 To see what is at stake consider a case where a patient is refusing a low risk treatment that is highly beneficial for those with her condition. And suppose as well that the patient will die without it. Of course, it is always true of any patient in any situation that she might make a mistake, i.e., a judgment that does not really serve her interests even as she understands them. But in this case if refusal is a mistake it is a mistake with much worse consequences for the patient. Since in this case the harms associated with mistaken refusal are much greater than the harms associated with mistaken consent, the level of competence required to refuse can legitimately be set higher. 