Dignity of risk

Dignity of risk is the idea that self-determination and the right to take reasonable risks are essential for dignity and self esteem and so should not be impeded by excessively-cautious caregivers, concerned about their duty of care.

The concept is applicable to adults who are under care such as elderly people,[1] people living with disability,[2] and people with mental health problems.[3] It has also been applied to children,[4] including those living with disabilities.[5][6]

History

The concept was first articulated in a 1972 article The dignity of risk and the mentally retarded by Robert Perske:

Overprotection may appear on the surface to be kind, but it can be really evil. An oversupply can smother people emotionally, squeeze the life out of their hopes and expectations, and strip them of their dignity. Overprotection can keep people from becoming all they could become. 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. Of course, we are talking about prudent risks. People should not be expected to blindly face challenges that, without a doubt, will explode in their faces. Knowing which chances are prudent and which are not – this is a new skill that needs to be acquired. On the other hand, a risk is really only when it is not known beforehand whether a person can succeed. The real world is not always safe, secure, and predictable, it does not always say “please,” “excuse me”, or “I’m sorry”. Every day we face the possibility of being thrown into situations where we will have to risk everything … In the past, we found clever ways to build avoidance of risk into the lives of persons living with disabilities. Now we must work equally hard to help find the proper amount of risk these people have the right to take. We have learned that there can be healthy development in risk taking and there can be crippling indignity in safety![7]

In 1980, the concept was relied upon by Julian Wolpert, Professor of Geography, Public Affairs, and Urban Planning at Princeton University, to support his argument in a paper, "The Dignity of Risk",[8] which has since been described as "seminal".[9] Wolpert's argument was that a paternalistic approach to people living with disability, prioritizing safeguarding over the rights of individuals to independent decision-making, is a limitation on personal freedom.[9]

Conflict with duty of care

Allowing people under care to take risks is often perceived to be in conflict with the caregivers' duty of care. Finding a balance between these competing considerations can be difficult when formulating policies and guidelines for caregiving.[10][2][7][11][12]

Problems of overprotection
Wheelchair rugby is a full contact sport played by wheelchair users. In spite of the protective features of the wheelchairs, the risk of injury is significant.[13]

Overprotection of people with disabilities causes low self-esteem and underachievement because of lowered expectations that come with overprotection. Internalisation of low expectations causes the person with a disability to believe that they are less capable than others in similar situations.[14]

In elderly people, overprotection can result in learned dependency and a decreased ability for self-care:[15]

"It is possible to deliver physical care that has positive outcomes and returns a person to full function, yet, if during that care they have not been involved, allowed to make choices and respectfully assisted with activities of daily living, it may be possible to cause psychological damage through undermining that person's dignity."[16]

Independent living

The right to fail and the dignity of risk is one of the basic tenets of the philosophy of the independent living movement.[17]

Convention on the Rights of Persons with Disabilities

The first of eight "guiding principles" of the United Nations' Convention on the Rights of Persons with Disabilities states: "Respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of persons."[18]

See also

References
  1. Norman Hermant (2015-11-22). "Dignity of Risk: Elderly should be allowed to do 'risky' activities to improve lifestyle, professor says - ABC News (Australian Broadcasting Corporation)". Abc.net.au. Retrieved 2017-04-19.
  2. "Duty of Care and Dignity of Risk - Coda South - Choice. Opportunity. Diversity. Ability". Coda South. 2013-09-15. Archived from the original on 2017-09-08. Retrieved 2017-04-19.
  3. Craig Parsons (2009-05-02). "Dignity of Risk: The right to self-governance for people with mental illness". Openforum. Retrieved 2017-04-19.
  4. Cook, Victoria Ann (2010). "Chapter 19: 'The teachers seemed a bit obsessive with health and safety': fieldwork risk and the social construction of childhood". In Holt, Louise (ed.). Geographies of Children, Youth and Families: An International Perspective. Abingdon, Oxon and New York: Routledge. pp. 279–291. ISBN 9781135191252. Retrieved 27 December 2018.
  5. Stillman, William (2007). Autism Answer Book: More Than 300 of the Top Questions Parents Ask. Naperville, IL: Sourcebooks, Inc. pp. 197–199. ISBN 9781402219375. Retrieved 27 December 2018.
  6. Green, Jarrod (2017). I'm OK! Building Resilience through Physical Play. St. Paul, MN: Redleaf Press. pp. 63–65. ISBN 9781605544526. Retrieved 27 December 2018.
  7. Perske, R (February 1972). "The dignity of risk and the mentally retarded". Mental Retardation. 10 (1): 24–7. PMID 5059995.
  8. Wolpert, Julian (1980). "The Dignity of Risk". Transactions of the Institute of British Geographers. 5 (4): 391–401. doi:10.2307/622018. JSTOR 622018.
  9. von Benzon, Nadia; van Blerk, Lorraine (2017). "Research relationships and responsibilities: 'Doing' research with 'vulnerable' participants: introduction to the special edition" (PDF). Social & Cultural Geography. 18 (7): 895–905. doi:10.1080/14649365.2017.1346199.
  10. Wendel Bamford (2016-05-04). "Duty of care and the dignity of risk | Interchange". Interchangewa.org.au. Retrieved 2017-04-19.
  11. Jackie Keast (2016-05-11). "A balancing act: dignity of risk vs. duty of care". Australian Ageing Agenda. Retrieved 2017-04-19.
  12. Ibrahim, Joseph E; Davis, Marie-Claire (September 2013). "Impediments to applying the 'dignity of risk' principle in residential aged care services". Australasian Journal on Ageing. 32 (3): 188–193. doi:10.1111/ajag.12014. PMID 24028460. S2CID 206981816.
  13. Bauerfeind, Joanna; Koper, Magdalena; Wieczorek, Jacek; Urbański, Piotr; Tasiemski, Tomasz (1 January 2015). "Sports Injuries in Wheelchair Rugby – A Pilot Study". Journal of Human Kinetics. 48 (1): 123–132. doi:10.1515/hukin-2015-0098. PMC 4721614. PMID 26834880.
  14. Sanders, KY (2006). "Overprotection and lowered expectations of persons with disabilities: the unforeseen consequences". Work (Reading, Mass.). 27 (2): 181–8. PMID 16971765.
  15. Kennie, David C. (1993). Preventive care for elderly people. Cambridge, Angleterre: Cambridge University Press. p. 24. ISBN 9780521436298.
  16. Fenton, Elizabeth; Mitchell, Theresa (June 2002). "growing old with dignity: a concept analysis". Nursing Older People. 14 (4): 19–21. doi:10.7748/nop2002.06.14.4.19.c2212. PMID 12094515.
  17. Deegan, Patricia E. (1992). "The Independent Living Movement and people with psychiatric disabilities: Taking back control over our own lives". Psychosocial Rehabilitation Journal. 15 (3): 3–19. doi:10.1037/h0095769.
  18. "Guiding Principles of the Convention". www.un.org. United Nations - Division for Social Policy and Development.
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