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.

If Not Now, Then When? Taking Disability Seriously in Bioethics.

The impression of bioethicists as "dangerous," as articulated in Mouth Magazine in 1994, has continued to be a theme in the disability movement. We respond to three common responses by bioethicists to this impression-namely, this is from the past, and bioethicists are different now; this is an angry and extremist position; and the Americans with Disabilities Act and other disability rights and justice efforts have solved historical inequities. We draw on the historical record and on our collective experiences as bioethicists engaged in clinical consultation and education and as the founding, former, and current directors of a program focused on disability and rehabilitation ethics to argue that ableism and unexamined assumptions about people with disabilities have persisted in bioethics despite decades of counternarratives, research, and divergent perspectives. Ableism and such assumptions can lead to health care decisions that are prone to bias, mistreatment, and a lack of consideration of viable options for living with disability. As the field of bioethics moves toward certification examinations and as new generations join the field's ranks, these problems need to be rectified with solutions at the individual, interpersonal, and structural levels. It is past time to take disability seriously.