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A positive risk approach when clients choose to live at risk: a palliative case discussion

De Bono, Christopher E.; Henry, Blair

Current Opinion in Supportive and Palliative Care: September 2016 - Volume 10 - Issue 3 - p 214–220
doi: 10.1097/SPC.0000000000000223

Purpose of review The article discusses recent approaches in the literature about clients who chose to live at risk in their homes. It argues for a positive risk-based approach and a tool to help manage risk in the home, and applies these to a hypothetical end-of-life scenario.

Recent findings Historically, safety plans to consider risk management involved a culture of risk aversion supported by sometimes paternalistic motives intended to protect vulnerable clients. New findings in the literature engage in a process that respects the ethical principles underlying harm reduction philosophies. The literature also argues for a perspective that moves away from viewing risk as only harmful, to one that supports a positive understanding of risk as part of a client's informed choice.

Summary A risk support management plan, based on a positive approach, can provide a way to both support a client's choice to live at risk, anticipate for expected complications, and inform the creation of a contingency plan to address concerns as they may arise. The added value of a structured approach like the one proposed here for risk support management plans is that it provides adequate due diligence and informed decision-making when planning for risk-taking in complex situations.

aToronto Central Community Care Access Centre

bJoint Centre for Bioethics

cEmmanuel College & St. Michael's College, University of Toronto

dDepartment of Family and Community Medicine, Division of Palliative Care, University of Toronto

eEthics Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Correspondence to Office of the Ethicist, Christopher E. De Bono, PhD, Toronto Central Community Care Access Centre, 250 Dundas Street West, Suite 305, Toronto, ON M5T 2Z5, Canada. Tel: +1 416 217 3820; e-mail:

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