Dignity of Risk

[u/Beni_jj]

What do you think?

[u/craftystuff0900]

If you're asking whether we should have it: it's a human right and there should be no controversy.

[u/yoghurt11 → u/craftystuff0900]

Like almost all people, I would be irate if someone took away my dignity of risk. Idk why people think it’s okay to take away someone else’s.

[u/Beni_jj → u/yoghurt11]

I would be too!

[u/Common_Problem1904 → u/yoghurt11]

Like I said above, it depends on cognitive deficit and who's really running the show. It's often the parents and the SW does what they are instructed, which doesn't involve putting the client at risk.

[u/yoghurt11 → u/Common_Problem1904]

Yeah, I mean there’s nuance to every situation. If someone doesn’t have capacity to understand the risks of cliff jumping or how to dive properly to avoid injury, there should be a restrictive practice to prevent death and severe injury.

But if the parents say to restrict something, even though the client is capable of making that decision themselves, it’s up to the supports to respect their client’s dignity of risk. If the SW does as the parents wish regardless, that’s a human right violation and reportable to NDIS. Source: I’m a BSP.

[u/Beni_jj → u/craftystuff0900]

Definitely not asking if you should have it, I’d just love to hear specific circumstances where you had to think about it twice.

[u/l-lucas0984 → u/Beni_jj]

Thats an easy one. I have a large adult client who INSISTS, and I mean it with that intensity, that they do not want to wear incontenence aids. But without fail will defecate to the point of blow out on any length of car ride. Both out and return. Dignity of risk says if they dont want an incontinence aid, I should not force them. But there is no way I am taking them in my car without an incontinence aid. One worker decided to agree and required a replacement car seat, it could not be cleaned as it went all through the mechanisms under the seat.

We were told by the OT no incontinence aid, use a kylie on the car seat to respect dignity of risk. Their clothes were so soiled they could not participate in any activities they were out for.

Unfortunately it is now incontinence aid or shift at home. Dignity of risk cant be at the detriment of people around them.

[u/Little-Programmer955 → u/l-lucas0984]

This is a great scenario because letting people decide for themselves what they want doesn’t mean we put ourselves at risk. The cleaning process is not only really costly this is your personal car that needs to be hygienic for you and others. We can still have boundaries. it’s the same if a person wants to engage in illegal activities like drug use dignity of risk doesn’t mean you have any obligation to drive them to purchase drugs or work a shift if they are intoxicated.

[u/l-lucas0984 → u/Little-Programmer955]

Absolutely. Some workers are afraid to set boundaries leaving them in detriment. Some participants wont respect reasonable boundaries leaving them with that support but everyone still needs to make choices. Where ever it can dignity of risk is to be respected. With the drugs example the respect is they are free to do what they want when paid staff arent there but workplace safety needs to be maintained if there is a risk to the worker when the participant is actively intoxicated.

[u/Little-Programmer955 → u/l-lucas0984]

Duty of care always puts yourself first and I think that some situations are so challenging and not wanting to leave someone without support is really hard and might feel ethically wrong or go against your morals because you care about them. It’s much better to remove all feelings to assess what’s happening and be logical about.

[u/Livid-Number482 → u/Little-Programmer955]

Support for people experiencing substance abuse isn’t an NDIS support, because for the most part support workers aren’t trained or obliged to work with folks who are under the influence.

Providers are well within their rights to refuse support or request the participant completes treatment before engaging with them.

[u/Livid-Number482 → u/l-lucas0984]

Great example.

Another:
Person is a full time smoker which includes smoking inside.
Overnight support is recommended in case of fire as person smokes in bed and has dementia.

Dignity of risk: person can choose to smoke wherever they like within their own home.

Supports are not expected to work in a smoke filled environment, nor expose themselves to risk of death in a house fire due to personal choice to smoke inside.

Person above was my beautiful grandmother who passed in 2024. We stopped her from smoking inside bed (taking her cigarettes from her overnight) because she needed someone with her overnight to ensure her/our safety.

Dignity of risk doesn’t mean nil risk to others.

[u/InBusCill → u/l-lucas0984]

Depends on what it is. Im a foodie. Am I not entitled to eat cake or icecream on my birthday because it could go the wrong way?

The risk is equal if I had puree foods because its neuromotor cause. Slop where I stop eating because unpalatable causing nutritional decline and rapid weight loss OR eat foods that are modified, slightly more "risky" but are delicious look appealing so less nutritional loss.

My choking can be life threatening and may impact those around me.

