Coggon and Miola state that the courts have failed to fully consider how "autonomy" might be exercised by patients. They have focused on what is "material" rather than any more substantive reflection on what autonomy really means for patients.

The end result they say is a misconceived attempt to prioritise a principle that may at times be counter-productive for patients. The focus is on provision of information without considering the question of understanding that information.

The fundamental flaw is that the provision of information does not in itself guarantee that an autonomous decision can be made. It only guarantees that information is passed on to the patient. It does not guarantee that the patient can then act autonomously

There appears to be an assumption by many in the medical profession that if a doctor provides a list of risks to the patient and then allows the patient to make his/her own choice based on that information then the decision is rendered autonomous.

While disclosure of relevant information is "part" of servicing autonomy that in itself is not enough. Other factors such as patient understanding must be recognised by the profession and the courts as relevant if patient choice is to be protected.

There has been a concerning move post Montgomery to providing patients simply with lists of recognised risks in various procedures. The lists are not particularised to the patient. Does this address what really needs to be done?

It is concerning that the courts have concluded that the clinicians obligation does not extend to ensuring the patient has understood. It is suggested that the the laws approach is flawed and counter productive for vulnerable patients who need it most

The law insists that information is given to patients as part of the tools necessary to make an autonomous decision but appear to have taken the protection of patient autonomy no further. They have also confused autonomy and liberty.