Cake or death? Ending confusions about asymmetries between consent and refusal

Lawlor, Rob

doi:10.1136/medethics-2016-103647

Cited by 10 publications

(27 citation statements)

References 6 publications

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“…I suggest that an acrobat of middling reliability might be foolhardy to walk the line without a safety net strung below, while there might be nothing untoward in their attempting it with net in place; and I see it as entirely in accordance with correct usage to describe this as a case where the acrobat is competent to walk the line in the second instance but not in the first 12. (p750) citing5 (p156)…”

Section: Risk-related Standards Of Competencementioning

confidence: 98%

“…In an excellent and rigorous article published in the JME in 2016, Rob Lawlor revisits the issue of asymmetry 10 12. Taken as a whole, his article argues that asymmetry is an ambiguous term.…”

Section: Clarifying the Issuementioning

confidence: 99%

“…Wilks is talking about an acrobat with only a moderate degree of tightrope-walking competence. For this individual, because of the different risks, and given his/her level of tightrope-walking competence, we are likely to judge him/her to be foolhardy if he/she walks the rope with no safety net, but we would not think it foolhardy if he/she chose to walk the rope with a safety net 12…”

Section: Risk-related Standards Of Competencementioning

confidence: 99%

“…In decision-making, just as in acrobatics, there can be two variables involved: (1) how difficult the decision is and (2) how risky or significant the decision is. If this is true, Wilks’ argument applies to decision-making as much as it applies to acrobatics 12. (p750)…”

Section: Risk-related Standards Of Competencementioning

confidence: 99%

“…However, because the significance of one choice (death) is much greater than the significance of the other choice, there is nothing incoherent about having different standards in each case, such that we require a higher level of competence in order to consider someone competent enough to choose death and a lower level of competence to choose cake. If I offer a person the choice of cake or death, the person can meet the standard that is appropriate to be considered competent enough to choose cake, even if they do not meet the standard appropriate to be competent enough to choose death 12. (p751)…”

Section: Risk-related Standards Of Competencementioning

confidence: 99%

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Risk-related standards of competence are a nonsense

2022

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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.

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Section: Risk-related Standards Of Competencementioning

confidence: 98%

Section: Clarifying the Issuementioning

confidence: 99%

Section: Risk-related Standards Of Competencementioning

confidence: 99%

Section: Risk-related Standards Of Competencementioning

confidence: 99%

Section: Risk-related Standards Of Competencementioning

confidence: 99%

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Risk-related standards of competence are a nonsense

2022

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Risk‐Sensitive Assessment of Decision‐Making Capacity: A Comprehensive Defense

Kim,

Berens

2023

Hastings Center Report

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Should the assessment of decision‐making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. We respond to the critics’ main concerns by providing a comprehensive account of how risk‐sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations.

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Capacity, Autonomy, and Risk: Reflecting on Asymmetries in Capacity to Consent and Capacity to Refuse

Pugh

2024

Ethic Theory Moral Prac

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There has been renewed interest in whether we should understand standards of decision-making capacity (DMC) to be risk-relative. Critics of risk-relative standards often highlight a puzzling asymmetry that they imply; a patient may have the requisite DMC to consent to a treatment that is in their best interests, whilst lacking the requisite DMC to refuse that same treatment, given the much higher risk that this would entail. Whilst some have argued that this asymmetry suggests that risk-relative standards are nonsensical, in this paper I defend a ‘quality of evidence’ view of such standards. I begin by outlining DMC’s purported gate-keeping role in medical ethics, and identifying three key normative claims that undergird this role. I then explain how two competing theories of risk-relative standards are incompatible with at least one of these claims. Drawing on Douglas’ distinction between standards of ‘true capacity’ and standards invoked in the ‘test’ for capacity, I then outline my ‘quality of evidence’ view. I explain how the view is compatible with the aforementioned normative claims, and outline the nature of the asymmetry it implies. I conclude by responding to the objection that there is no meaningful distinction between ‘true capacity’ and the ‘test’ for capacity.

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Cake or death? Ending confusions about asymmetries between consent and refusal

Cited by 10 publications

References 6 publications

Risk-related standards of competence are a nonsense

Risk-related standards of competence are a nonsense

Risk‐Sensitive Assessment of Decision‐Making Capacity: A Comprehensive Defense

Capacity, Autonomy, and Risk: Reflecting on Asymmetries in Capacity to Consent and Capacity to Refuse

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