Development of the principle of respect for autonomy in neurology: an ethical examination of current approaches

The article is devoted to the analysis of the transformation of the principle of patient autonomy in modern neurological practice. With the digitalization of medicine and the growing number of patients with cognitive impairments, traditional concepts of patient autonomy are giving way to more complex concepts: relational, dynamic, contextual, and hybrid autonomy. The authors investigate how these models are applied in the management of patients with dementia, ALS, multiple sclerosis and other neurological diseases accompanied by fluctuating cognitive decision-making ability. Special attention is paid to ethical dilemmas at the junction of neurotechnology and the human factor: from algorithmic paternalism in AI systems to the problems of «digital inequality». Concrete clinical examples demonstrate the practical application of the «sliding scale of autonomy» and maps of partial capacity. The authors propose decision-making algorithms for neurologists that balance respect for the patient’s will, medical expediency, and the demands of the digital age.