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In developmental psychology and moral, political, and bioethical philosophy, autonomy[note 1] is the capacity to make an informed, uncoerced decision. Autonomous organizations or institutions are independent or self-governing. Autonomy can also be defined from a human resources perspective, where it denotes a (relatively high) level of discretion granted to an employee in his or her work. In such cases, autonomy is known to generally increase job satisfaction. Self-actualized Individuals are thought to operate autonomously of external expectations. In a medical context, respect for a patient's personal autonomy is considered one of many fundamental ethical principles in medicine.
In the sociology of knowledge, a controversy over the boundaries of autonomy inhibited analysis of any concept beyond relative autonomy, until a typology of autonomy was created and developed within science and technology studies. According to it, the institution of science's existing autonomy is “reflexive autonomy”: actors and structures within the scientific field are able to translate or to reflect diverse themes presented by social and political fields, as well as influence them regarding the thematic choices on research projects.
Institutional autonomy is having the capacities as a legislator to be able to implant and pursue official goals. Autonomous institutions are responsible for finding sufficient resources or modifying their plans, programs, courses, responsibilities, and services accordingly. But in doing so, they must contend with any obstacles that can occur, such as social pressure against cut-backs or socioeconomic difficulties. From a legislator's point of view, to increase institutional autonomy, conditions of self-management and institutional self-governance must be put in place. An increase in leadership and a redistribution of decision-making responsibilities would be beneficial to the research of resources.
Institutional autonomy was often seen as a synonym for self-determination, and many governments feared that it would lead institutions to an irredentist or secessionist region. But autonomy should be seen as a solution to self-determination struggles. Self-determination is a movement toward independence, whereas autonomy is a way to accommodate the distinct regions/groups within a country. Institutional autonomy can diffuse conflicts regarding minorities and ethnic groups in a society. Allowing more autonomy to groups and institutions helps create diplomatic relationships between them and the central government.
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Autonomy is a key concept that has a broad impact on different fields of philosophy. In metaphysical philosophy, the concept of autonomy is referenced in discussions about free will, fatalism, determinism, and agency. In How to Make Good Decisions and Be Right All the Time, philosopher Iain King developed an 'Autonomy Principle', which he defines as "Let people choose for themselves, unless we know their interests better than they can." King argues it is not enough to know someone else's interests better than that person; their autonomy should only be infringed if that person is unable to know their own interests on a particular matter. In moral philosophy, autonomy refers to subjecting oneself to objective moral law.
According to KantEdit
Immanuel Kant (1724–1804) defined autonomy by three themes regarding contemporary ethics. Firstly, autonomy as the right for one to make their own decisions excluding any interference from others. Secondly, autonomy as the capacity to make such decisions through one's own independence of mind and after personal reflection. Thirdly, as an ideal way of living life autonomously. In summary, autonomy is the moral right one possesses, or the capacity we have in order to think and make decisions for oneself providing some degree of control or power over the events that unfold within one's everyday life.
The context in which Kant addresses autonomy is in regards to moral theory, asking both foundational and abstract questions. He believed that in order for there to be morality, there must be autonomy. He breaks down autonomy into two distinct components. "Auto" can be defined as the negative form of independence, or to be free in a negative sense. This is the aspect where decisions are made on your own. Whereas, "nomos" is the positive sense, a freedom or lawfulness, where you are choosing a law to follow. Kantian autonomy also provides a sense of rational autonomy, simply meaning one rationally possesses the motivation to govern their own life. Rational autonomy entails making your own decisions but it cannot be done solely in isolation. Cooperative rational interactions are required to both develop and exercise our ability to live in a world with others.
Kant argued that morality presupposes this autonomy (German: Autonomie) in moral agents, since moral requirements are expressed in categorical imperatives. An imperative is categorical if it issues a valid command independent of personal desires or interests that would provide a reason for obeying the command. It is hypothetical if the validity of its command, if the reason why one can be expected to obey it, is the fact that one desires or is interested in something further that obedience to the command would entail. "Don't speed on the freeway if you don't want to be stopped by the police" is a hypothetical imperative. "It is wrong to break the law, so don't speed on the freeway" is a categorical imperative. The hypothetical command not to speed on the freeway is not valid for you if you do not care whether you are stopped by the police. The categorical command is valid for you either way. Autonomous moral agents can be expected to obey the command of a categorical imperative even if they lack a personal desire or interest in doing so. It remains an open question whether they will, however.
