A clinically accepted decision may remain ethically contestable even when it reflects competent professional judgment and ordinary standards of care. The unresolved question is whether patients can trigger a credible process through which disagreement is heard, independently reconsidered when necessary, and connected to an institution capable of giving reasons or providing remedy. This article develops a Decision-Rights / Procedural Justice Architecture for patient-initiated challenge. It distinguishes the right to trigger scrutiny from authority to make, review, uphold, revise, or overturn a clinical decision. Evidence on ethics consultation, rapid review, complaints, patient-safety participation, communication, and ethics-service design indicates that pathway availability alone is insufficient. Meaningful procedural justice requires accessible initiation, intelligible routing, epistemic standing, timely and reasoned response, appropriate independence, defined review authority, and a route to remedy. Ethics consultation, independent review, and clinical appeal therefore perform different institutional functions. A patient may justifiably possess a broad right to initiate challenge without receiving unilateral decisional control, provided that the institutional response is accessible, appropriately independent, reason-giving, timely, and capable of acting on the concern.