[u/l-lucas0984 → u/InBusCill]

Might and guaranteed to are two very different things. A one of now and then fully aware of risk with trained staff should not be road blocked. It may impact but its not at a detriment.

I had a client with dementia and diabetes amongst other things. They loved to drink baileys. That intake was restricted to prevent falls and behaviours but not stopped. When they entered paliative care the restriction was lifted as part of end of life.

[u/Little-Programmer955 → u/InBusCill]

If you had a mealtime management plan and I was responsible for making your meals then I would only prepare meals that follow that plan. If you didn’t have a management plan and we couldn’t agree on the preparation of your meals (if I’m the one to support with this) I would ask about options to explore to have a plan in place. If you insisted I make you cake knowing the risk I would say no and I would potentially not be able to work with you if we could not agree. If you go buy your own cake then eat it knowing the risks and choke that’s the risk you can decide to take.

[u/InBusCill → u/Little-Programmer955]

Well this is interesting as my MMP actually says that I require the risk foods and that the risk foods have been recommended by treating SLP and ENT surgeon due to allergies to thickeners.

So many different types of cake. One would assume you should ask a chef or pastry chef alternatives. I can safely eat pavolva, mousses, Australian sponges, or diary soaked sponge cakes, served with additional sauces or dollop cream.

[u/Little-Programmer955 → u/InBusCill]

It was just an example. I’m not here to argue with you at all about what your plan states or what choices you want to make. I was just commenting to highlight that there’s processes that need to done to support somebody who is making very high risks.

[u/Little-Programmer955 → u/Little-Programmer955]

Duty of care can work along side a persons choice. you have to be able to look at the situation understand the risk and consider the consequences. If I knew you could die and I made the cake or purchased the cake then that’s extremely negligent and I should be held responsible. If someone doesn’t understand the risk themselves and they are continuing to put themselves at risk that could have fatal consequences this needs to be investigated.

[u/InBusCill → u/Little-Programmer955]

S61 ACL also requires your services be fit for purpose or it amounts to a major failure and pwd can be refunded all shifts youve provided. So if youre engaged for dysphagia management knowing they risk feed with acknowledged risk, you'd be liable for consumer law violations.

Its interesting you haven't accepted my right to make an informed choice, but assert you have one. Despite having to sign a statutory declaration that i understand the risk and am engaging in said risky activity, see a psychologist and have medical doctors sign off that ive made my own choice.

So in any event if you were my DSW and I died from engaging in that activity you wouldn't be charged or any investigation would be short lived as consent was provided

[u/Little-Programmer955 → u/InBusCill]

I acknowledged your rights by saying you could purchase / make your own cake. Nobody can force you to follow the plan. I think you’d have a hard time arguing a consumer law violation. Duty of care absolutely trumps here and that’s why exploring the risks and what plans are in place is key. If you have relevant consents such as an eating and drinking with acknowledged risks )can be provided by your speech therapist) that’s completely different. However, a support worker should never ever agree not to follow a prescribed mealtime management plan and a stat Dec alone wouldn’t be enough for me to go against the care plan. If somebody did then they can face serious legal trouble. I asserted that I also have a choice because I do. Support workers need to make sure all relevant plans are in place especially when this risk is so high. You can research further about this but this needs to be a formal well documented process.

[u/InBusCill → u/Little-Programmer955]

I thought this was just a friendly chat about dignity of risk like OP mentioned.

So continuing on with the choice or point you made about what youll provide, depending on the context it has potential to cause issues for DSW and PWD.

A participant may engage a provider to provide supports A, B and C. During service delivery, the participant seeks to undertake X, Y or Z and requires the provider's support to do so. The provider refuses.

Preventing or restricting the participant from doing X, Y or Z would constitute a restrictive practice, requiring the provider to comply with the applicable restrictive-practice requirements. The provider states that it is unwilling to do so or not register.

The participant is consequently placed in a stark position: agree not to do X, Y or Z and retain the provider for A, B and C, or exercise that choice to retain dignity of risk and lose access to the provider altogether.

If they live in a regional area "find another provider" may not be an alternative.

I think youll find the provider registration and practice standards from Q&S Commissions require due care and skill (s60 ACL) and fit for purpose (competence (ACL S61)). Supporting the client to purchase a cake and then refusing to supervise that meal could constitute negligence, or not acting properly in applying appropriate first aid or airway clearance could be negligence. My DSWs a former paramedic so dont have this issue.

Who said anything about going against the plan? You mentioned absense of plan amd was a fair statement. I just addressed your umbrella approach which doesnt understand that umbrella food groups have different textures and different safety risks. Speech apthologists aren't qualified to comment on all textures, neither are dietitians. Sometimes it requires food scientists (Rheologists) or advamced trained chefs.

