Dignity Of Risk Research Articles

What Is Right? Ethics in Intellectual Disabilities Research

AbstractThere are important benefits to including adults with intellectual disabilities in research. Calls for their increased participation in research co‐occur with notable discussion about how to conduct ethically strong research with adults with intellectual disabilities, a population widely considered vulnerable in the context of research. The authors systematically researched the peer‐reviewed literature on ethical practices in research with adults with intellectual disabilities to identify and analyze conceptually and empirically supported ethical approaches to research in the area of research with adults with intellectual disabilities. They conducted a thematic analysis of the 37 articles that met inclusion criteria. They identified three overarching themes: (1) guiding frameworks and approaches; (2) strategies to promote accountability to ethics; and (3) making decisions about participation, including considerations for coercion, capacity to consent, surrogate decision‐making, and promoting understanding. From the review, they noted diverse recommendations for ethical research practices, characterized by a lack of consensus, entrenched tensions in value orientations, and gaps in knowledge and practice. Attention to promising strands of scholarship that emphasize attention to strengths, autonomy, dignity of risk, and a contextually based framing of consent capacity may be particularly fruitful. Similarly, bringing to the forefront the role of accommodations in promoting participation, systematically studying diverse ethical aspects of research, and identifying and considering the perspectives of persons with intellectual disabilities may represent critical next steps. They suggest that research collaborations between academics and persons with intellectual disabilities present opportunities to further strengthen the ethical integrity of research in the field.A video abstract of this article can be viewed at http://youtu.be/5Oqx02Aw3xs.

The Dignity to Fail

Back to table of contents Next article Taking IssueFull AccessThe Dignity to FailPatrick W. Corrigan, Psy.D.Patrick W. CorriganSearch for more papers by this author, Psy.D.Published Online:1 Mar 2011https://doi.org/10.1176/ps.62.3.pss6203_0241AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Although evidence supporting the effectiveness of several treatments for people with serious mental illnesses increases exponentially, adherence to such treatments remains alarmingly low. Service providers are concerned that absence of treatment leads to exacerbation of symptoms and to disabilities. At its extreme, treatment nonadherence becomes a legal issue for psychiatrists or other providers that leads them to make unilateral and sometimes restrictive decisions. Many family members share this concern about a loved one's nonadherence to treatment.Unfortunately, some consumer advocates are troubled that giving this kind of responsibility to providers leads them to make overprotective decisions. The physical disability community refers to this as “dignity of risk” and “right to failure.” Attempting to make life “risk free” robs people of potential opportunities. People do not land a better job, move to a nicer neighborhood, build more intimate relationships, or enjoy fewer medication side effects if they do not consider and pursue the risky option. One of the things that make these pursuits a risk is the absence of a priori clear results. For example, it is uncertain whether meeting new people at a synagogue will broaden one's support network or cause more social anxiety. Many of a person's best achievements come the hard way: falling flat, picking oneself up, and moving on. Without these flops, people are unclear about their potential limits and miss out on unforeseen alternatives that may benefit them.Some people seem to be unable to make clear decisions because of cognitive deficits associated with serious mental illnesses. Evaluating a person's decision capacity, however, is not a black-and-white process. Even people with major psychotic illnesses have lucid periods. What is the final arbiter of whether a person's decision represents a pathological process? Is a decision to stop medications by a person with a formal thought disorder necessarily indicative of poor cognition? Research shows that opting out of a treatment does not necessarily lead to worse symptoms or to disabilities. When an illness intensifies, a person rarely cascades into a situation with irreversible consequences. Most decisions about ending psychosocial treatments related to work or independent living do not lead to relapse and catastrophe. Even nonadherence to medication regimens does not necessarily lead to tragedy. Risk and failure are part of human agency. Saving people from these is taking away their dignity.Joint Center for Psychiatric Rehabilitation, Illinois Institute of Technology, Chicago FiguresReferencesCited byDetailsCited ByPsychiatry Research, Vol. 241Patient-Centered, Recovery-Oriented Psychiatric Care and Treatment Are Not Always VoluntaryJeffrey L. Geller, M.D., M.P.H.1 May 2012 | Psychiatric Services, Vol. 63, No. 5From Adherence to Self-Determination: Evolution of a Treatment Paradigm for People With Serious Mental IllnessesPatrick W. Corrigan, Psy.D., Beth Angell, Ph.D., Larry Davidson, Ph.D., Steven C. Marcus, Ph.D., Mark S. Salzer, Ph.D., Petra Kottsieper, Ph.D., Jonathon E. Larson, Ed.D., Colleen A. Mahoney, Ph.D., Maria J. O'Connell, Ph.D., and Victoria Stanhope, Ph.D.1 February 2012 | Psychiatric Services, Vol. 63, No. 2 Volume 62Issue 3 March 2011Pages 241-241 Metrics PDF download History Published online 1 March 2011 Published in print 1 March 2011

