Patient autonomy became increasingly important during the last decades. It is often described to be an antagonist to medical paternalism. Like for patients with full decisional capacity, autonomy should also be protected for incapacitated patients. To enable this, the Austrian legislator recently regulated advance directives and durable powers of attorney. These tools should be combined with a process of communication with the patient's loved ones and consultation by a caring physician according to the integrative model. This can enhance and supplement the patient's autonomy. This article demonstrates surrogate decision making in theory and by the example of a case report.