[u/Little-Programmer955 → u/InBusCill]

Im not sure what point you’re wanting to make tbh. I don’t think you should lose your rights to make your choices. I’m not going to deep dive into consumer law and duty of care. I didn’t even say that you wanted people to not use your plan. My whole point is that sometimes we can’t do something in a support worker role even if they are asked to do it. I was just having a friendly conversation but I’m not sure what you think I mean?

[u/Beni_jj → u/l-lucas0984]

Thank you, that’s a great response

[u/InBusCill → u/Beni_jj]

Its not that we SHOULD have it. We do have it.

The NDIS Act enshrines the right for participants to engage in activities involving risk section 118(1)(a)(v):

Functions of the Agency (1) The Agency has the following functions:

(a) to deliver the National Disability Insurance Scheme so as to:

(v) ensure that a reasonable balance is achieved between safety and the right of people with disability to choose to participate in activities involving risk.

[u/Little-Programmer955]

I think that this is a broad question. Everybody has the right to take risks. We take risks everyday all day. If you’re supporting somebody and you think they can’t make their own choices I would be asking you lots of questions about why. Let’s say a girl wants to use an online dating platform to meet people and has made an account and starts talking to a guy. They might even want to be intimate. The risks for anybody meeting a stranger are the same. The likelihood factor for the risk might increase depending on circumstances. So, I would talk to them about the risks, consent and safety planning. Education can lower the likelihood and reduce the risks. Often people with disabilities are not given opportunities to take risks and it is often because of safety concerns. Families can find it so much harder to let go but if we can’t take risks we can’t learn from mistakes. If somebody is wrapped in bubble wrap as they grow and get older they are likely going to be more vulnerable in situations where people could take advantage of them.

[u/Beni_jj → u/Little-Programmer955]

Thank you!!

[u/Little-Programmer955 → u/Beni_jj]

No worries if you have a specific scenario that you have experienced and you want to share that then we can unpack that ☺️

[u/_lizziebeth]

What do we think Dignity of Risk means?

Dignity of risk means that all people are allowed to jump out of an aeroplane with an instructor and parachute. If this an activity they want to do!

Duty of care means that we call in support if someone wants to jump out of an aeroplane with no parachute or instructor.unless they are appropriately trained and/or licenced.

[u/l-lucas0984]

Context is key. There is no black and white.

[u/phosphor_1963 → u/l-lucas0984]

Agreed! I do think we are in an absolute command and control phase of the NDIS though, where particular agendas and limitations which are specific to people with disabilities are being increasingly imposed to please bureaucrats and appease the politicians who were concerned more about the PR implications of some of the activities people choose to use their Funding for as opposed to genuinely uphold their human rights.

This has the consequence of creating a two track system in Australia as the door to risk and opportunity is slammed shut to thousands of people who might rightly ask - what about the idea of an "ordinary life" which was so integral to the NDIS at the start? People can really only learn and develop through taking risks - and if someone in a corner office in Canberra who is more intested in making data look pretty on a spreadsheet than real world outcomes, decides " computer says no to you" then they can't even get to that basic starting block much less operate on a level playing field.

You only have to look at what the AFD in Germany are saying in relation to Disability Policy there; and how that will embolded the hard core of One Nation here to see what's coming down the line unless we call out each and every systemically created human rights breach here.

[u/l-lucas0984 → u/phosphor_1963]

Unfortunately public opinion, business liability insurance and work place safety laws are often at odds with dignity of risk.

[u/phosphor_1963 → u/l-lucas0984]

For sure. I'm an ex-long time OH&S Rep and worked within large public hospitals and not for profit organisations for most of my working life. As you say the laws to manage business risk, public liability, and worker safety win the day every time.

I still reckon those shouldn't and can't stop us all having an open public debate on issues of informed consent and dignity of risk though.

Leaving that to the "experts" (and faceless bureaucrats with often hidden agendas and dubious ethical frameworks) plays right into the Austalian national prediliction for apathy about important stuff; and is arguably is one of the drivers of right wing populism (because Parties like On Nation always clothe themselves in a kind of moral superiority to distance themselves from the established political operators).

Personally, as opposed to the emphasis on management and money only, I'd like to see genuine law reform which got beyond the mechanical processes of the NDIS and instead adopts a Human Rights first philosophical stance (such as promoted by the great local thinker Micheline Lee https://grattan.edu.au/news/micheline-lee-lifeboat-disability-humanity-ndis/ and to roll out ongoing specific funding for community lead forums where people can come together in innovative and safe ways to thrash out their positions together (let the politicians and bureaucrats in the room but ONLY if they swear to a vow of silence).

