Dignity of risk
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Dignity of risk is the idea that self-determination and the right to take reasonable risks are essential for
dignity Dignity is the right of a person to be valued and respected for their own sake, and to be treated ethically. It is of significance in morality, ethics, law and politics as an extension of the Enlightenment-era concepts of inherent, inalienable ...
and
self esteem Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
and so should not be impeded by excessively-cautious
caregiver A caregiver or carer is a paid or unpaid member of a person's social network who helps them with activities of daily living. Since they have no specific professional training, they are often described as informal caregivers. Caregivers most commo ...
s, concerned about their
duty of care In tort law, a duty of care is a legal obligation that is imposed on an individual, requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others. It is the first element that must be establi ...
. The concept is applicable to adults who are under care such as elderly people, people living with
disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...
, and people with
mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental hea ...
problems. It has also been applied to children, including those living with disabilities.


History

Ideas that would later develop into the concept of dignity of risk arose during the late 1960s in Sweden. Dr. Bengt Nirje formed a group for people both with and without
intellectual disabilities Intellectual disability (ID), also known as general learning disability in the United Kingdom and formerly mental retardation, Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010). is a generalized neurodevelopmental disorder characterized by signif ...
. The group would meet to plan an outing, go on the outing, and meet afterwards to discuss how the meeting went. This allowed people with intellectual disabilities to have some 'normal experiences' in the community, and members without intellectual disabilities were told that the participants with disabilities should make their own decisions without interference, even if mistakes were made. Dr. Nirje once said, "to be allowed to be human means to be allowed to fail." This group would go on to inspire self advocacy groups around the world. The concept was first articulated in a 1972 article ''The dignity of risk and the mentally retarded'' by
Robert Perske Robert Perske (1927 – August 14, 2016) was an American author, theologian, and disability rights activist. He advocated in particular for intellectual disability, intellectually disabled people wrongly convicted for crimes they did not commit. H ...
: In 1980, the concept was relied upon by
Julian Wolpert Julian Wolpert (born 1932) is Bryant Professor Emeritus of Geography, Public Affairs, and Urban Planning at Princeton University's Woodrow Wilson School, where he taught from 1973 to 2005 and chaired the Program in Urban and Regional Planning. He ...
, Professor of Geography, Public Affairs, and Urban Planning at
Princeton University Princeton University is a private research university in Princeton, New Jersey. Founded in 1746 in Elizabeth as the College of New Jersey, Princeton is the fourth-oldest institution of higher education in the United States and one of the ...
, to support his argument in a paper, "The Dignity of Risk", which has since been described as "seminal". Wolpert's argument was that a paternalistic approach to people living with disability, prioritizing safeguarding over the rights of individuals to independent decision-making, is a limitation on personal freedom.


Conflict with duty of care

Allowing people under care to take risks is often perceived to be in conflict with the caregivers'
duty of care In tort law, a duty of care is a legal obligation that is imposed on an individual, requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others. It is the first element that must be establi ...
. Finding a balance between these competing considerations can be difficult when formulating policies and guidelines for caregiving.


Problems of overprotection

Protection is often used to justify violating the rights of people with disabilities. To deny someone the opportunity to make mistakes is to violate the right to make decisions about their own lives. Many self-advocates see the dignity of risk as a human right. Max Barrows, a self-advocates from Vermont, says "Life is about learning from the mistakes that you make I appreciate and we appreciate protection from people, but please don't protect us too much or at all from living our lives." Protection has been used to justify institutionalization, sheltered workshops and other segregated settings. Many institutions were and are sites of abuse, neglect and sexual assault. Many people with disabilities are also placed under guardianship, which is when someone else makes decisions about their life, including where they live, how they spend their money, and the health care they receive. This is done to stop people from making "bad choices." Many disability advocates argue for the replacement of guardianship with supported decision making, where people with disabilities make their own decisions with support and accommodations. Overprotection of people with disabilities causes low self-esteem and underachievement because of lowered expectations that come with overprotection. Internalisation of low expectations causes the person with a disability to believe that they are less capable than others in similar situations. In elderly people, overprotection can result in learned dependency and a decreased ability for
self-care Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and to actively management of illness when it occurs. Individuals engage in some form of self-care daily with food ...
: "It is possible to deliver physical care that has positive outcomes and returns a person to full function, yet, if during that care they have not been involved, allowed to make choices and respectfully assisted with activities of daily living, it may be possible to cause psychological damage through undermining that person's dignity."


Disability rights movement

The right to fail and the dignity of risk are basic tenets of multiple movements, including the independent living movement and the self advocacy movement.


Convention on the Rights of Persons with Disabilities

The first of eight "guiding principles" of the United Nations' Convention on the Rights of Persons with Disabilities states: "Respect for inherent dignity, individual autonomy including the freedom to make one's own choices, and independence of persons." Article 12 of the Convention states that states "shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life" and that "shall take all appropriate and effective measures to ensure the equal right of persons with disabilities to own or inherit property, to control their own financial affairs and to have equal access to bank loans, mortgages and other forms of financial credit, and shall ensure that persons with disabilities are not arbitrarily deprived of their property."


See also

*
Agency (sociology) In social science, agency is the capacity of individuals to have the power and resources to fulfill their potential. For instance, structure consists of those factors of influence (such as social class, religion, gender, ethnicity, ability, custom ...
*
Gillick competence Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child (a person under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or kn ...
*
Infantilization Infantilization is the prolonged treatment of one who has a mental capacity greater than that of a child as though they are a child. Studies have shown that an individual, when infantilized, is overwhelmingly likely to feel disrespected. Such ind ...
* Normalization *
Institutional syndrome In clinical and abnormal psychology, institutionalization or institutional syndrome refers to deficits or disabilities in social and life skills, which develop after a person has spent a long period living in mental hospitals, prisons or other r ...
* '' Olmstead v. L.C.''


References

{{Care navbox, state=collapsed Autonomy Caregiving Disability rights Elderly care Treatment of mental disorders Positive psychology Social constructionism