The Kantian concept of autonomy is often misconstrued, leaving out the important point about the autonomous agent's self-subjection to the moral law. It is thought that autonomy is fully explained as the ability to obey a categorical command independently of a personal desire or interest in doing so—or worse, that autonomy is "obeying" a categorical command independently of a natural desire or interest; and that heteronomy, its opposite, is acting instead on personal motives of the kind referenced in hypothetical imperatives.
In his Groundwork of the Metaphysic of Morals, Kant applied the concept of autonomy also to define the concept of personhood and human dignity. Autonomy, along with rationality, are seen by Kant as the two criteria for a meaningful life. Kant would consider a life lived without these not worth living; it would be a life of value equal to that of a plant or insect. According to Kant autonomy is part of the reason that we hold others morally accountable for their actions. Human actions are morally praise- or blame-worthy in virtue of our autonomy. Non- autonomous beings such as plants or animals are not blameworthy due to their actions being non-autonomous. Kant's position on crime and punishment is influenced by his views on autonomy. Brainwashing or drugging criminals into being law-abiding citizens would be immoral as it would not be respecting their autonomy. Rehabilitation must be sought in a way that respects their autonomy and dignity as human beings.
According to NietzscheEdit
Friedrich Nietzsche wrote about autonomy and the moral fight. Autonomy in this sense is referred to as the free self and entails several aspects of the self, including self-respect and even self-love. This can be interpreted as influenced by Kant (self-respect) and Aristotle (self-love). For Nietzsche, valuing ethical autonomy can dissolve the conflict between love (self-love) and law (self-respect) which can then translate into reality through experiences of being self-responsible. Because Nietzsche defines having a sense of freedom with being responsible for one's own life, freedom and self-responsibility can be very much linked to autonomy.
According to PiagetEdit
The Swiss philosopher Jean Piaget (1896-1980) believed that autonomy comes from within and results from a "free decision". It is of intrinsic value and the morality of autonomy is not only accepted but obligatory. When an attempt at social interchange occurs, it is reciprocal, ideal and natural for there to be autonomy regardless of why the collaboration with others has taken place. For Piaget, the term autonomous can be used to explain the idea that rules are self-chosen. By choosing which rules to follow or not, we are in turn determining our own behaviour.
Piaget studied the cognitive development of children by analyzing them during their games and through interviews, establishing (among other principles) that the children's moral maturation process occurred in two phases, the first of heteronomy and the second of autonomy:
According to KohlbergEdit
The American psychologist Lawrence Kohlberg (1927-1987) continues the studies of Piaget. His studies collected information from different latitudes to eliminate the cultural variability, and focused on the moral reasoning, and not so much in the behavior or its consequences. Through interviews with adolescent and teenage boys, who were to try and solve "moral dilemmas," Kohlberg went on to further develop the stages of moral development. The answers they provided could be one of two things. Either they choose to obey a given law, authority figure or rule of some sort or they chose to take actions that would serve a human need but in turn break this given rule or command.
The most popular moral dilemma asked involved the wife of a man approaching death due to a special type of cancer. Because the drug was too expensive to obtain on his own, and because the pharmacist who discovered and sold the drug had no compassion for him and only wanted profits, he stole it. Kohlberg asks these adolescent and teenage boys (10-, 13- and 16-year-olds) if they think that is what the husband should have done or not. Therefore, depending on their decisions, they provided answers to Kohlberg about deeper rationales and thoughts and determined what they value as important. This value then determined the "structure" of their moral reasoning.
Kohlberg established three stages of morality, each of which is subdivided into two levels. They are read in progressive sense, that is, higher levels indicate greater autonomy.
Autonomy in childhood and adolescence is when one strives to gain a sense of oneself as a separate, self-governing individual. Between ages 1–3, during the second stage of Erikson's and Freud's stages of development, the psychosocial crisis that occurs is autonomy versus shame and doubt. The significant event that occurs during this stage is that children must learn to be autonomous, and failure to do so may lead to the child doubting their own abilities and feel ashamed. When a child becomes autonomous it allows them to explore and acquire new skills. Autonomy has two vital aspects wherein there is an emotional component where one relies more on themselves rather than their parents and a behavioural component where one makes decisions independently by using their judgement. The styles of child rearing affect the development of a child's autonomy. Authoritative child rearing is the most successful approach, where the parents engage in autonomy granting appropriate to their age and abilities. Autonomy in adolescence is closely related to their quest for identity. In adolescence parents and peers act as agents of influence. Peer influence in early adolescence may help the process of an adolescent to gradually become more autonomous by being less susceptible to parental or peer influence as they get older. In adolescence the most important developmental task is to develop a healthy sense of autonomy.
