Competence standards should not be risk-related

Associate Professor Neil Pickering1

1University of Otago

A patient, A, is faced by a choice between two options – to consent to a treatment which will highly likely cure their otherwise almost certainly fatal disease, or to refuse to consent, meaning they will almost certainly die and quickly. Health professionals, as is a fairly common practice, say that in order for A to choose the very risky outcome, A will need to show a very high standard of decision-making competence. In order for A to choose the safe outcome, A will need to show a much lower standard of decision-making competence. This approach is called asymmetry. The question is, does asymmetry make any sense? The answer is no – and this paper undertakes a discussion of some recent literature in this area in order to show why.

Keywords: decision-making competence


Kia ora kou tou – ko Neil Pickering ahau. I work at the Bioethics Centre at the University of Otago. My current main research focus is decision-making competence.

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