Despite the distinguished history that medical ethics has enjoyed, traditional codes and practices of medical ethics proved to be inadequate to address a great many problems arising from modern medicine and scientific research. At this point bioethics was born and displaced much in the Hippocratic tradition. It brought new ideas about the rights of patients and research subject to decide what will happen to them--their autonomy rights. In the last 40 years it has come to be appreciated that protection of the autonomy of patients and research is a very special value, but one often abused in the history of medicine and research. This transformation in medical ethics has been one dimension of a larger struggle over patient’s rights, physician responsibility, and appropriate public policy. Several conditions explain the new prominence of autonomy. Perhaps most important were the issues raised in the 1960s and 1970s by the civil rights, women's rights, and consumer movements, and the emergence of rights of informed consent and informed refusal as major doctrines of law and biomedical ethics. I will discuss how such movements increased autonomy rights and set bioethics on the path of a better understanding of the nature and value of autonomy for patients and subjects. I will be arguing that these movements in defense of autonomy continue vigorously today and will discuss the especially revolutionary manner in North America in which public policy regarding the right to die is right now being transformed. I will also discuss where autonomy should play a major role in bioethics and where it should not in upcoming years.