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The right to take risks

I've been on holiday this week - we couldn't go to our boat in France so settled on a week on Dartmoor, walking, wild swimming and tasting the wonderful Devon produce. Our current accommodation even has a vineyard...

All this time has led to me spending time reflecting on how we discourage people from making their own decisions and urge caution, rather than encourage self-determination and setting their own risk threshold. Words of warning trip off the tongues of health and social care professionals far quicker than words of encouragement; healthcare professionals want to look after people and keep them safe. That feels very natural and is often no bad thing when they lack the capacity, or experience and knowledge, to make their own 'unwise' decisions.

I can't count how many times I have been advised by perfectly nice people that wild swimming is very dangerous, that people die from swimming in cold water and the British waterways are full of disease and detritus. Many places have warnings on wooden posts banged into the hard ground. |some of the signs might be warranted, but many are just about concerns around liability rather than any particular risk.

I uphold my right to swim in beautiful places that may be a bit harder than the local leisure centre to access. I really hope as I become older still, I do not face increased pressure not to do what I love doing and what it incredibly good for me. In the main text book in my Towards Outstanding series, I tell the story of an 86 year-old woman, who swims every day, (all year round) in the sea, but who faces increasing pressure from her family and neighbours to stop because they are worried about the risks. They fail to see the huge benefits this brings this woman - not only physical wellbeing but social contact and mental wellbeing too. She says it keeps her young - and I believe her. That is worth the risks, to her.

This was one of our swimming spots this week. A beautiful moorland quarry, filled with the sparkling water of the Tavy. Lots of people (like our children, who now, mistakenly, think they are in a place to determine what risks we can take) tell us they think it is 'a step too far' and ask what will happen if we get injured or develop hypothermia. What they fail to acknowledge is that whilst we could fall scrambling down the rocks to enter the water, we always check carefully for the safest entry point. Yes, it really is very cold and we would get hypothermia in the depths of winter if we weren't acclimatised, or if we stayed in too long. Yes, it is a good way from the nearest road but we always ensure we know the grid reference and postcode of the car park that we have used. Basically, we are reasonably competent adults who are capable of assessing risks, taking any action we consider necessary to mitigate risk and then deciding whether we want to take the plunge.

Many, many adults are either fully cognisant and have full capacity, or can be supported to make their own decisions. The law requires them to be allowed to; one of the principles of the Mental Capacity Act (2005) is the right to make unwise decision. There are two principles that are particularly key for wild swimming (or skydiving, or riding pillion on a motorcycle or having sex with five different people in a week, or drinking more than one glass of Sancerre).

  • - a person is not to be treated as unable to make a decision for themselves unless all practical steps have been taken to help them make it, without success

  • - a person is not to be treated as unable to make a decision merely because they make an unwise or eccentric decision

Obviously, there are times when people are unable to make decisions and need others to make decisions to support or discourage particular activities in their best interests. That isn't when the family think Granny going to the shops in the rain without a coat or eating two whole tubs of ice cream is something that should be stopped (unless Granny really can't be supported to make that decision for herself). It is where there are risks that Granny cannot truly consider or assess for herself.

Still on Dartmoor, there were some sweet foals around and it made me think that we are programmed to care for those who cannot protect themselves. The very young, the injured or unwell and the elderly. Striking the balance between caring or protecting and removing their right to self determination isn't always easy - but is always important.

I recall telling my late mother that I wasn't going to support her smoking habit, and lecturing her about the risks. She listened with a half-smile and then pointed out that the greatest risk was that it might shorten her life, since she was already 91 years-old at the time, it wasn't really a problem was it? I reluctantly recognised her right to make, what I considered, was a very unwise decision. Point being, it wasn't my decision to make.

Questions you might want to reflect on;

  • How often do you make decisions for people who can make decisions for themselves

  • Do you apply pressure or fail to give full information about alternative courses and risks/benefits?

  • Might you promote one treatment over another because you believe it is in the patient's best interests?

  • What if Mr. Smith wants to have daily tot of whisky despite end stage liver failure or a history of falls?

My self-development workbook is a good resource if you want to build the use of reflection , to improve your own, your team's and your service's everyday practice.

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