The author also names four exceptions to informed consent, which are arguably applicable more to acute trauma centers and emergency rooms than to decision making by the chronically and terminally ill. The first and second exceptions, coma and legal incompetence, appear self-evident. The third exception, however, "when a patient waives his or her right to be fully informed," is materially wrong and violates autonomy theory—the ability to choose. (I believe that by "the ability to make a choice," Grisso and Appelbaum  meant to establish a low threshold for competency. Since those with certain obsessional problems routinely have difficulty in making choices, there is no intimation that it should be considered as an indication of informed consent per se.) Even if a patient refuses to receive "full" knowledge of the situation, there is neither enough to assume waiver of liberty nor evidence of futility regarding his or her treatment. Since without knowledge of the relevant facts there can be no waiver, there is no waiver by "refusal to know" (Black’s Law Dictionary, 7th ed., p. 1574). The fourth exception, "therapeutic privilege," is admittedly paternalistic and rarely condoned. All in all, these are not exceptions to informed consent, since in each of the above-mentioned states, a surrogate would inevitably be appointed to actualize the informed consent.