This article provides a partial defence of the Court of Appeal's controversial view in Re R and Re W that there can be concurrent powers to give effective consent to medical treatment in parent and child, and suggests how those cases might be distinguished in a future case. The defence is based on emphasising the distinction between a refusal to consent and a refusal of treatment. The article argues that this distinction explains why in some cases a parent can have the power to consent, even where the child has refused to consent. The article also considers ethical arguments in support of this approach.