Right to medical autonomy: refusal of treatment as an element of personal freedom

Abstract

The right to refuse medical treatment represents one of the most complex intersections of personal freedom, medical ethics, and legal regulation. This article examines the theoretical and legal foundations of the patient’s right to refuse medical intervention, tracing its evolution from paternalistic medical practice to the modern autonomy-centered paradigm. Drawing on international legal instruments, including the Oviedo Convention and the Charter of Fundamental Rights of the European Union, as well as the case law of the European Court of Human Rights, notably the Grand Chamber’s decision in Pindo Mulla v. Spain, the article establishes that the right to refuse treatment constitutes an independently recognized subjective right rooted in the principles of personal autonomy, bodily integrity, and human dignity.

The article analyzes the doctrine of informed consent as the legal foundation upon which the right to refuse is built, emphasizing that genuine informed refusal presupposes both awareness and voluntariness. Particular attention is paid to the limits of this right, which are determined by the patient’s legal capacity, the nature of the medical situation, and the legal validity of advance directives. The study further addresses the theoretical tension between patient autonomy and the physician’s duty of beneficence, arguing that these principles are not mutually exclusive: in situations involving a competent patient, autonomous will takes priority, while beneficence is realized through ensuring the quality of the decision-making process rather than overriding the patient’s choice.

A comparative dimension is incorporated through analysis of regulatory approaches in France, Germany, the Netherlands, Italy, the United Kingdom, and Japan, revealing a pan-European doctrinal convergence toward recognizing informed refusal as a legally enforceable right. The article concludes that the absence of a unified legislative mechanism in Ukraine for implementing the right to refuse treatment, coupled with vague legality criteria and gaps in defining medical professionals’ liability, necessitates systematic legal reform aligned with European standards.