In Re T ^1,2 the Court of Appeal had to consider the case of an adult Jehovah's Witness who refused treatment. A pregnant woman was involved in a car accident and, after speaking with her mother, signed a form of refusal of blood transfusion. After the delivery of a stillborn baby, her condition deteriorated, therefore a Court order was obtained in order to legalise a blood transfusion on the grounds that it was in the woman's best interest. In this case the Court of Appeal addressed the question related to capacity, life-threatening situation and right to refuse a medical treatment, particularly in relation to the degree of risk involved in a particular decision: ‘What matters is that the doctor should consider whether at that time he had a capacity which was commensurate with the gravity of the decision. The more serious the decision, the greater the capacity required.’ It is interesting to consider, as pointed out by Buchanan, ^{Reference Buchanan3} ‘What principles then govern the practice, described in Re T, whereby the level of capacity required for competence rises in proportion to what is at stake?’ In other terms, is the assessed capacity required for legal competence increased with the seriousness of what is at stake? Perhaps the assessment of capacity has to consider the importance, the risk and the gravity of the decision that the patient has to make. Following this train of thought, maybe different standards of competence are needed in order to ensure that genuine choices are being made.

Buchanan & Brock ^{Reference Buchanan and Brock4} were more inclined to sustain this view in terms of capacity, whereas Culvert & Gert ^{Reference Culver and Gert5} and Wicclair ^{Reference Wicclair6} found the idea of different standards of competence more paternalistic-oriented. Culvert & Gert argued that the capacity related to the degree of risk was against the principle of ‘symmetrical competence’ and pointed out that the change of external risk can potentially change the status of a person from competent to incompetent, ‘a fact inconsistent with the idea that competence is a genuine attribute of a person’.