Animal Assistance in Chronic Illness

Dogs guide humans, hear for humans and assist humans with physical disabilities by pulling, pushing, or picking up items; they sniff out bombs and mines, money, drugs, and missing people; they participate in sports, leisure, and TV; they help humans during times of anxiety, depression, trauma, and PTSD, and keep them safe during seizure and epileptic events. The roles dogs play in human lives are becoming ever more wide-ranging, as Fenella Eason shows in her new book Human–Canine Collaboration in Care: Doing Diabetes. Combining anthrozoology and disability literature with wider human–animal knowledge from sociology, anthropology, geography, philosophy, biology, and psychology, Eason examines “care practices performed by human-canine partnerships to improve ‘personal’ health, welfare, domestic, and social life within the limitations of Type 1 diabetes” (18). In doing so Eason asks “how do chronically ill people engage with medical alert assistance dogs in their self- and other-care behaviours and in their lives?” (3). To answer this question Eason adopts a multispecies ethnographic approach, telling stories by eloquently combining conceptual debates with first-hand observational entry points into the lives of the humans and diabetes alert dogs. Eason draws on relevant posthuman and more-than-human scholars throughout her book to critically discuss key ethical issues involved in the human use of animals since the entwined strands of human–dog symbiotic coexistence are also subject to issues of morality.

Eason makes three key contributions to animal and disability studies. The first is to the concept of care. Through an analysis of human and assistance dog practices Eason expands what care means from its human-centred conceptualization to appreciate how animals play an active role in care practices. This contribution builds towards Eason’s main aim: to explore how chronically ill people and medical alert assistance dogs engage in care behaviours in their lives.

To reconceptualize care, Eason draws on what I call a cautious anthropomorphism of assistance dogs, one that leans on a dogs’ ability to “be like us”. This cautious anthropomorphism relies on a spatial retelling of anthropomorphism, one that sees anthropomorphism expanding the potentiality of human–animal relations outwards. The cautiousness here is about how often anthropomorphism is used and relies on the human partner’s anthropomorphic understanding of their assistance dog. Using cautious anthropomorphism to extend the capacity to care for another, to be a canine characteristic, Eason argues that:

no matter the pleasurable reward gained for correct alerting, no dog will exert him or herself to serve “those in need” unless they care or at least have some concern about others[.] Unless they feel the mutual attraction of a bond and are conscious of their companions’ altered states of being when blood sugar levels drop dangerously low — and that something needs to be done (135).

This relies on the prior relationship between human and assistance dog and the humans’ view of their dogs as caring for and about them. To further extend the notions of care into the realm of doggy­ness, Eason draws on a variety of theoretical concepts, such as interspecies solidarity, and more-than-human readings of empathy and compassion. It is Eason’s understanding and building of Vinciane Despret’s conceptualization of empathy that is important to extending the ability to care beyond human boundedness. Eason argues that sympathy is “intended to offer kindness and perhaps elements of sorrow that someone else has received injury, bereavement, loss of employment, or similar. But this perspective seems to come from above, looking down; it carries faint condescension, separateness, and perhaps a concealed sense of relief that the other is suffering and not oneself” (141–42). Whereas “empathy is an essential quality in the development or improvement of human–human relationships, enabling greater understanding of one another’s hopes, desires and despairs and the ability to reflect this comprehension appropriately and meaningfully by each attempting to ‘walk in the shoes of the other’” (142). For Eason, empathy is more inclusive as an act of mutual recognition, a looking-with, rather than down at. Eason’s negotiations of empathetic engagement and the human–animal relationship as one of mutualism lead to better management of the intricacies and complexities of chronic illness and form the basis for ethical human–animal relations. Conceptually, I think this reframing of care is valuable because it recognizes animals as minded individuals, able not just to care for, but also to care about others. Furthermore, viewing care in this way, through cautious anthropomorphism instead of damaging anthropocentrism, opens the potentialities of sharing worlds with animals. Here, I think broader questions of anthropomorphism versus anthropocentrism, ableism, and speciesism arise. How can understanding animals as caring for and about others challenge ableist and speciesist hierarchies?

