Before we can design medical decision procedures which adequately balance patient autonomy against broader well-being and social concerns, we must first understand what autonomy is and why it is important. An adequate conception of autonomy ought to be both theoretically sound and pragmatically useful. I propose an expanded and clarified individualistic conception of autonomy for use in bioethics that provides action-guidance in regard to obtaining genuinely informed consent and which can avoid many of the pitfalls which face more revisionary notions of autonomy.