Chapter 2 presents hard cases involving consent. These cases involve acts which are physically harmful or risky and which often challenge or transgress social norms. The first category consists of “self-directed” activities, such as suicide or body modifications. The second category, “bodily integrity exchanges,” consists of activities which involve the body on an intimate level. They pose varying degrees of risk of harm but the risk is generally considered reasonable. The basis for the objection to the activity is not that the risk is unreasonably high, but that the commercialization of the exchange or activity is morally objectionable because it commodifies the body. This category includes surrogacy contracts and kidney sales. The third category encompasses activities which involve a high risk of serious bodily injury or death. The purpose of the activity is not to harm oneself but to achieve some other objective through a dangerous or highly risky undertaking. This Chapter explores the consentability issues raised by these hard cases.