 Some authors oppose the terminology of presumed consent as a contrived “myth” or “fiction” of actual consent (Harmon 1990; Brownsword 2004, 232–3; Beauchamp and Childress 2008, 107; Dworkin 1988, 117). They concede that when a nurse approaches a patient with a syringe, the patient’s failure to protest constitutes actual, albeit tacit, consent per convention. But they add that it is fraudulent to presume consent when consent is not explicitly given and no relevant convention specifies that silence expresses consent.