Dignity of Risk in Rehabilitation: Theory and Practice

Dignity of risk, as originally defined by Robert Perske (1972), focused on the treatment of people with intellectual impairments and the need to shift away from paternalism. However, the term also resonates deeply in other health-care situations today. The concept of dignity of risk is tricky to operationalize in many contexts, including in medical decision-making during rehabilitation. In some cases, clinicians may focus solely on risk and how best to "minimize" risk to patients, rather than on understanding and fleshing out options and choices. Questions naturally surface, such as: whose risk are we seeking to limit and at what cost to a patient's dignity? How do personal choices relate to patients' values and quality of life? Can we employ a shared decision-making model when discussing risk taking? When we look closely, we recognize that dignity of risk is at play when cognitively intact patients disregard medical advice that is viewed as the standard of care. This article closely examines this type of risk, the context in which it arises in rehabilitation, and opportunities for shared decision-making that can integrate dignity of risk principles.