Dr. Wirshing and colleagues applied a rigorous procedure to maximize patients’ potential for understanding and to assess their ability to understand. In their Method section, the authors wrote about understanding, comprehension, knowledge, and the ability to grasp. They kept administering the Informed Consent Survey "until the patient answered all items of the survey correctly, at which point the informed consent form was signed" (italics added) (p. 1509). Evidently, the procedure was not about assessment of comprehension only. It was about securing the consent. Despite their acknowledgment of "a phase for decision making" (p. 1508), the authors reduced the consent process to a phase in which information is transmitted.