Theories of autonomy: individual, relational and family-centred
- Topic
Autonomy does not always mean deciding alone: many people decide with their family or with support, and that can be autonomous too.
What it is
The respect-for-autonomy page explains the principle; this page explains the theories behind it. The individual model sees a capable person as someone who decides for themselves and asks, above all, not to be interfered with. Relational theories point out that people live in relationships: family, culture and social conditions shape the capacity to decide and can strengthen or erode it, for example when poverty, fear or gender norms undermine trust in one's own judgement. In many Latin American families decisions are made together, and that is legitimate if the capable patient chooses it. The opposite risk is that the family hides information or replaces the patient's voice. In Colombia, Ley 1996 de 2019 replaced substituted decision-making with supports that help the person decide.
Key facts
- Procedural theories: a decision is autonomous if the person reflects on it and makes it their own, whatever its content.
- Substantive theories: they also require certain conditions, such as self-respect or trust in one's own judgement.
- Oppressive socialization: gender norms, poverty or discrimination can reduce critical reflection, even without coercion or illness.
- Second-order decision: the person can decide who decides, for example asking that a son receive the information.
- Risk of the family model: the family hides information or imposes its own view «for the patient's good».
- Risk of the individual model: leaving the patient alone with technical data and calling it respect.
Three models of autonomy in the consultation
| Model | Who decides | Role of the family | Risk |
|---|---|---|---|
| Individual | The capable patient | Optional, if the patient wishes | Abandonment: «it's up to you» |
| Relational | The patient, supported by their relationships | Support and context for deciding | Mistaking support for pressure |
| Family-centred | The family with the patient, or by delegation | Leading role | Hiding information or substituting the patient's will |
In clinical practice
- Ask at the start: «How would you like us to handle information and decisions? Would you like anyone to be present?», and record it.
- An older patient says «whatever my son says»: explore whether it is a free preference or fear and dependence; speak with her alone for a moment.
- If the family asks that the diagnosis not be disclosed, first ask the patient how much they want to know.
- A person with an intellectual disability: offer supports (plain language, pictures, a trusted person) before concluding they cannot decide.
Legal framework in Colombia
- Ley 1996 de 2019, art. 4, num. 2 and 3: autonomy and primacy of the person's will and preferences; if the will cannot be established unequivocally, the best interpretation of the will is used, based on the person's life history and previous statements.
- Ley 1996 de 2019, art. 6: presumption of capacity; all persons with disabilities hold rights and obligations, whether or not they use supports.
- Resolución 813 de 2026, art. 16, par. 2: for adjusting therapeutic effort (AET), close persons include the chosen family, the foster family and the care network; the representative can be whoever best reflects the patient's known preferences.
- Ley 1751 de 2015, art. 10 d): clear, appropriate and sufficient information for free decisions, and no one may be forced to receive treatment against their will.
- Official texts checked on 2026-11-13 at cancilleria.gov.co (normograma), minsalud.gov.co and normograma.supersalud.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
What distinguishes a relational theory of autonomy from an individual one?
The relational view holds that the capacity to decide is formed in relationships and social conditions that can strengthen or erode it; the individual view focuses on non-interference.
Is a capable patient who asks that their daughter receive the information and decide acting autonomously?
Yes, if the choice is free and informed: deciding who decides is an autonomous decision. It is recorded and the patient can return to the conversation at any time.
What did Ley 1996 de 2019 replace in decision-making for persons with disabilities?
Substituted decision-making, replaced by a system of supports in which the person's will and preferences come first.
What is the main risk of a family-centred decision model?
That the family hides information from a capable patient or imposes its own view instead of the patient's.
Elsewhere in DurgiPedia
- Law 1996 of 2019: legal capacity of adults with disability
- Culture, explanatory models and interpreters
- Shared decision-making
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: Feminist Perspectives on Autonomy (Stanford Encyclopedia of Philosophy, 2024); Ley 1996 de 2019, régimen para el ejercicio de la capacidad legal de las personas con discapacidad mayores de edad (Cancillería de Colombia, Normograma, 2019); Boletín Jurídico No. 04 de 2026, sección 2.2.6: Resolución 813 de 2026 (Ministerio de Salud y Protección Social, 2026); Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud (Superintendencia Nacional de Salud, Normograma, 2015).
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Representative model, for educational purposes only.