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Risk-related standards of competence are a nonsense
  1. Neil John Pickering1,
  2. Giles Newton-Howes2,
  3. Simon Walker1
  1. 1 Bioethics Centre, University of Otago Medical School, Dunedin, New Zealand
  2. 2 Psychological Medicine, University of Otago Medical School, Wellington, New Zealand
  1. Correspondence to Dr Neil John Pickering, Bioethics Centre, University of Otago Medical School, Dunedin, New Zealand; neil.pickering{at}


If a person is competent to consent to a treatment, is that person necessarily competent to refuse the very same treatment? Risk relativists answer no to this question. If the refusal of a treatment is risky, we may demand a higher level of decision-making capacity to choose this option. The position is known as asymmetry. Risk relativity rests on the possibility of setting variable levels of competence by reference to variable levels of risk. In an excellent 2016 article in Journal of Medical Ethics (JME), Rob Lawlor defends asymmetry of this kind by defending risk relativity, using and developing arguments and approaches found in earlier work such as that of Wilks. He offers what we call the two-scale approach: a scale of risk is to be used to set a standard of competence on a scale of decision-making difficulty. However, can this be done in any rational way? We argue it cannot, and in this sense, and to this extent, risk relativity is a nonsense.

  • decision making
  • ethics- medical
  • ethics
  • mental competency
  • philosophy- medical

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  • Contributors NJP conceived paper and wrote drafts, and is guarantor, GN-H and SW extensively commented on and edited drafts.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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