When autonomous rights cannot be exercised by an individual because that person is comatose, mentally retarded or mentally ill, or a child, a surrogate exercises this power through proxy consent. The traditional choice of the family as proxy for children is under attack. The concept of relative competence is an alternative to determinations of competence or incompetence. Proxy consent involves not only deciding who speaks for the child but defining who needs proxies. Psychiatrists must familiarize themselves with the issues, in such concepts as autonomy, autonomous rights, consent, competence, surrogation of authority, representation, paternalism vs. individuality, and the hierarchy of values.