Assessing risk and harm: the convergence of ethical and empirical considerations

Neurorehabilitation clinicians are frequently asked to make clinical predictions of risk and harm in cases where persons with brain injury are believed to be unable or unsafe to conduct normal activities of daily living. Because predictions of risk and harm may ultimately limit a brain-injured person's autonomy, clinical decision makers should be aware of the ethical and empirical issues involved in such determinations. Constraining autonomy can be an ethical problem even when clinicians are apparently acting in patients' best interests. Clinicians must consider their ability to make accurate risk and harm predictions based on clinical data. Clinicians who are aware of contemporary ethical principles will be most prepared to integrate ethical and empirical considerations when determining risk and harm.