title: Competence and paternalism.
abstract: Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics.
authors.affiliation: Cleveland State University, Department of Philosophy, Cleveland, Ohio 44115, USA. jdemarco@popmail.csuohio.edu
authors.forename: Joseph P
authors.initials: JP
authors.lastname: DeMarco
mesh_terms: D000671:Amputation, Surgical; D026689:Ethical Analysis; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D016743:Mental Competency; D026706:Paternalism; D026684:Personal Autonomy; D012306:Risk; D016312:Treatment Refusal / Q000331:legislation & jurisprudence