 Of course there is no inconsistency if a refusal requires a greater degree of understanding and appreciation of the issues than a positive acceptance. But where the choice is a simple disjunction it is hard to see how this can be the case. Are not the issues at stake the same for both disjuncts? If the courts believe that an obligation to act in the best interests of the child trumps one to respect the wishes of a competent child it needs to be shown why this obligation does not have force in all circumstances. Why would a court not deny treatment to a child it does not believe in her best interests when it judges her competent to choose? If a child is competent then she is in all significant and relevant respects the equal of an adult and should be able both to choose and to refuse treatment.