BC Medical Journal, Vol. 60, No. 6, July/August 2018, bcmj.org
ABSTRACT
Persons living at home or in care facilities may make choices that health care providers believe pose a risk of harm to themselves or others. Living at risk may include eating when aspiration is possible, living at home without adequate support, going on unsupervised outings, smoking around oxygen supplies, or refusing to use a walker needed to prevent falls. Deciding when and how to intervene in patients’ choices can be challenging. In these complex situations health care providers can benefit from using a decision-making process that is informed by BC legislation (specifically the Mental Health Act and Adult Guardianship Act), a literature review, and an analysis based on the bioethical principles of respect for autonomy, nonmaleficence, beneficence, and justice. This process can be used to make ethically justifiable decisions about when and how to intervene when patients choose to live at risk, as illustrated by the fictionalized case of a residential care patient with cognitive impairment who wishes to go on unsupervised outings. While risk cannot be eliminated totally and is inherent in patient-centred care, energy should be directed to ensuring that risks of harm are reduced to a tolerable level.