Autonomy ought-is gap and its potential solution: a call for ‘autonomy consultants’ in modern healthcare

Respect for patient autonomy is a fundamental principle in healthcare and medical ethics. However, empirical evidence reveals a persistent gap between ethical standards and their practical implementation. Autonomy requires more than obtaining informed consent—it can also involve supporting deliberation, clarifying preferences, engaging with family members, assessing decision-making competence, interpreting advance directives and reconstructing presumed wishes. These tasks are complex, time-consuming and demand specialised skills that many healthcare professionals lack. To address this challenge, we propose the establishment of a new professional role: autonomy consultant . This role aims to bridge the gap between ethical requirements and current practice by distributing responsibility beyond existing clinical roles. We outline the potential tasks and competencies of autonomy consultants and discuss anticipated challenges. While unconventional, our proposal underscores the importance of ensuring that patient autonomy is genuinely respected and promoted in healthcare.