Exploring the Limits of Autonomy

Background: The ethical principle of autonomy is explored as it applies to situations in which patients' capacities to make decisions are questionable. Case Report: A 40-year-old man presented to the Emergency Department with an epidural hematoma, and refused to undergo emergent surgical treatment. Considering the acutely life-threatening nature of his problem and the inability to confirm the patient's capacity in the presence of a traumatic brain injury, the decision was made to proceed with emergent surgical treatment without consent. Discussion: The concept of conditional autonomy is introduced, defined, and employed to defend the process whereby a select group of patients may be treated without full knowledge of their wishes.