Patient autonomy is a cornerstone principle of medical ethics and widely discussed issue in specialized literature. In general, patient autonomy can be defined as self-determination, an expression of one’s own will, based on the ability of a person to guide and manage his/her own life in accordance with rational principles and rules, thus allowing him/her to consciously accept or refuse medical interventions.
The right to self-determination is ensured by the presence of valid consent by adherence to the principle of voluntariness and after the patient has been thoroughly introduced to the objective, nature of the procedures, potential risks, duration, anticipated effect of the intervention, etc.
In the context of neurodegenerative diseases particularly stands out the collision between the right to autonomy of a patient and the limits of his/her competence. The altered cognitive status expressed in memory deficit, sensory impairment, confusion, disorientation and compromised capacity to retain long enough and assess information due to brain lesions raises the ethical question about the real boundaries of competence and personal identity of AD subjects.
This faces the preclinically diagnosed individuals with the challenge to make decisions regarding their own future. To what extent do the above-mentioned subjects have the capacity to decide in their own best interest is a disputable issue where the positions of the authors divide and which has been already covered in the answer to the previous question.
Although patient autonomy is considered to be a key point and prerequisite for any medical intervention and has therefore been well debated in the literature on bioethics, data on ethical aspects regarding the application of experimental therapeutic methods in patients with mild cognitive impairment are scarce at best or missing.