Risk-related standards of competence: continuing the debate over risk-related standards of competence

Bioethics. 1999 Apr;13(2):131-48. doi: 10.1111/1467-8519.00137.


This discussion paper addresses Ian Wilks' defence of the risk-related standard of competence that appears in Bioethics 11. Wilks there argues that the puzzle posed by Mark Wicclair in Bioethics 5 against Dan Brock's argument in favour of a risk-related standard of competence -- namely that Brock's argument allows for situations of asymmetrical competence -- is not a genuine problem for a risk-related standard of competence. To show this, Wilks presents what he believes to be two examples of real situations in which asymmetrical competence arises. I argue that insofar as Wilks equivocates two senses of competence in his examples -- namely, competence to perform a task and competence in performing a task -- Wilks is unable to illustrate the existence of real situations of asymmetrical competence. By examining the way in which Wilks equivocates two senses of competence in his examples, and by applying the results of this examination to the problem of patient competency within the medical field, I argue that not only does Wilks fail to show that situations of asymmetrical competence exist, but he is also unable to provide a foundation for understanding how the risk-related standard of competence can strike a balance between an individual's autonomy and benevolent intervention. I thus conclude that insofar as Wilks fails to answer the objections raised by Wicclair and others against the risk-related standard of competence, the risk-related standard of competence continues to be undermined by the problem of asymmetrical competence.

MeSH terms

  • Altruism
  • Beneficence
  • Decision Making*
  • Ethics*
  • Evaluation Studies as Topic
  • Freedom*
  • Humans
  • Informed Consent*
  • Mental Competency*
  • Patient Care
  • Patients
  • Personal Autonomy*
  • Reference Standards*
  • Risk Assessment*
  • Risk*
  • Treatment Refusal*