Clinical Ethics Consultation and the Reframing of Risk.

Abstract

As a clinical ethics consultant, I've received numerous consultation requests from health-care providers that reflect the tension at the heart of the concept of dignity of risk, often presented in this form: "The patient wants to [do something that we think is unsafe]. How can we change their mind or stop them?" These consultation requests are almost always framed within a medicalized conception of risk: each is presented as a medical provider's concern that a patient's behavior or choice will lead to a specific physiological harm that the medical team wishes to avoid. However, this medicalized perspective neglects the subjective nature of self-determined choices and ignores important aspects of how patients integrate their disability or illness into a broader narrative of how their preferences and actions fit within their self-understanding. In this article, I offer ways to reframe provider perspectives as an attempt to foster an empathetic understanding of "risky" patient preferences at the physiological, environmental, and psychosocial levels.