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The ethical principle of respect for patient autonomy is firmly grounded in western ethical principles valuing individual freedoms. This chapter talks about autonomous choices, presenting a case of a 35-year-old man with colectomy. Of the four foundational principles in medical ethics: beneficence, nonmaleficence, respect for autonomy, and justice, the principle with the strongest influence in the United States is respect for personal autonomy. Three conditions must be met in order for an act (or choice) to be autonomous: a person must act with intention, with understanding, and without controlling influences. In the informed consent process, physicians have ethical obligations to avoid controlling influences that invalidate autonomous choice. Generally speaking intentional acts require planning, although not necessarily reflective thought or strategy. Coercion and manipulation are unethical because they violate the principle of respect for patient autonomy, and because manipulation often involves deception and violates physician obligations of veracity.