The Dignity to Fail

Back to table of contents Next article Taking IssueFull AccessThe Dignity to FailPatrick W. Corrigan, Psy.D.Patrick W. CorriganSearch for more papers by this author, Psy.D.Published Online:1 Mar 2011https://doi.org/10.1176/ps.62.3.pss6203_0241AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Although evidence supporting the effectiveness of several treatments for people with serious mental illnesses increases exponentially, adherence to such treatments remains alarmingly low. Service providers are concerned that absence of treatment leads to exacerbation of symptoms and to disabilities. At its extreme, treatment nonadherence becomes a legal issue for psychiatrists or other providers that leads them to make unilateral and sometimes restrictive decisions. Many family members share this concern about a loved one's nonadherence to treatment.Unfortunately, some consumer advocates are troubled that giving this kind of responsibility to providers leads them to make overprotective decisions. The physical disability community refers to this as “dignity of risk” and “right to failure.” Attempting to make life “risk free” robs people of potential opportunities. People do not land a better job, move to a nicer neighborhood, build more intimate relationships, or enjoy fewer medication side effects if they do not consider and pursue the risky option. One of the things that make these pursuits a risk is the absence of a priori clear results. For example, it is uncertain whether meeting new people at a synagogue will broaden one's support network or cause more social anxiety. Many of a person's best achievements come the hard way: falling flat, picking oneself up, and moving on. Without these flops, people are unclear about their potential limits and miss out on unforeseen alternatives that may benefit them.Some people seem to be unable to make clear decisions because of cognitive deficits associated with serious mental illnesses. Evaluating a person's decision capacity, however, is not a black-and-white process. Even people with major psychotic illnesses have lucid periods. What is the final arbiter of whether a person's decision represents a pathological process? Is a decision to stop medications by a person with a formal thought disorder necessarily indicative of poor cognition? Research shows that opting out of a treatment does not necessarily lead to worse symptoms or to disabilities. When an illness intensifies, a person rarely cascades into a situation with irreversible consequences. Most decisions about ending psychosocial treatments related to work or independent living do not lead to relapse and catastrophe. Even nonadherence to medication regimens does not necessarily lead to tragedy. Risk and failure are part of human agency. Saving people from these is taking away their dignity.Joint Center for Psychiatric Rehabilitation, Illinois Institute of Technology, Chicago FiguresReferencesCited byDetailsCited byPractice Dilemmas, Successes, and Challenges in the Delivery of Homeless Services: Voices from the Frontline27 June 2019Psychiatry Research, Vol. 241Patient-Centered, Recovery-Oriented Psychiatric Care and Treatment Are Not Always VoluntaryJeffrey L. Geller, M.D., M.P.H.1 May 2012 | Psychiatric Services, Vol. 63, No. 5From Adherence to Self-Determination: Evolution of a Treatment Paradigm for People With Serious Mental IllnessesPatrick W. Corrigan, Psy.D., Beth Angell, Ph.D., Larry Davidson, Ph.D., Steven C. Marcus, Ph.D., Mark S. Salzer, Ph.D., Petra Kottsieper, Ph.D., Jonathon E. Larson, Ed.D., Colleen A. Mahoney, Ph.D., Maria J. O'Connell, Ph.D., and Victoria Stanhope, Ph.D.1 February 2012 | Psychiatric Services, Vol. 63, No. 2 Volume 62Issue 3 March 2011Pages 241-241 Metrics PDF download History Published online 1 March 2011 Published in print 1 March 2011

