This chapter, Autonomy and Ethical Principles in Surgical Practice, by Claudio S. Cinà and Labib Abouzahr examines the changing meaning of autonomy in surgical practice, emphasizing the need to balance it with beneficence, non-maleficence, and justice. It briefly talks about informed consent, but most of it is about the philosophical roots of autonomy, how it changes with different cultures, and how it interacts with technological progress and global inequalities. The analysis of cultural competencies and the ethical challenges arising from technological progress, including artificial intelligence (AI) and robotics, is approached through the lenses of autonomy and justice. The chapter underscores the importance of patient autonomy through collaborative decision-making and cultural sensitivity. It encourages modifications aimed at augmenting patient autonomy while adhering to established fundamental ethical principles.