Dignity of risk in the community: a review of and reflections on the literature

Taking risks is a part of everyday living, and a contributor to our sense of dignity. Yet as people age, or develop cognitive, mental or physical impairments, opportunities to take risks can diminish. A life without risks can erode a person’s dignity. The purpose of this narrative review was to explore the application of the concepts of the Dignity of Risk and Therapeutic Risk in literature pertaining to community-based support for people living with a range of physical, mental and/or cognitive constraints. We aimed to understand how these concepts are conceptualised, articulated, negotiated and enacted in theory and practice. During a period from October 2017 to January 2018, seven databases were searched for relevant literature. Thematic analysis techniques were applied to synthesise the data from 47 academic papers that met the inclusion criteria. Our analysis demonstrates persistent ethical tensions. There is widespread support for the application of both concepts across a range of discourses, but a number of long-standing ethical considerations pertaining to risk, safety, rights and negotiation persist. We argue that the way forward is to resist the temptation to simplify the issues, but instead to accept and accommodate ethical complexities while implementing evidence-informed solutions such as intersubjective risk negotiation strategies, community-centred relational approaches to decision-making, and education and training in communication skills and the positive potential of risk. Future research to examine the impacts of the implementation of these strategies would be timely, beneficial and welcome.