When a patient’s choices entail risks for others: third-party risks, relational ethics, and responsibilities of rehabilitation professionals

Abstract

Purpose

Patients receiving rehabilitation care may act in ways that pose risks to the wellbeing of others. There are numerous situations when patients’ actions might pose risks to others, including family members, other patients, or society. For example, such risks arise if patients wish to return home to living in an apartment but risk starting a fire while cooking, or if they insist on driving but their health condition makes doing so unsafe. These situations give rise to ethical challenges, including for health professionals as they seek to promote their patient’s autonomy while minimizing risks for the patient and others.

Methods

We develop a conceptual analysis examining how relational ethics can inform understanding of rehabilitation professionals’ responsibilities in responding to third-party risk.

Results

Relational ethics foregrounds the situated, dynamic, and interdependent nature of relationships between people, and supports dialogic approaches to clarify how best to respond. We present a set of 10 questions linked to the concepts of relational autonomy and relational social justice that can contribute to ethical reflection and deliberation among providers, patients, families, and others involved.

Conclusion

Relational ethics provides a distinctive angle of view on challenging issues of third-party risk in rehabilitation care.

Implications for rehabilitation

• Managing risk is a recurrent source of ethical challenge in rehabilitation care.

• Risks to third parties give rise to significant ethical tensions.

• We propose ten questions that can support a relational ethics approach for responding to situations of third-party risk.

Keywords:

• Clinical ethics
• feminist ethics
• personal autonomy
• rehabilitation
• risk
• social justice

Acknowledgments

The authors are grateful to members of the Global Health, Ethics and Rehabilitation lab group for their helpful comments on an earlier version of this article.

Disclosure statement

The authors report no declarations of interest.

Additional information

Funding

Matthew Hunt and Raphael Lencucha are supported by Research Scholar Awards from the Fonds de recherche du Québec – Santé.