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.


METHODS
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.


CONCLUSIONS
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.
Shuman
Andrew G
AG
University of Michigan Medical School, Ann Arbor, Michigan, USA.
Barnosky
Andrew R
AR
D000328:Adult; D006407:Hematoma, Epidural, Cranial / Q000601:surgery; D006801:Humans; D008297:Male; D016743:Mental Competency; D028701:Patient Rights / Q000941:ethics*; D026684:Personal Autonomy; D016312:Treatment Refusal / Q000941:ethics*