To be clear, such a system requires all the elements of informed consent with the sole exception of the active agreement of the patient or surrogate. Dr. Curtis, Professor Burt, and Dr. Manthous clearly articulate the necessity for open and clear communication, and the hazards of overestimating patient or surrogate comprehension. As Dr. Curtis and Professor Burt discuss, merely obtaining a signature on a piece of paper or a “yes” response does not ensure that such consent is informed. I myself have witnessed a physician obtain “informed consent” from a family, including having the father sign the consent form, without realizing that the family in fact comprehended only minimal English. The authors rightly explain that any method of shared decision making relies on excellent communication and sufficient comprehension regardless of whether one employs a consent or nondissent model. I do believe, however, that the term assent in such a context confuses the issue.