This term was first coined around the issue of care for people with intellectual disabilities in the 1970’s. At that time, people with intellectual or developmental disabilities were often viewed as incapable of living independently or making decisions for themselves – a view which often deprived them of many typical life experiences that others take for granted.

The Dignity of Risk acknowledges that life experiences come with risk, and that we must support people in experiencing  success and failure throughout their lives. However, it can be a challenge to support decisions that we feel are risky, or with which we don’t agree, without our safety-oriented health care culture.

Recent work has begun to extend the Dignity of Risk into the care of older adults. In some parts of Australia it is being integrated into residential care for older adults, and the “Maine Approach” spearheaded by Dr. Allan Teel in Maine, USA implements the Dignity of Risk as the cornerstone of their aging in place system. When older adults are hospitalized, the instinct is often to protect them and to avoid all risk in attempts to keep them safe. Our work with the Dignity of Risk project seeks to find a balance between this need for duty of care and the right of patients to decide what level of risk they are comfortable with themselves.

As anyone who works in care of older adults can confirm, it is difficult if not impossible to talk about this type of care without considering the issue of capacity and decision-making. It is because of this that the Dignity of Risk – a concept born out of the struggle to come to terms with the rights of the intellectually challenged – is particularly well suited to the issue of care for older adults.

“…that that which makes us most human is our ability to enjoy our successes by having the ability to own our own failures. It is that contrast, that yin and that yang if you will, of human nature that allows us to truly be a person. A true human being.”

Christopher Lyons, Senior Director and Counsel at AIM Services

Our Perspective on the Dignity of Risk and the Care of Older Adults

The UK, Australia and Canada have many similarities in their understanding of the issue of decision making for older adults. We have summarized these perspectives into four principles that we believe best inform our view on the Dignity of Risk in older adults.

1. Adults have the right to make their own decisions, and to be assumed to have capacity to do so unless shown otherwise – and capacity should be viewed as decision-specific.
2. A person should be offered all reasonable support and assistance in making and following through on their decisions before others step in to make decisions for them.
3. People have the right to make decisions that others feel are unwise or disagree with, the right to have a different tolerance for the risks associated with a decision, and the right to fail after making a decision.
4. When others are involved in decision making with person, any decisions must be made with the person’s best interest and preferences at the forefront, and must strive to infringe the least upon their basic rights and freedoms.

Of course, understanding the impact of these four statements in relation to care of older adults, and then working to embed these principles into a balanced approach to care is a complex issue that may often be dependent on the setting in which the care occurs. For this reason, we have designed –  and are implementing and evaluating –  participatory workshops, that allow health care personnel to explore these issues and then create the methods for embedding them in their practice.

Source
The Dignity of Risk Project
What is the Dignity of Risk?