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1221 S. Hartmann Drive, Suite F, Lebanon, TN 37090 1-615-377-0950

Dignity of Choice and Dignity of Risk

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What does Dignity of Choice mean?
The right of a person to make an informed decision to engage in experiences of his or her own choosing, which are necessary for personal growth and development. Informed choice means the person is well informed to make an educated and voluntary decision about moving forward with his/her goal or planned activity after s/he has had a meaningful discussion about risks and potential outcomes, both positive and negative, that may result.

What does Dignity of Risk mean?
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 caregivers, concerned about their responsibility to ensure health and welfare.

What is Self-Determination?
A person’s right to make choices about their own life. All persons are entitled to opportunities, respectful support, and the authority to exert control in their lives, to direct their services, and to act on their own behalf.

Dignity of Choice protocol:
Three components of balancing choice and risk include actions to:
1. Identify and document choices and risks during initial assessment and reassessment.
2. Develop a person-centered support plan that includes individualized strategies to honor choices and address each risk.
3. 3. Regularly revisit choice and risk discussion, analyze data (e.g. critical incident management system), monitor individual risks, and modify plans as needed.

How is Dignity of Risk implemented?
The person is supported to develop a risk mitigation plan through identifying the following:
▪ The risk(s) associated with their choices and/or goals.
▪ The potential benefits and potential harm that may be associated with taking the risk(s).
▪ The options for mitigating the risk(s) identified.
▪ Assuming the identified risk mitigation strategies are put in place, whether the person feels the identified risk(s) are worth accepting/taking. The person is supported to make an informed choice once all potential benefits and potential risks have been identified and discussed.

Why is this important?
❖ Supporting dignity of choice means honoring a person’s right to make choices and engage in activities that may involve risks, and committing to assist the person to identify, consider, and implement strategies to mitigate the identified potential negative consequences of these choices.
❖ A proactive approach to risk awareness and identification, and subsequent planning to reasonably mitigate foreseeable risks, is essential in order to avoid adopting an approach that attempts to eliminate all risk from people’s lives. An approach that attempts to eliminate all risk does not recognize that risk is a natural part of life that cannot be eradicated. There is risk in both action and inaction, in choosing to do something or not choosing to do something. Even more important, personal growth is not possible without some amount of risk. Therefore, an approach that seeks to avoid or eliminate all risk results in a person missing opportunities to grow, learn, and experience life. Instead of trying to avoid or eliminate all risks, an approach that values dignity of choice is essential, coupled with a commitment to identify, evaluate, and plan for mitigation of risks that come with living life and striving to reach one’s full potential.

Through this conversation, Joe and his staff were able to make a plan that will enable him to try something he has always wanted to try, while being aware of the associated risk involved and taking steps to mitigate this risk. Joe also feels empowered because he made an informed choice.

Joe wants to go hiking, but his staff is concerned that he will get too hot which can cause him to have a seizure. Joe’s staff tells him that he can’t hike, and he needs to choose something else.

What should staff have done?
Staff should have discussed the risks associated with hiking as well as Joe’s seizure disorder with him. Additionally, staff should assist Joe with identifying ways to make hiking less risky for him.

The way it should go:
Staff: Joe, I understand you want to hike, but since your getting too hot can bring on a seizure, I’m worried that hiking may be risky for you.
Joe: I know, but I’ve always wanted to go hiking and it’s really important to me that I get to try it.
Staff: Let’s see if there are some things that we could do to help minimize the risks for you then.
Joe: I like that idea. I could do a short hike to see how it goes. And take water to drink.
Staff: That’s a good idea, we also can look at the weather forecast and plan to when it will be cooler outside.
Joe: That’s a good idea. We also can take my emergency medication with us in case I have a seizure.

Dignity of Choice and Dignity of Risk
In this scenario, the staff member originally told Joe “No” and that he could not do something. Although this came from a place of concern for Joe’s safety, this is the opposite of Dignity of Risk and is not how services should be implemented. In this situation, the staff member is disregarding Joe’s right to make decisions for himself when focusing solely on the possible risk. Staff should be supportive and work with the person to create a plan of action that enables the person to safely accomplish goals and try new things. Once the staff and Joe had a conversation about why the staff was concerned with Joe going hiking and the risk of seizure was identified, they then worked together to identify ways Joe could safely try hiking for the first time.

In the event Joe does have a seizure while hiking, it would be the expectation of the agency that the staff is not terminated, as risk mitigation was discussed, and the person was supported to create a plan for trying hiking in a safe way. (Indicator 9.1) Also, Joe feels empowered because he chose an activity for himself and is being supported to try something he has always wanted to do. Joe’s rights were not infringed upon, and his staff understood that he is able to make choices even when there is a risk involved. (Indicators 4.5, 4.6, 4.7 and 6.1)

It is important to remember that by empowering persons to take risks when exercising choice and control, staff and natural supports are helping them to reduce their vulnerability. This ultimately makes persons safer as they learn to identify and mitigate potential risks which helps them to safeguard themselves.

1221 S. Hartmann Dr., Suite F, Lebanon, TN 37090 +1-615-377-0950 ext. 2453