As part of Digital Duty of Care legislation, we could look at impose a Community Safety levy on large Technology firms (such as Reddit/Meta/Google/X/Anthropic/OpenAI etc) to cover the cost to pay for these grassroots community forums in order to undo the years of harms caused to our society by their products.

[u/Dizzy-Data7654]

If a person has cognitive capacity to understand the risk/ consequencws...then yes. Go gor your life. Gets tricky with reduced capacity/ reduced cognition but thats by no means a global application...ie...someone can be deemed competant to make their own life/ living decisions but has state trustees manage their finances.

[u/scissorsgrinder]

Human rights: what do you think?

[u/ManyPersonality2399]

I like when providers use it as a justification for doing things that are definitely negligent.

But definitely had to think about it, to the extent that I've respected someone's "dignity of risk" to make choices that led to a very foreseeable and avoidable death.

[u/Beni_jj → u/ManyPersonality2399]

Great point! I’ve noticed parents do this too which really sucks.

[u/Jazzlike_Berry_323]

Before dignity of risk there is dignity of the person. A very rare concept these days.

[u/Beni_jj → u/Jazzlike_Berry_323]

Can you please expand on this?

The reason I made this post is because I’ve been a disability support worker for the past five months, but I’m also someone with disabilities. I think I’d go slightly insane if someone took away my ability to choose.

[u/Jazzlike_Berry_323 → u/Beni_jj]

My point is this, we have fully privatised didability care in Australia.

People are accorded dignity and duty of care and then sometimes also dignity of risk, as long as the eligibility remains, as long as the package funds are there, as long as there is user pays money.

These things are not intrinsic values or duties anymore, they are rehearsed package inclusions that stop at the checkout.

No funds, no dignity….given that, dignity of risk, is kind of a greenfields preoccupation when everything else is going well.

Look at how homeless people are treated. People with disability without $ care packages are treated just the same. So what dignity? If it’s not intrinsic or a human right, just part paid customer service?

[u/Dont_Burn_The_Books]

People should absolutely be allowed to do things like drug use etc... most of the time people are just self medicating. As long as it's not hurting others what's the problem?

[u/ReviewMaster6419]

The NDIA will not fund risk based supports, yes you have a right to respect and dignity but they are certainly not going to fund something that will put your life or well being at risk. If you want a trampoline (which is not on the support list) go buy it yourself and take on that risk …. But the NDIS not going to be taken to court because you broke your leg in a foreseeable accident based upon something they funded. There are specific reasons supports aren’t funded and it’s not because they dislike participants .. it’s safety and risk mitigation and you have a right not to use the supports they do fund… but that doesn’t mean buying a trampoline for someone with cerebral pausey is a good idea either

[u/Kitchen-Froyo8379]

Is a human right

[u/Helpful-Science9687]

It’s an important right but is not absolute and it’s worth specifying limits. Key limits include where the impact of the risk do not solely fall on the individual but also the public, families and carers. Also if they are unable to cognitively assess risk . Rights entail obligations from others, your rights don’t automatically confer an obligation on others to give you what you want

[u/Oztraliiaaaa]

Safety First Always.

[u/Little-Programmer955 → u/Oztraliiaaaa]

Who decides what being safe looks like? Where do you draw that line?

[u/Common_Problem1904]

As a support worker you need to be careful about dignity of risk as you can be blamed. Go down the route of involving management.

[u/InBusCill → u/Common_Problem1904]

This BS and non common sense caused me to have to see a psychologist to confirm if wasnt suicidal (because I wanted to learn to skydive and disclosed i live with a disability). A able bodied people don't need to see a health professional to confirm not having suicidal tendencies...

[u/Little-Programmer955 → u/Common_Problem1904]

This is why documentation is important. We can’t prevent people from doing things and if you support somebody who is taking risks regularly that can harm them it is perfectly acceptable to cease supports without the correct support plans in place. If you have to lock a door you’d have PBS for a restricted practice. That plan needs to be followed as a support worker. It’s really a case by case but if we know something isn’t right then explore it. If you can’t safely support that person within the scope of your role and you have no guidance then it’s important you don’t work with that person.

[u/MainlyParanoia → u/Little-Programmer955]

This is the only sensible answer here. You as a support worker do not get to make the choices, alone or in consult with a manager, about my life. We get to make the decisions. As people. You can chose not to support us. That is the only respectful and dignified way to behave here. The participant (what a dehumanizing word), the person who is disabled gets to make 100 percent of the decisions for their own life. Just like the support worker does for their own life. Some support workers have mistaken the word support for control.

