 As a final challenge to grounding informed consent in autonomy, consider a patient who has been treated fairly and offered a simple explanation of her treatment and the alternatives, which she could comprehend if she tried; her failure to comprehend it and to choose autonomously is the fruit of her own neglect. Can the physician or the investigator really be blamed for the patient’s consequent non-autonomous choice (Sreenivasan 2003; Miller and Wertheimer 2010, 85, 95; Millum and Bromwich 2013)? In many areas of life in which consent seems necessary, what matters is not so much the “quality of choice,” say, how autonomous it is, but whether the person had been given the opportunity to make a choice of that quality (Scanlon 1988). Advocates of the autonomy rationale may respond in one of two ways. First, they may insist that when an investigator did due diligence to help candidate participants understand the significant risks of a study yet sees that they have not been understood, she has a reason to explain again, or recruit other candidates, precisely because the autonomy of study participation matters; alternatively, they may insist that having been given real opportunity to decide autonomously already counts as having been given autonomy over the matter.