjoy this with some of their facilitators or
handlers they work with in the health care setting
as they are always waiting for the next command.
However, these dogs seem to do fine if taken to a
dog park with other dogs by a family member of a
facilitator or handler. Any facilitator or handler can
help his or her service dog enjoy relaxation time in
his or her presence by participating in off-duty
activities, such as taking their service dog to a dog
park, on a consistent basis. However, it is impor-
tant for a facilitator or handler to practice work
commands before they reenter the work environ-
ment. This provides the service dog with a clear
signal that it is time to be on-duty and to wait for
the next command.
The most important element to remember when
working with a service dog is that they are in fact
dogs. It sounds silly, but because these dogs per-
form on a consistent basis and are so well trained it
is easy to forget that they can be inconsistent. It is a
leaders role to try and interpret the cause of the
inconsistency and act appropriately. For example,
if a service dog is shying away from a patient who
is trying to pet behind the dogs ear, then the
leader needs to recognize that behavior and re-
quest that the patient refrain from petting the dog
behind the ear. Next the leader needs to determine
what has caused the dogs resistance. This is usu-
ally done by noting the dogs reaction and discuss-
ing it with other leaders for the dog. Then it is
determined if the problem is physical or psycho-
logical. A veterinarian can treat a physical prob-
lem, such as an ear infection, and the service dog
will refrain from working until the infection is
gone. However, the problem may be psychologi-
cal, such as the previous day a patient grabbed the
dogs ear too tightly while petting and now the dog
has developed a negative association with having
his or her ears petted. This type of problem takes
more time to work through as the facilitators and
handlers will need to help the service dog develop
more positive associations to having his or her ears
petted. The facilitators and handlers will need to
spend extra time to bond with the dog to reassure
him or her that no discomfort will come to the dog
while the facilitators and handlers are present. In
addition, the facilitators and handlers will advise
all patients and staff to refrain from petting the
dogs ears until the service dog is comfortable hav-
ing his or her ears petted by strangers.
Physical and mental capabilities of a service dog
are decided by the dogs owners, facilitators, han-
dlers, and veterinarians. Sometimes these deci-
sions are made collectively as a group and some-
times they are individual judgments made as a
result of a particular situation. This is why it is so
important for each person who handles a service
dog in a health care setting to be trained and
maintain a certain level of expertise. The popular-
ity of service animals can mean that any given
facility may have a number of service animals at
any given time. Occasionally, there are some dogs
that do not do well around other animals. An
important qualification of being a facilitator or
handler of a service dog is to know how to lead
dogs in an emergency situation, such as if another
animal provokes them or is threatening to the
facilitator or handler. A qualified facilitator or han-
dler is required to direct the service animal
through situations such as these to ensure safety is
maintained.
It is ideal for a facilitator or handler to recognize
and provide the service dog with a break before

common stress signs are apparent. However, if a
facilitator or handler notices panting, shedding, or
hesitation, it is a sign that the service dog is experi-
encing stress and needs a break. This may necessi-
tate shortening a session with a patient or moving
up the dogs break time. Usually, the service dog
will be ready to work again after a 30-minute break
that allows for water and a nap in the dogs crate.
A service dog that displays signs of chronic
stress such as digestive problems, lack of enthusi-
asm, or fearfulness/aggression requires more than
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a 30-minute break. These are signs that something
is clearly not working, and a lifestyle change may
be required. For a service dog working in a health
care facility, chronic stress signs are most likely
symptoms caused by a lack of consistency in the
dogs lifestyle. Dogs rely on habits, and service
dogs rely on the habits of their facilitator or han-
dler to ensure their comfort level. Therefore, a
change in the leaders behavior or a 2-week ab-
sence from a dogs facilitator or handler can be
stress triggers. Stress can also be a sign that the way
a facilitator or handler is acting in a situation needs
to be changed. An example of the latter occurs
frequently when a service dog hesitates. When the
dog hesitates, the facilitator or handler will stop
walking and face the service dog as if to ask the dog
what is wrong. These actions indicate to the service
dog that the facilitator or handler is relinquishing
the leadership role and this encourages the dogs
hesitation further. In a situation like this, the lead-
ership style needs to be altered. The facilitator or
handler needs to first identify if there are any
obvious reasons for the dogs hesitation, then he or
she needs to demonstrate leadership body lan-
guage and redirect the service dogs focus through
treats or additional commands to curb the service
dogs hesitation. If these stress signs are not recog-
nized or not properly managed, a service dog may
experience chronic stress.
Since service dogs in health care facilities are
accustomed to receiving lots of attention, some-
times the lack of attention from an absent leader
can cause significant stress. Again, communication
between leaders is vital to predict and recognize
when a service dog is exhibiting stress signs. The
other leaders may need to provide more attention
to the service dog or adjust the dogs work sched-
Ethical Issues with Service Animals 73
ule to ensure the dogs well-being and prevent the
dog from experiencing unnecessary stress.
Facility service dogs are selected specifically be-
cause they have a high desire to interact with
people. Therefore, many of these dogs are strongly
impacted by separation from the facilitators or
handlers. Being left alone in a dog crate at work for
an afternoon can be just as stressful working all
afternoon without a break. Therefore, scheduling
the duration of break time is just as important as
work time. During times when facilities are short
staffed, such as over the holidays, it seems to be
less stressful for a service dog to stay home in an
off-duty mode than to come to work and sit alone
for an extended period.
Anticipating separation through retirement or
death
Each agency that owns service dogs has different
parameters that address when a dog is ready for
retirement. Most service dogs are from work
breeds such as German shepherd, Labrador re-
triever, or golden retriever, which have life expect-
ancies of 1213 years.12 Many of these agencies
predict a 610 year work life for the dog and the
majority of service dogs enter the work force
around 2 years of age, so they are expected to work
until the ages of 812 years. The number of years
that a service dog is able to work is directly related
to the physical and psychological well-being of the
service dog. Physical aliments such as arthritis, hip
dysplasia, and cataracts and psychological ail-
ments in the form of gastrointestinal problems,
hesitation, or fearfulness behavior can all contrib-
ute to an earlier retirement.
The agency that owns the service dog makes the
final decision of when a service dog is ready to
retire. This decision is based on veterinarian medi-
cal reports, annual reports submitted by facilita-
tors and handlers, and site visits. The agency also
decides the disposition of the dog when the dog
retires. Recognizing that consistency is of vital im-
portance in any dogs life, especially in a service
dogs life, the facilitator has the first option to keep
the retired service dog. Multiple handlers or facili-
tators may make this situation difficult, but the
agency has final say as to who keeps the dog. If the
 74 TOPICS IN STROKE REHABILITATION/MAR-APR 2007
facilitator is unable to take the dog, the dog is
typically returned to the agency and an appropri-
ate home for the dogs retirement is found. Usually
the individual who raised the dog as a puppy has
first option, and most of these agencies have long
waiting lists for retired service dogs. If for some
reason a home cannot be found, the dog is guaran-
teed a home at the agency.
When a loss occurs in the life of a service dog, a
facilitator, a handler, a frequently seen patient, or
another animal that lives with the service dog, the
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dog may exhibit signs of grief in the form of de-
pression or withdrawal. As with humans, time and
understanding may help the dog through this
grieving process.13 During this time, it is important
for a service dog to feel secure and successful. This
can be done by giving a dog easy commands and
adequate praise before having the dog complete
more complex commands. It is also always impor-
tant to make commands and work fun from the
dogs perspective. The more fun there is in a ser-
vice dog and facilitator/handler partnership, the
greater the potential for success. The effect of the
death of the service animal should not be mini-
mized. Often the service dog is thought of as a
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