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Clarifying this issue is, however, of considerable importance when dealing with patients who, though competent and properly informed by the healthcare professionals,\n                    <jats:italic>withhold belief<\/jats:italic>\n                    in the medical facts presented to them. Are such self-imposed false believes compatible with autonomous decision-making and therefore demand respect, or do they undermine its epistemic foundation? Discussing two basic concepts of \u201cunderstanding\u201d as well as the resulting moral impasse between paternalism and arbitrariness, we propose a new direction of inquiry along two lines: First we interrogate a tacit assumption underlying the very notion of \u201cself-imposed false beliefs\u201d by discussing the question \u201cCan we believe at will?\u201d. This discussion yields a promising account that emphasizes the importance of\n                    <jats:italic>reasons-responsiveness<\/jats:italic>\n                    , shifting the focus from the\n                    <jats:italic>belief itself<\/jats:italic>\n                    to the\n                    <jats:italic>process of belief formation<\/jats:italic>\n                    . We conclude that not the truthfulness or falsity of patients\u2019 beliefs is key but by the procedural quality of their development. By drawing on the Elaboration Likelihood Model, we are invoking psychological research that supports this claim. Secondly, in order to transfer these insights to the theory and practice of medical ethics, we distinguish two notions of autonomy based on their functions as (1) ideal philosophical concept and (2) basic status designation in real life. The paper argues that in the first realm the notion of reasons-responsiveness informs our assessment of false beliefs and strategies to enhance the \u201cunderstanding\u201d part of autonomy, entailing limited positive duties for healthcare professionals. At the same time, appealing to the relevance of a basic concept of autonomy in the realm of legally binding decisions we argue that the strong duty of non-interference with competent patient\u2019s decisions must prevail.\n                  <\/jats:p>","DOI":"10.1007\/s11019-026-10396-6","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:42:22Z","timestamp":1790070142000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient autonomy despite false beliefs? On the epistemic prerequisites for autonomous treatment decisions"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9265-5324","authenticated-orcid":false,"given":"Christiane","family":"Burmeister","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0026-6389","authenticated-orcid":false,"given":"Nikolai","family":"M\u00fcnch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"10396_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.30965\/9783969753149","volume-title":"Informed Consent in der Medizin. Begr\u00fcndung, Voraussetzungen, Kontroversen","author":"Johann S Ach","year":"2024","unstructured":"Ach, Johann S., and Bettina Sch\u00f6ne-Seifert. 2024. Aufkl\u00e4ren, Verstehen und Einwilligen in der Medizin: Nachfragen und Pr\u00e4zisierungen. 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Retrieved July 29, 2026, from https:\/\/ssrn.com\/abstract=5047145"}],"container-title":["Medicine, Health Care and Philosophy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11019-026-10396-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11019-026-10396-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11019-026-10396-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:42:34Z","timestamp":1790070154000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11019-026-10396-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":62,"alternative-id":["10396"],"URL":"https:\/\/doi.org\/10.1007\/s11019-026-10396-6","relation":{},"ISSN":["1386-7423","1572-8633"],"issn-type":[{"value":"1386-7423","type":"print"},{"value":"1572-8633","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"assertion":[{"value":"25 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they do not have competing interests or relevant financial relationships to disclose.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}