This article traces the development of a patient's right to medical self-determination. It demonstrates that although this right has been boldly proclaimed in court rhetoric, it has been carefully constrained in court decisionmaking. In delineating the duty on physicians to disclose information essential for their patients to make their own decisions, courts have responded more to physician resistance than to patient need. To date, the tort doctrine of informed consent has proven inadequate to achieve true patient autonomy. The article explains why managed care constraints on insurance-covered treatment options and on physician disclosure of noncovered options warrants a reconsideration and expansion of the disclosure duty. Guiding principles are proposed to assure that patients are informed of medically appropriate treatment options even if their insurance will not pay for them.