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.
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.
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: firstname.lastname@example.org