Should Physicians Approve Emotional-Support Animals for Air Travel?

Keith L. Martin


November 05, 2018

Emotional-Support Animals: Necessary or Nuisance?

Dogs, cats, and even birds are becoming a more common sight in the nation's airports due to an increase in the use of emotional-support animals (ESAs).

A recent article on Medscape stirred some debate in the comments section among physicians regarding the necessity of these animals. While many supported the use of legitimate service or therapy animals, whose owners say they rely on them for emotional or psychiatric support, other readers were more skeptical. Some cited questionable Internet-based certification allowing pets to accompany their owners on planes, calling it an abuse of the system.

Many commenters noted that they've had patients request a signed document, often required by airlines, to permit their support animal to board a plane with them (often free of charge). And many said they declined the request after discussion with their patients.

Doctors' Discretion Varies

From their perspective, some physicians questioned the need for ESAs—or at least long-distance travel—in the first place.

Said one anesthesiologist:

Could we please stop contributing to the insanity of some of our patients? If it's too stressful to fly, then stay home. I sure as hell do not want to be sitting next to somebody's peacock on a flight. What an unprofessional cop out to acquiesce to these people's demands.

Other physicians took the responsibility of granting permission seriously and didn't like to see peers abuse that privilege just to make their patients happy. Said one internist:

I see no reason for a person taking an animal for "emotional support." Most travels are not absolutely essential barring medical need or change of jobs. If travel is so "stressful," one should not travel. Conversely, consider the other passengers. I travel long distances often. I would not like to sit next to an animal for 16 hours in an airplane.

Many physicians, including several mental health professionals, relayed stories from their own exam rooms about being confronted with requests to certify their animals for travel.

As a psychologist, I have been asked to certify the need for "emotional support animals." I always refuse. My rationale is that if the patient believes they need such, the patient has not engaged completely and vigorously enough in other validated treatments to overcome their anxiety, depression, PTSD or whatever condition. I encourage them to redouble their efforts in effective treatment rather than become 'dependent' on critters.

A psychiatrist had a patient who received an approval letter for a service dog from another psychiatrist but then used that letter for her pet Chihuahua—not the animal noted in the letter. So if you do consent to providing such a letter for a patient, peers recommend being specific about the identity of the animal.

One nurse specialist said she has written ESA letters in the past and is not closed to the idea, but she needs to assess patients prior to giving any such permission.

Recently I had a former patient come to my office and request a letter for an ESA, as she wanted to buy a dog and bring it into her new apartment. I hadn't treated her in 3 years and she was a minor at that time. Previously, there were "family issues" and I'm not sure she would truly qualify as having a current persisting mental health disorder. ...I refused this time because I had no knowledge of her current health status and she was unwilling to "re-enroll" at my clinic, even for a brief visit, to allow me to reassess her condition.


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