Substance Abuse and Mental Retardation: Balancing Risk Management with the “Dignity of Risk”

Substance abuse (SA) is a documented issue for many people with mental retardation/developmental disabilities (MR/DD). However, little empirical data exist regarding the appropriateness or effectiveness of prevention or treatment approaches for this population. Compounding this issue, access to SA treatment for this population is also limited, making social work case management a challenge. For social workers, the problem of SA among people with MR falls into a gray area between the facilitation of the “dignity of risk” and risk management. Discussions of Deborah Stone's commentary on balancing liberty, equality, and security in social policy are presented in light of ways to encourage the implementation of the “dignity of risk.” Linking theory to practice, a baseline framework is provided for planning individualized, self-determination-oriented case management approaches for people with SA who have MR.

The Real Sin Is Separation

SUMMARY The overpowering themes of Bob Perske's early writings are “friendship” and “inclusion.” The article describes how Bob lives out these themes in his later life through the “Friends of Richard” group and his work as Executive Director at the Greater Omaha Association for Retarded Citizens. The author discusses the impact of these themes on his daughter's life through her relationship with her church and her acceptance of the dignity of risk.

The dignity of risk

The dignity of risk

‘There may be trouble ahead’

It was John Perske who wrote about the ‘dignity of risk’ and reminded us that a good quality of life includes the right to try things out, to experiment, to fail. If every toddler who tumbled over was protected from further harm, then nobody would be walking on two legs. Many employment and education projects for people who use mental health services invite their participants to take a risk — to try out a new activity, take on a new role, or learn a new skill. But how is this risk managed? In the advanced capitalist economy of the late 1990s, a whole industry has grown up around the reality of risk. People at risk of theft or loss have property insurance. Those at risk of loss of earnings can take out cover. There is injury and sickness protection, and finally financial protection against the devastation of premature death. Empowerment is about having the same right as every other citizen, about having the same insurance policy in your pocket as the next person. Where do people who participate in mental health workschemes fit in? Do they hold this key to power?

Enhancing Independence in Supported Employment

Independence-related issues are the topics of the day in supported employment discussions. These issues find their roots in earlier discussions of the principle of normalization and other related principles. Today's discussions revolve around the achievement of full employment access and the integration of people with severe disabilities in the most normalized manner possible. This article discusses two facets of enhancing independence: first, increasing access to employment settings and the community in general as a result of the enactment of the Americans with Disabilities Act; second, identifying naturally available support sys­ tems in today's business and industry settings. The roles of employment specialists in service provision within the context of naturally available resources and the limitations related to the use of these resources are also discussed. In 1972 Wolf Wolfensberger published the book Normalization. Among the philosophies detailed in this book were principles of the dignity of risk (Perske, 1972), the right to self-determination (Nirje, 1972), and normalization. These princi­ ples have formed the philosophical bases for the provision of human services since their inception. Two decades later, however, service providers are still struggling to apply these same three princi­ ples. Despite using community locations, appro­ priate materials, and real tasks, human service providers have yet to actualize these principles in intervention methods used and types of services delivered. Taken together, the three principles provide the idealized service model, a model in which services are delivered in the community in a manner that enhances the dignity of the persons who receive these services and are under the maxi­ mal control of these same persons. Clearly, the application of these principles was intended to afford all people, including those with the most severe disabilities, the dignity of independence and the right to full community participation. Community participation, independence, de­ pendence, am:!. interdependence are topics at the heart of every current disability discussion. They are typified in events that have surrounded the enactment of the Americans with Disabilities Act of 1990 (ADA) and debates about the best prac­ tices in supported employment.

The dignity of risk

The dignity of risk

The Dignity of Risk

The paper provides a preliminary attempt to integrate the research traditions in social and natural hazards. Attention is given to institutional and technological hazards and the mechanisms for risk management and -prevention of catastrophe. The concepts of competency and dangerousness are integrated into the discussion of risk management, with emphasis given to the insights provided by the clinical and legal literature on the mentally handicapped. The method of fault-tree and event-tree analysis, as used by nuclear engineers, is suggested as a promising approach to the analysis of catastrophe prevention arising from social hazards.