To the Editor: We read with interest the case study in the November-December 2007 issue (“Old Enough,” commentaries by Robert D. Orr and Debra Craig). The commentaries focus on whether a teenager named “Joy” is sufficiently mature that physicians should respect her blood transfusion refusal. The commentators consider only one issue: “Is Joy competent?” But even if she is, that is not the end of the story. While competence is essential in medical decision-making, so are two other requirements: voluntariness and the availability of full information. These three elements are equally necessary for a patient to have the capacity to accept or refuse proposed medical treatment. In 2006, we published in Paediatrics & Child Health on similar but real Canadian cases, with an unexpected outcome. The Watchtower Society wrote to the editors of that journal in an apparent attempt to prevent publication of what we had written. Fortunately, the journal editors exercised their independence and published our article.