Since the end of the 20th century, patient autonomy does not only aim at protecting patients’ personal rights, but also to promote their active cooperation in the health system. In Germany, the legal development of patient autonomy goes hand in hand with the concerted establishment of patient counseling and training designed to produce „informed decision makers“. This article examines the practice of patient autonomy and its corresponding subject beyond the sphere of formal law. Therefore, it draws on (1) reports of the German „Sachverständigenrates zur Begutachtung der Entwicklung des Gesundheitswesens“ and (2) a medical genetic counseling session. On the basis of an influential political-economic discourse on health policy and an advisory doctor-patient encounter it can be shown that the original goal of patient autonomy, namely the protection of personal freedom, tends to be perverted: Patient counseling and training increasingly requires that autonomy be exercised on the condition that it incorporate an expert-controlled rationality and exhibit the subject-position of an „informed decision maker“.