The ethical principle of autonomy is supported when

• A. A clinician treats all patients with similar attention
• B. Explaining the benefits and risks of enteral nutrition to the wife of a man in a persistent vegetative state
• C. Enteral nutrition is provided to a postoperative patient requiring mechanical ventilation
• D. A patient at end of life is allowed to refuse parenteral nutrition

Answer: (D)

Autonomy means respecting a patient’s right to make their own decisions about medical care, based on informed understanding of options, benefits, and burdens. When a patient at end of life chooses to refuse parenteral nutrition, the care team honors that self-determined choice, provided the patient has decision-making capacity. This puts the patient’s values and goals at the center and avoids forcing treatments that they do not want, even if those treatments could potentially extend life. The other scenarios don’t center a patient’s own decision in the same way: treating all patients with the same attention reflects justice, not autonomy; providing enteral nutrition to a postoperative patient on ventilation is standard treatment, not a patient-driven choice; discussing benefits and risks with a spouse supports informed decision making but autonomy is about the patient’s own decision, or decisions made via a chosen surrogate when capacity is lacking.