 Many theorists stop at this minimal interpretation, but even this requirement is significant, for it rules out certain kinds of patients who are delusional, who can grasp what their doctor is saying to them, but refuse to believe that anything their doctor says is true (Grisso &amp; Appelbaum 1998: 42–43). In addition, in order to apply this requirement, clinicians must be able to distinguish between cases where patients refuse to believe doctors for doctrinal or cultural reasons—for example a Christian Scientist who believes that despite what her doctor says only prayer can heal—and cases where failure of appreciation results from losing touch with reality (Grisso &amp; Appelbaum 1998: 45–49). For example, imagine a case in which an elderly demented woman clearly grasps the fact that her surgeons wish to amputate her feet because her feet are gangrenous and they believe that she is in real danger of dying if they do not amputate. But despite being able to state these facts back to her doctors, the woman, who seems confused and disoriented, says things that reveal she does not really believe there is anything seriously wrong with her feet. For example, she talks about what she will do once her feet are all healed. She may fail appreciation and so may not be deemed competent to refuse the treatment (based on a case described in Abernathy 1984).