 What we here call “the value neutrality constraint” is a bit more complex, but its significance makes it important to explain clearly. Value neutrality refers to the idea that we need to leave room for patients to make unusual or unpopular choices (Craigie 2013a: 1). People vary greatly in their values and so, even when confronted with similar situations, make very different kinds of choices. If the freedom to decide for oneself is to be meaningful, we need to ensure that individuals are not deemed to lack decisional capacity to make a choice simply because they are choosing something others disapprove of. The worry is real. In the not-too-distant medical past, doctors often did assume incapacity and would therefore refuse to honor patient wishes whenever a patient rejected what the doctor saw as beneficial treatment (Culver, Ferrell, &amp; Green 1980: 587). Thus it seems important to find a way to distinguish competent though unusual choices from choices that are unusual because incompetent (because arrived at by flawed or inadequate mental processes).