 Philosophers might naturally suppose that moral theorizing about informed consent would lead to and shape a theory of decisional capacity. After all, if the point of informed consent is to enable and promote autonomous decision-making, one might naturally suppose that the task is to distinguish those who can actually make autonomous decisions from those who cannot. This, in turn, would require a more detailed account of what goes into an autonomous decision. However, this is not what one finds in the literature, and for good reason. To begin with, to take such ideas seriously one would have to have an independent theory of autonomous decision-making that was concrete enough to guide practice, i.e., the development of tests and instruments. But philosophical theories of autonomy are, at least currently, far too abstract for this purpose. Moreover they are typically far too demanding (i.e., they appear to count far too many decisions as  non-autonomous).[1]  So, interestingly, although many philosophers and bioethicists continue to equate decisional capacity and the capacity for autonomous decision-making, it is really not true that our current notion of decisional capacity has been derived from the notion of autonomous decision-making. Instead, the current notion of decisional capacity has been built from the ground up, largely (though not entirely) independently of philosophical theory. And this means that it is an open question whether a competent decision is an autonomous decision.