Respect for autonomy
- Principle
A capable, informed person has the right to decide about their own body and treatment, even when the doctor disagrees.
What it is
Respecting autonomy means recognising that a capable adult decides about their own life and health according to their own values. A decision is autonomous when the person understands the information, acts intentionally and is free of coercion. The principle has a negative side (do not impose treatment or manipulate) and a positive side (inform truthfully and support the person in deciding). It underpins informed consent, the right to refuse treatment and confidentiality.
What it requires
- Inform truthfully, in plain language, about the diagnosis, the options, their risks and the option of no treatment.
- Check that the person understands and can reason about the information.
- Make sure they decide without coercion, manipulation or undue pressure from family or staff.
- Accept the decision of a capable person even if the doctor thinks it is wrong.
- Protect their privacy: what the patient tells belongs to the patient.
In clinical practice
- Refusal of treatment: explain the consequences, record it in the medical record and keep offering the care the person accepts.
- Patient unable to decide: look for their earlier wishes (advance directive) and let the surrogate decide according to them.
- Cultural differences: some people prefer to decide with their family; respecting autonomy includes respecting that choice if it is free.
- Autonomy does not oblige the doctor to give treatments without an indication: the patient chooses among reasonable options.
Limits and exceptions
- Emergency: if there is no time or way to obtain consent, act to save life (Law 23 of 1981, arts. 14 and 15).
- Waiver: the person may ask not to be informed and delegate the decision.
- Therapeutic privilege: withholding information is discussed only when telling would cause serious, immediate harm; it is a narrow and much-criticised exception.
- Public health: some measures (quarantine, mandatory reporting) limit autonomy to protect others.
Test yourself
Think of the answer, then tap the question to see it.
Which four conditions make a decision autonomous?
Capacity, enough information, understanding and voluntariness (no coercion).
May a capable patient refuse a treatment that would save their life?
Yes. If they are capable, informed and decide freely, the refusal is respected; it is recorded and other care keeps being offered.
Which exceptions allow acting without consent?
A life-threatening emergency with no way to ask, incapacity (the surrogate decides), the patient's waiver and, very narrowly, therapeutic privilege.
Which article of Colombia's Law 23 of 1981 requires asking for the patient's consent?
Article 15: the doctor will ask consent for the treatments considered necessary that may affect the patient, except when this is not possible.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research (U.S. Department of Health and Human Services, Office for Human Research Protections, 1979); WMA International Code of Medical Ethics (World Medical Association, 2022); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo (Colombia), 1981).
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Representative model, for educational purposes only.