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Do we need a threshold conception of competence?

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  • 1University of Amsterdam, Staten Bolwerk 16, 2011ML, Haarlem, The Netherlands. g.a.denhartogh@uva.nl.

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Summary

Assessing decision-making competence requires evaluating abilities alongside potential harms and autonomy. This research advocates for a nuanced, multi-dimensional approach, moving beyond simple thresholds and the hard versus soft paternalism distinction.

Keywords:
CompetenceDecision-making abilityDecision-making authorityHard paternalismSoft paternalismThreshold of competenceVariable standard of competence

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Area of Science:

  • Bioethics
  • Philosophy of Medicine
  • Decision Theory

Background:

  • The standard view assesses competence based on abilities, separate from the decision itself.
  • This leads to debates on overriding decisions due to harm (hard paternalism).
  • Current practice often uses a risk-dependent competence model.

Purpose of the Study:

  • To advocate for recognizing the multi-dimensional nature of competence judgments.
  • To challenge the threshold conception of competence.
  • To reject the strict distinction between hard and soft paternalism.

Main Methods:

  • Conceptual analysis of competence assessment.
  • Examination of decision-making authority and autonomy.
  • Critique of existing paternalism frameworks.

Main Results:

  • The standard competence assessment is insufficient.
  • Practical competence assessment is inherently multi-dimensional, weighing consequences, values, autonomy, and abilities.
  • A unified approach to competence and paternalism is proposed.

Conclusions:

  • Competence judgments should openly acknowledge their multi-dimensional nature.
  • The threshold model of competence is inadequate.
  • The categorical distinction between hard and soft paternalism should be abandoned in favor of a more integrated approach.