Balancing risk-taking and safety among patients, families, and clinicians during transitions in care from brain injury rehabilitation.

摘要

This study examines the factors that influence how patients, families, and clinicians make decisions about risk-taking and safety in brain injury rehabilitation. Despite the importance of these decisions, particularly during transitions in care, there is scant literature to help guide these care partners in ethical and clinical decision-making related to risk-taking and safety. This study suggests that there are tensions between rehabilitation and patient safety efforts. Risk-taking lies at the core of brain injury rehabilitation; however, decisions about risk-taking are also influenced by conflicting values, system pressures, and patient abilities. A relational approach to autonomy that addresses patients' decisional and functional abilities within their social contexts is more nuanced than a liberal individualist approach to autonomy, and provides a better framework for understanding decision-making. Relational autonomy may help clinicians make better decisions that balance risk-taking and safety, decisions that are committed to the principles of respecting autonomy and advancing safety.