 Closely associated with this approach is a particular picture of what it is for a decision to be rational. This is sometimes referred to as “internal” rationality, because it makes rationality a matter of the internal relations between beliefs, values and particular choices. It could also be called “instrumental rationality plus”. On this view, there must be internal consistency among the beliefs and values relevant to the decision at hand. In addition, an individual must be able to prioritize among her (decision-relevant) ends, and continue to update this priority ranking as circumstances change and evolve. And it requires (this is the instrumental part) being able to recognize which of the options available will best serve her ends. So consider again refusal of life-saving transfusion based on adherence to religious doctrine. It can be argued that, in such a case, the subject is decisionally capable to refuse the transfusion as long as the decision is rational according to internal reasons that he recognizes as his own, i.e., his choice (refusing transfusion/accepting death) best serves his ends (adherence to God’s commands as his religion interprets these), even if others find the choice puzzling.