 However, there remain some theorists who insist that there are cases in which irrationality is also a matter of outcome, of what one chooses. They resist the idea that we should focus exclusively on process when assessing capacity because of worries about particular kinds of cases. Consider the example of a subject who refuses electroconvulsive therapy for a severe depression that has not responded to any other forms of treatment. The patient refuses because of a deep fear of the procedure, even though she consented to it and benefited from it at one point in the past (Culver, Ferrell, &amp; Green 1980; Culver &amp; Gert 2004). In this case, given how harmful the subject’s choice may ultimately be to her, the decision not to accept the treatment seems problematic and, according to Culver &amp; Gert, ought to be challenged. However, in order to say that this patient is not capable of refusing this treatment, it seems that we would be forced to abandon a restricted focus on process. For it is most likely true that the process by which she reaches the decision is beyond reproach from the standpoint of internal rationality. Her current fear of the therapy is so great that she would rather die than undergo the treatment. Even if one thinks this is a re-prioritization of values brought on by her fear (which would be hard to establish), it remains true that currently she is reaching a decision consistent with what she currently cares most about. And that is all that is required by internal rationality. Yet Culver &amp; Gert think such a choice should be grounds for declaring the patient incompetent. They think such a choice is irrational in a broader sense than allowed by internal rationality.