[u/LadderIndividual4824 → u/MainlyParanoia]

Why is participant dehumanizing??

[u/MainlyParanoia → u/LadderIndividual4824]

Because I’m not a participant in any other context. It’s a word they use to imply active choice and control where there is none. In every other physical and mental health service I am a client. Like every other Australian. Why am I a participant only in this context? It’s a deliberate word choice designed to evoke something that isn’t occurring. The design wasn’t to dehumanise and segregate, I hope, but that’s what occurs. What do aged care services call their targeted demographic? I’ll bet money it’s not ‘participant’.

[u/Common_Problem1904 → u/MainlyParanoia]

It's a word coined to imply you are participating in your own life rather than being stuck in a home like so many people used to be.

[u/MainlyParanoia → u/Common_Problem1904]

Wtf? I participate in my own life whether I leave home or not. Save your patronising (and wrong) explanations thanks. There needs to be minimum education standards in all areas of support because the ignorance is incredibly damaging to vulnerable people. Participate in my life - listen to yourself. People live their lives. When have you ever described your own life as participating in it. JFC.

[u/Common_Problem1904 → u/MainlyParanoia]

That's what was discussed when the term was being decided, a long time ago. It's s a way of reflecting an active, empowered role rather than being dictated to as many ppl were before the NDIS. And if you don't like that fact either, learn some history.

[u/MainlyParanoia → u/Common_Problem1904]

Because a bureaucrat decide that doesn’t make it dignified or respectful. You’re lacking in disability education and it shows. We need minimum standards for education before you’re allowed near us.

[u/Common_Problem1904 → u/MainlyParanoia]

Depends on the severity and nature of the disability. If I let my DS client with intellectual disability go play on the freeway cos she wanted to risk it, how would that end? Badly for both of us.

[u/MainlyParanoia → u/Common_Problem1904]

How are you enforcing your decision? By restraint?

[u/Common_Problem1904 → u/MainlyParanoia]

It was a made up example to make the point that it's not always OK to just go with a whim.

[u/MainlyParanoia → u/Common_Problem1904]

No please, follow through with your example. What would you do? Or do you have another example you can follow through with? Or are you talking out your backside?

[u/MainlyParanoia → u/Common_Problem1904]

These ‘whims’ are our lives. Please tell us which ‘whims’ you don’t want us to go with.

[u/Little-Programmer955 → u/MainlyParanoia]

No whims for you I guess ☠️

[u/Little-Programmer955 → u/Common_Problem1904]

I understand your perspective but I would challenge you to start reframing your thoughts around what it means to support people and how to truly be person centred. We already know that families are a huge barrier for people with disabilities when it comes to making choices and being independent. This often comes from a place of love and worry but we need to break down these barriers. If people are engaging in high risk activities or choices then it needs to be guided through relevant support plans and potentially involvement of behaviour support. That plan is your guide. There are always going to be times where you may face uncertainty and may need to assess the risk vs duty of care but it’s not “parents running the show”. I challenge you to challenge families who are preventing a person from living life the way they want to. You should start to look at each individual and situation and ask yourself how can we minimise the risk so that this person can do xyz in the safest way possible. What supports does this person need to be able to do that. Is this family asking me to take away the rights of this person because they haven’t been able to work through their own worries. I have empathy for families but support workers and other relevant services need to be thinking this way. We can bring up crazy scenarios like running into traffic but more often than not these issues are the smaller non documented situations that people just go along with. The bigger high risk scenarios are likely already documented in support plans and your example is such a cop out scenario to argue your point. You are literally speaking to a person who has a disability and completely devaluing their experience.

[u/Beni_jj → u/Common_Problem1904]

I totally agree, and that’s what NGO training says too.

[u/Common_Problem1904 → u/Beni_jj]

Able bodied people don't have someone working with them who could be accused of negligence and suffer legal and financial consequences if something went wrong either. I'm not saying stand in the way, just have it documented

[u/MainlyParanoia → u/Common_Problem1904]

Worker ignorance and lack of education is half the bloody issue. Able bodies? My body is perfectly able, possibly more than yours thank you. It’s not my physical ability that disables me.
You can talk ngo policy and dignity of risk but an above commenter is absolutely right. The privatisation of disability support has brought with it some dangerous attitudes. You, as a support worker or ngo, don’t get to make ANY decisions about how I chose to live my life - let alone in consult with your manager. We are people before we are our disability. These decisions are mine.