Viewpoint argues that respecting autonomy requires retaining clinical responsibility

In a viewpoint published in the Journal of General Internal Medicine, physicians Carter Winberg and Marat Slessarev argue that clinicians can unintentionally withdraw from professional responsibility when they treat a patient’s request as decisive. Their proposed “autonomy trap” describes situations in which ethical care is equated with maximizing patient choice, even when clinicians must assess medical appropriateness, offer recommendations, explain concerns, and share responsibility for difficult decisions. The essay is an argument and proposed approach rather than an empirical study or clinical guideline.

The authors identify code-status discussions as a recurring example of the problem. Clinical notes may record that a patient wishes to receive cardiopulmonary resuscitation after cardiac arrest, sometimes alongside qualifications about advanced comorbidities, clinical frailty, or the limited likelihood that CPR will benefit the patient. The authors argue that clinicians often respond by presenting available interventions and positioning themselves as neutral parties. They contend that this practice can shift the moral and emotional burden of life-and-death decisions to patients, families, or substitute decision-makers without distinguishing between a patient’s authority to refuse treatment and an unrestricted claim to receive any requested intervention.

The critique is grounded in the principlist framework associated with Beauchamp and Childress, which allows competing moral principles to override respect for autonomy and rejects any fixed hierarchy among principles. Winberg and Slessarev describe how an autonomy-focused approach can become dominant in clinical practice: clinicians offer options, outline risks and benefits, obtain informed consent, and regard their ethical obligations as fulfilled. They call the resulting model consumeristic because patients or substitute decision-makers may bear responsibility for choices made during periods of vulnerability. According to the essay, this shift can weaken shared responsibility and the patient-physician relationship, although the authors do not present measured outcomes from the model.

The authors distinguish the autonomy trap from every decision to provide CPR that clinicians judge unlikely to benefit a patient. CPR may be unable to restore circulation, or it may restore circulation without producing an outcome clinicians consider worthwhile. The latter includes judgments about survival, disability, suffering, and the value of additional time, which are not purely physiological. Patients and families may value brief survival, the assurance that clinicians did not give up, or freedom from feeling responsible for a relative’s death. These considerations may reflect cultural, religious, or social understandings of a good death. The authors state that failure to recognize such meanings can contribute to distrust and inequity, but their essay does not quantify those effects.

They also caution that providing CPR in carefully selected cases after considering broader benefits may itself be an exercise of professional judgment rather than an abdication of responsibility, provided clinicians consider potential suffering. The problematic pattern, in their view, is supplying CPR solely because it was requested without evaluating, communicating about, or accepting responsibility for its medical and ethical appropriateness. This distinction means the essay does not characterize all patient requests for resuscitation as irrational or inappropriate, nor does it support unilateral decisions without contextual evaluation.

The authors propose three origins for the autonomy trap. First, they associate the growth of bioethics with neoliberal economic structures emphasizing market primacy, individualism, and preference maximization, noting that respect for autonomy aligns readily with an understanding of patients as consumers. Second, they identify defensive medicine, defined as practice driven by concern about litigation rather than patient benefit, as a factor that may encourage clinicians to defer to requested interventions to avoid legal, reputational, and institutional pressures. Third, they describe a collapse of administrative and clinical contexts: the former establishes what the biomedical community regards as legitimate medical care, while shared decision-making allows a patient to select among established options that fit their values.

The consequences they anticipate include burdens on patients making decisions during acute stress, pain, and uncertainty; guilt and delayed remorse after informed decisions; and the offer of interventions that cannot achieve their intended goal, which they describe as false choices. Clinicians who provide care they believe is misaligned with a patient’s best interest or approaches harm may experience moral distress and disengagement from outcomes. These are arguments advanced by the viewpoint, not findings from a cohort, simulation, survey, or other outcome study, and the article provides no estimates of their frequency or magnitude.

To avoid the trap while preserving the rejection of paternalism, the authors say physicians should first determine which interventions are medically appropriate through thorough clinical assessment, supplemented where applicable by validated prognostic and risk-stratification tools. Recommendations should integrate prior wishes, baseline functional status, comorbidities, current illness severity and trajectory, treatment risks and benefits, and the patient’s values and acceptable outcomes. Because the efficacy of advance care planning is mixed, they argue that clinicians should help construct values-based care plans in real time amid clinical uncertainty. They frame evidence-informed assessment combined with patient values as shared responsibility rather than a unilateral command.

Trust is central to this model, according to the essay. Clinicians are encouraged to demonstrate competence, communicate clearly and honestly, listen with empathy, explore the patient’s experience, and provide understandable information. The authors also recommend ethics education that deepens understanding of principlism while familiarizing clinicians with care ethics and virtue ethics. They describe microethics as a practical lens for self-reflection, perspective-taking, cultural humility, and attention to how language, framing, and behavior shape trust and redistribute decision-making responsibility. Their final claim is that autonomy remains indispensable to medicine, yet respect for autonomy and informed consent alone cannot carry the full ethical responsibility of care.

Subject of Research: A bioethics viewpoint on balancing patient autonomy with clinical judgment and shared responsibility in care decisions.

Article Title: The Autonomy Trap: When Respect for Choice Becomes Withdrawal of Professional Responsibility

Article References: Winberg, C., & Slessarev, M. (2026). The Autonomy Trap: When Respect for Choice Becomes Withdrawal of Professional Responsibility. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10866-w

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10866-w

Keywords: medical ethics, patient autonomy, shared decision-making, clinical judgment, cardiopulmonary resuscitation, code status, defensive medicine, advance care planning, professional responsibility, Autonomy, Trap, Respect