The sovereign-domain conception of autonomy is not the operative sense of autonomy in bioethics.

A third challenge is that not all acts that are generally assumed to violate informed consent seem contrary to autonomous decision-making. Suppose that a sufficiently capacitated adult patient refuses a safe, beneficial, and time-sensitive surgery to prevent a moderate disability, due to a simple misunderstanding of medical facts. There is no time to convince him of his mistake. Being uninformed, his decision cannot count as autonomous. But present medical practices surrounding informed consent