Eason’s second key contribution, which draws on the above, is a discussion about the various “doings” of diabetes. Highlighting how the “doing” of diabetes — that is the detection of changing blood sugar levels and injection of insulin — is a surveillant practice requiring constant bodily monitoring,¹ Eason skillfully guides us through Type 1 diabetes as an illness and the effects of its diagnosis on the human. It is where the diabetes alert dogs come into concern, through the human loss of hypo-awareness, that animal studies scholars might find most useful. This is useful because Eason spotlights a key human–animal relationship and the attendant embodied actions that shape this relationship through the “doing” of diabetes. As Eason notes, human participants “are compelled to rely on guesswork and repetitive success or failure of the optional test. In this situation [loss of hypo-awareness], the scenting ability of a hypo-alert assistance dog is influential” (75). The diabetes alert dog provides an accurate sensing ability when the human body becomes normalized to — and unable to detect — the territorialization of hypoglycaemic episodes. The sentient sensing ability of a diabetes alert dog (DAD) is valued as “the DAD will continue to perform an alert regardless of the individual’s mood or language; will provide good practices of care despite argument and tension; and being animate, warm, and friendly, is likely to gain acceptance of the alert and the need to follow it with a blood test, reducing friction and the need to nag” (75). Thus, the diabetes alert dog can make decisions for the care of the human and help facilitate — and reduce the stress in — other human–human relationships. What permeates through this first contribution is the all-consuming nature of living with diabetes: as participant Janet explains, “you just find your mind is always thinking about diabetes” (84). Here I think Eason provides a timely and much-needed critical discussion of human–animal practices, showing the “life-saving” role of diabetes alert dogs.

Furthermore, I believe Eason follows Kendra Coulter and Neil Pemberton in recognizing the importance of agency of animals with jobs, moving beyond the idea that animals are merely aids for human wellbeing.² In my own research I have shown that for assistance dogs who help people with physical disabilities and chronic illness, the agency of assistance dogs is vital in their training and in the care practices for their human partners.³ For Eason (and myself) it is the dogs’ liveliness, their sentience and ability to make decisions that form a crucial part of their role. Eason illustrates examples of canine sentience such as their “urgent nudging to encourage swift testing or the […] physical ‘blocking’ of the stairs to prevent fall and injury” (134). It is thus the diabetes alert dog’s “warm practices of care” (127) that help them become an empowering part of human self-care practices, something that a blood sugar monitor, or in the case of my work with assistance dogs for physical disability, a reacher-grabber, cannot provide. Eason provides a valuable dialogue that can be expanded outwards to question how agency and sentience is understood in relation to all working animals.

Eason’s final key contribution, as I see it, is a challenge to the human–animal relationship through a critical examination of how power, status, and care are all concomitantly developed through human–canine relationships. The unequal status of dogs, as tool, companion, pet, and assistant provide a useful starting point for considering larger ethical discussions about “using” animals as commodities for bettering human lives. In the official terminology, diabetes alert dogs are described as the “equipment” of their human companions. Eason shows how this instrumental logic is both confirmed and troubled by disabled humans, who value the “warm” nature of assistance dogs. Eason notes, “being a device or property belonging to another for health benefit can, as in this case, ensure a high standard of care and affection” (47). In this sense, Eason outlines that the ascribed identity given to assistance dogs as a “tool” or “aid” can lead to better welfare practices for the assistance dog. However, Eason makes an interesting challenge to the conceptualization of assistance dogs put forward by her participants and wider literature, as she states, “the likelihood that a proportion of canine and human research participants currently consume products manufactured from other animals, who did not choose martyrdom based on a utilitarian maxim, may seem to undermine a non-speciesist ethic supporting the kindly, nonexploitative use of assistance animals” (107). The consideration here is: how can you live ethically with one animal but exploit others? This is a question that needs greater exploration and is a point for future research.

Human–Canine Collaboration in Care did leave me wanting more empirical detail, but this is not a criticism. Rather, it is because I found the empirical detail fascinating. Furthermore, pictures of the technologies described alongside photographs of the embodied alerts of the dogs, could have added an affective visual dimension to the “doing” of diabetes that was central to the book. That being said, however, the book is essential reading for those interested in animal studies and disability studies. The book makes a vital contribution by bringing disability and animality into conversation, which too often goes amiss in conversations around animality and intersectionality. The book, as I read it, is a challenge to our ableist and speciesist society. It shows how empathetic engagement and care flows both ways in a crucial human–animal relationship. Eason is successful in completing the aims of her book in presenting the “doing” of diabetes, the role of a diabetes alert dog, and in creating greater knowledge and understanding around such partnerships. In summary, Human–Canine Collaboration in Care, is a thoughtful, provocative book, which helps enlighten the world of human–diabetes–dog partnerships. A world where human and animal “doings” of care is a life-saving and life-giving practice.