Dignity of Risk

‘Many of our best achievements came the hard way: We took risks, fell flat, suffered, picked ourselves up, and tried again. Sometimes we made it and sometimes we did not. Even so, we were given the chance to try. Persons with special needs need these chances, too.’

What is ‘Dignity of Risk’?

‘Dignity of risk’ refers to the concept of affording a person the right (or dignity) to take reasonable risks, and that the impeding of this right can suffocate personal growth, self-esteem and the overall quality of life (Ibrahim & Davis 2013).

The term, dignity of risk, first coined in 1972 by Robert Perske in relation to people living with disabilities (and further expanded in Wolpert’s 1980 ‘The Dignity of Risk’ paper), was a reaction to over-protective safeguards and a paternalistic nature witnessed in care living, which they argued, was patronising and diminished a person’s freedoms and self-esteem.

Consumer Dignity and Choice

Since the first use of the phrase, our care settings have come a long way in encouraging independence and resident decision-making, and in Australia, the ‘dignity of risk’ approach is being formally integrated into residential care settings around the country (QORF 2015).

In care settings such as residential aged care, affording dignity of risk to allow a resident the same personal freedoms they would enjoy if living in an independent setting is directly tied to Standard 1 of the Aged Care Quality Standards: Consumer Dignity and Choice.

At times, however, care workers are still faced with the difficult job of balancing the dignity of risk of their clients, with their duty of care (Keast 2016).

Concerns are often raised about the disconnect between theory and practice, for instance, how risks can be taken when care workers have responsibilities and could face the brunt of complaints, or even compliance action.

Reframe Your Thinking

The key to all this is, lies in reframing how care providers think about risk (Hermant 2015).

Home Care Today manager Ronda Held states, instead of thinking about how to avoid all risks, we should be thinking about how we can support someone to do what they want, safely (Keast 2016).

A care provider’s role could include ensuring a client’s decision is an informed one, by offering them all relevant information, and then maintaining support, whatever the outcome.

As Perske states, ‘knowing which chances are prudent and which are not’, is a skill that must be learned (1972).

Ways You Can Support a Resident’s Dignity of Risk

A resident’s autonomy and right to make decisions for themselves should be paramount in all settings, however, your responsibilities and duty of care should not be compromised when striving to uphold these dignities.

Keep in mind the following:

• Always consider a resident’s capacity to make decisions. Are they present of mind? Do they have all the information they require? Should a family member or the resident’s GP be consulted first?
• Consider what is a ‘reasonable’ risk, e.g. food choices, daily walks or refusal of recommended care.
• Keep sufficient documentation. Ensure you have documented every facet of the decision-making process, from who has been consulted, to the information you have provided to the resident regarding potential risks, and their subsequent acknowledgement of these risks.
• Familiarise yourself with your organisation’s policies. Make sure you are only working within the scope of your role and what processes must be followed to fulfil a resident's request.

(Keast 2016; Woolford 2017)

Additional Resources

• Aged Care Quality Standards: https://www.agedcarequality.gov.au/...Standards.pdf

References

• Hermant, N 2015, ‘Dignity of Risk: Elderly should be allowed to do ‘risky’ activities to improve lifestyle, professor says’, ABC News, 22 November, viewed 23 August 2019, https://www.abc.net.au/news/2015-11-22/risky-activities-could-improve-quality-of-life-for-elderly/6939166.
• Ibrahim, JE & Davis, MC 2013, ‘Impediments to applying the ‘dignity of risk’ principle in residential aged care services’, Australasian Journal of Ageing, vol. 32, no. 3, pp. 188-93, viewed 23 August 2019, https://www.ncbi.nlm.nih.gov/pubmed/24028460.
• Keast, J 2016, ‘A balancing act: dignity of risk vs. duty of care’, in Australian Ageing Agenda, 11 May, viewed 23 August 2019, https://www.australianageingagenda.com.au/2016/05/11/balancing-act-dignity-risk-vs-duty-care/.
• Perske, R 1972, ‘The dignity of risk and the mentally retarded’, Mental Retardation, vol. 10, no. 1, 24-7, viewed 23 August 2019, https://www.ncbi.nlm.nih.gov/pubmed/5059995.
• Queensland Outdoor Recreation Federation 2015, ‘What is the Dignity of Risk’, QORF, 24 November, viewed 23 August 2019, https://qorf.org.au/what-is-the-dignity-of-risk/.
• Wolpert, J 1980, ‘The Dignity of Risk’, Transactions of the Institute of the British Geographers, vol. 5, no. 4, pp. 391-401.
• Woolford, M 2017, Exploring the concept of ‘Dignity of Risk’, Monash Forensic Medicine, Monash University, 25 May, viewed 23 August 2019, https://www2.health.vic.gov.au/~/media/Health/Files/Collections/Presentations/S/Striving-For-Care-Excellence/Exploring-the-concept-of-Dignity-of-Risk.