Dutch legislation attaches substantial legal consequences to patient decision-making
(in)competence. Since clear standards are lacking,laborious research efforts are directed towards formulating adequate criteria. In operationalising the concept,it is the question how legally valid criteria can be formulated that are also useful to everyday clinical practice. Two attempts to bridge the gap between abstract norms and concrete evaluations - starting from theory with its origins in health care - are discussed: the sliding scale approach and the use of therapeutic models. Also,some risks of fixation on competence and the attendant call for criteria are exposed.