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Posted on February 17, 2020 at 9:53 AM

Among the most fundamental concerns regarding medical,
biomedical, and bioethical decision making are the concepts of risk and
benefit. Of course, benefit is better than risk so this might seem to be a
fairly easy balance to calculate. But it is not. In order to truly assess the
balance between risk and benefit of an act one needs to know not only each of
the possible risks and each of the possible benefits but also the magnitude of
the risks and benefits as well as the likelihood that each of these risks or
benefits might occur. Even if one can actually identify each of the risks and
benefits the ability to quantify the likelihood and magnitude of those risks
and benefits is rarely available. Lack of this information makes this a notably
imposing if not impossible calculation. In order to illustrate this, I would
like to consider a risk versus benefit analysis of an action that most of us
may face on a fairly regular basis. This takes place in the immediate
environment of the offices of the Alden March Bioethics Institute, an office in
which I spend a considerable proportion of my professional time.

The Alden March Bioethics Institute occupies most of the
second of three floors of the administration building located in the northwest
corner of the Albany Medical Center campus. Each of these floors has two
bathrooms. As befits a medical center environment these bathrooms are kept
scrupulously clean which includes the frequent mopping of the floor. The floors
are tile. The floors get wet when they are mopped. Apparently, these wet floors
are viewed as a risk by the institution. In particular these are viewed as
slippery and therefore a risk of falling and injury. As any responsible
organization would the medical center makes an effort protect its employees,
students, and visitors by warning of that risk and therefore ameliorating that
risk. They warn us with signs placed on the wet floor.

These signs are bright yellow and come up a bit higher than
the top of my knees. They not only warn me with bright red letters that caution
me in English (caution) but also in Spanish (cuidado), and French (attention).
They also tell me in all three languages that the floor is wet, and in the
event that someone knows none of those languages there is a cartoonish picture
of a person falling. I think there are few who would be frequenting this building
who could not receive and interpret the message clearly and unambiguously. But
do these signs, in fact, protect the individual venturing into that room from
the risk of slipping, falling, and possibly injuring themselves. My own
experience produces doubt that these warnings actually afford protection.

The data which I bring to this analysis is the hundreds
(perhaps thousands) of times I have entered these rooms. In all of those
experiences I have never slipped on the wet floor. However, one time several
years ago I tripped on one of these signs. In the interest of complete candor,
I did not fall to the floor, but I did need to grab the edge of the stall to
keep myself from falling. This data lacks statistical power but does tell me
that perhaps the signs themselves produce a risk. This is certainly no double
blinded randomized trial, or even a cohort study. Perhaps the basis for
proposing a case-control study. Based on careful analysis I believe I have
identified a weakness in this warning system. I only see the sign if I am
looking down. If I am looking down, I can also see that the floor is wet. There
is no basis for making a conclusion here. But on that basis, I feel that the
question of whether the risk of wet floor signs exceeds their benefit is a question
meriting further reflection but probably no further study.

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