Which principle is invoked when a patient’s right to refuse treatment is respected?

• A. Beneficence
• B. Autonomy
• C. Nonmaleficence
• D. Justice

Answer: (B)

Autonomy, the right to self-determination, is the principle at work when a patient’s choice to refuse treatment is honored. This reflects respect for the patient as an independent decision-maker who values their own goals, beliefs, and quality of life. For autonomy to apply, the patient must have decision-making capacity and be provided with adequate information to make an informed choice about the treatment, including what the treatment involves, its benefits and risks, and alternatives, along with the likely consequences of refusing.

If the patient is competent, their decision stands even if it leads to harm or worsens their condition, because respecting autonomy honors their values and preferences. Beneficence and nonmaleficence describe the clinician’s duty to help or not harm, but they do not override an informed, competent patient’s right to refuse. Justice concerns fairness in distribution of resources and opportunities, not the individual’s treatment choice. If a patient lacks capacity, decisions may be guided by advance directives or a legally authorized representative, but that shifts the focus away from honoring the failing capacity and toward ensuring decisions reflect the patient’s values as much as possible.