Four concepts of autonomy, a process which allows patients under medical care to control treatment decisions, exists as a way to combat the lack of a universal interpretation of autonomy amongst health professionals. Each method discusses a unique view on what an autonomous decision entails, varying in conditions that must be reached to garner a decision as autonomous. Libertarian autonomy, in particular, states that full autonomy is achieved when an individual is free from external factors that may influence an individual's decision making (Mackenzie, pg. 282). The government remains neutral to the lifestyles of its citizens, avoiding standards of what consists of ethical and unethical personal endeavors. Under libertarian autonomy, the state should have no authority over individual liberty as the government solemnly exists to protect the liberty and freedom granted to its citizens. Freedom of choice is given full benefit even in cases where a patient's decision may be harmful to themselves as patients are assumed to know best about their own needs. While liberatarian autonomy attempts to grant total liberty to individuals, it fails to address the role of government in protecting citizens incapable of rendering rational personal decisions as a result of limited capacity and competence, an essential of rendering a fully autonomous decision.

Capacity, defined as having the ability and capability to make an informed medical decision, must be evident in order to have an autonomous decision (Berg and Makielski, pg. 292). Rationality is essential to achieving autonomy, as patients must be able to comprehend the consequences and substantial effects of refusing treatment. If patients cannot rationalize how a decision impacts their life, they have failed to grasp the consequences of their choices, potentially influencing them to elect a decision that may not be in their best interests. Libertarian autonomy rejects government interference with personal liberty, conflicting with the role of the state in protecting the rights of citizens by determining whether they have the competence to make an informed decision. Competence, determined by the court, rules whether a patient holds the capacity to make medical decisions (Berg and Makielski, pg. 292). Under libertarian autonomy, this act by the state violates an individual's freedom of choice, dwindling their personal decision of choices. Freedom of choice, however, works best in individuals who have full capacity to render decisions. For individuals who have limited capacity, freedom of choice cannot be autonomous as said individuals lack the capacity to reach a rational autonomous decision crucial to autonomy. For patients with certain illnesses, decisions are not a mere reflection of personal choice, but rather a result of their infliction. In the case of depression, suicidal ideation can influence an individual to favor death over mortality, a process inherently unnatural as humans generally value mortality. Sufferers cannot comprehend the concept of mortality and its finality, failing to understand the severity of refusing medical help. As a result, they cannot be determined by officials to have the capacity to make medical decisions as they cannot appreciate the necessity of treatment. This step is essential in protecting vulnerable patients from medical professionals attempting to manipulate patients for personal benefits, such as in the case of pushing a new incentivized treatment or unethical experiments.

The state aims to secure the personal liberty and safety of incapable patients, interfering only in regards to preventing irrational treatment decisions, something that cannot be done under libertarian autonomy. As capacity is embedded in autonomy, governmental interference is essential to defending the rights of patients not able to conceptualize the results of their decisions. The state does not restrict personal freedom, but rather attempts to protect individuals from decisions which may not reflect the best interests of the patient or have been chosen under a rational, fully autonomous mind.