title: A positive risk approach when clients choose to live at risk: a palliative case discussion.
abstract: The article discusses recent approaches in the literature about clients who chose to live at risk in their homes. It argues for a positive risk-based approach and a tool to help manage risk in the home, and applies these to a hypothetical end-of-life scenario.
  
  
  
  Historically, safety plans to consider risk management involved a culture of risk aversion supported by sometimes paternalistic motives intended to protect vulnerable clients. New findings in the literature engage in a process that respects the ethical principles underlying harm reduction philosophies. The literature also argues for a perspective that moves away from viewing risk as only harmful, to one that supports a positive understanding of risk as part of a client's informed choice.
  
  
  
  A risk support management plan, based on a positive approach, can provide a way to both support a client's choice to live at risk, anticipate for expected complications, and inform the creation of a contingency plan to address concerns as they may arise. The added value of a structured approach like the one proposed here for risk support management plans is that it provides adequate due diligence and informed decision-making when planning for risk-taking in complex situations.
authors.affiliation: aToronto Central Community Care Access Centre bJoint Centre for Bioethics cEmmanuel College & St. Michael's College, University of Toronto dDepartment of Family and Community Medicine, Division of Palliative Care, University of Toronto eEthics Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: De Bono
authors.forename: Blair
authors.initials: B
authors.lastname: Henry
mesh_terms: D003657:Decision Making; D040261:Harm Reduction; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D061214:Patient Safety; D026684:Personal Autonomy; D012306:Risk; D017751:Safety Management / Q000458:organization & administration