What Is Autonomy When the System Decides You Don't Get to Have It?
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What Is Autonomy When the System Decides You Don't Get to Have It?
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We like to pretend autonomy is neat and clean — a signature on a consent form, an advance directive in a drawer. But what happens when saying "no" costs the system something? And what happens when the decision isn't even left in your hands?
In this episode, Mike and Rob take on the pillar they keep circling back to: patient autonomy — your right to say yes, and your right to say no. They lay out what autonomy actually requires (informed consent, capacity, competence), why a treatment can be medically beneficial yet morally unacceptable to the patient, and how autonomy gets quietly stripped away in ways that never make headlines.
Then they connect the threads from recent cases: the Georgia law that overrode Adriana Smith's surrogate decision-maker, the WISeR model where a third party thousands of miles away can deny approved care, and Pete Jacobs — the competent patient who mouthed "suction me," pointed to his airway, and was ignored while staff hid behind scope. Different stories, same erosion.
The uncomfortable question at the center: are we treating the patient's goals, or our own institutional protocol?
Congratulations also to co-host Rob — New Hampshire's Respiratory Care Practitioner of the Year 2026.
Join the conversation. Let's get ethical.