In Christianity, autonomy is manifested as a partial self-governance on various levels of church administration. During the history of Christianity, there were two basic types of autonomy. Some important parishes and monasteries have been given special autonomous rights and privileges, and the best known example of monastic autonomy is the famous Eastern Orthodox monastic community on Mount Athos in Greece. On the other hand, administrative autonomy of entire ecclesiastical provinces has throughout history included various degrees of internal self-governance.
In ecclesiology of Eastern Orthodox Churches, there is a clear distinction between autonomy and autocephaly, since autocephalous churches have full self-governance and independence, while every autonomous church is subject to some autocephalous church, having a certain degree of internal self-governance. Since every autonomous church had its own historical path to ecclesiastical autonomy, there are significant differences between various autonomous churches in respect of their particular degrees of self-governance. For example, churches that are autonomous can have their highest-ranking bishops, such as an archbishop or metropolitan, appointed or confirmed by the patriarch of the mother church from which it was granted its autonomy, but generally they remain self-governing in many other respects.
In the history of Western Christianity the question of ecclesiastical autonomy was also one of the most important questions, especially during the first centuries of Christianity, since various archbishops and metropolitans in Western Europe have often opposed centralizing tendencies of the Church of Rome. As of 2019[update], the Catholic Church comprises 24 autonomous (sui iuris) Churches in communion with the Holy See. Various denominations of Protestant churches usually have more decentralized power, and churches may be autonomous, thus having their own rules or laws of government, at the national, local, or even individual level.
Sartre brings the concept of the Cartesian god being totally free and autonomous. He states that existence precedes essence with god being the creator of the essences, eternal truths and divine will. This pure freedom of god relates to human freedom and autonomy; where a human is not subjected to pre-existing ideas and values.
According to the first amendment, In the United States of America, the federal government is restricted in building a national church. This is due to the first amendment's recognizing people's freedom's to worship their faith according to their own belief's. For example, the American government has removed the church from their "sphere of authority" due to the churches' historical impact on politics and their authority on the public. This was the beginning of the disestablishment process. The Protestant churches in the United States had a significant impact on American culture in the nineteenth century, when they organized the establishment of schools, hospitals, orphanages, colleges, magazines, and so forth. This has brought up the famous, however, misinterpreted term of the separation of church and state. These churches lost the legislative and financial support from the state.
The disestablishment processEdit
The first disestablishment began with the introduction of the bill of rights. In the twentieth century, due to the great depression of the 1930s and the completion of the second world war, the American churches were revived. Specifically the Protestant churches. This was the beginning of the second disestablishment when churches had become popular again but held no legislative power. One of the reasons why the churches gained attendance and popularity was due to the baby boom, when soldiers came back from the second world war and started their families. The large influx of newborns gave the churches a new wave of followers. However, these followers did not hold the same beliefs as their parents and brought about the political, and religious revolutions of the 1960s.
During the 1960s, the collapse of religious and cultural middle brought upon the third disestablishment. Religion became more important to the individual and less so to the community. The changes brought from these revolutions significantly increased the personal autonomy of individuals due to the lack of structural restraints giving them added freedom of choice. This concept is known as "new voluntarism" where individuals have free choice on how to be religious and the free choice whether to be religious or not.
In a medical context, respect for a patient's personal autonomy is considered one of many fundamental ethical principles in medicine. Autonomy can be defined as the ability of the person to make his or her own decisions. This faith in autonomy is the central premise of the concept of informed consent and shared decision making. This idea, while considered essential to today's practice of medicine, was developed in the last 50 years. According to Tom Beauchamp and James Childress (in Principles of Biomedical Ethics), the Nuremberg trials detailed accounts of horrifyingly exploitative medical "experiments" which violated the subjects' physical integrity and personal autonomy. These incidences prompted calls for safeguards in medical research, such as the Nuremberg Code which stressed the importance of voluntary participation in medical research. It is believed that the Nuremberg Code served as the premise for many current documents regarding research ethics.
Respect for autonomy became incorporated in health care and patients could be allowed to make personal decisions about the health care services that they receive. Notably, autonomy has several aspects as well as challenges that affect health care operations. The manner in which a patient is handled may undermine or support the autonomy of a patient and for this reason, the way a patient is communicated to becomes very crucial. A good relationship between a patient and a health care practitioner needs to be well defined to ensure that autonomy of a patient is respected. Just like in any other life situation, a patient would not like to be under the control of another person. The move to emphasize respect for patient's autonomy rose from the vulnerabilities that were pointed out in regards to autonomy.
However, autonomy does not only apply in a research context. Users of the health care system have the right to be treated with respect for their autonomy, instead of being dominated by the physician. This is referred to as paternalism. While paternalism is meant to be overall good for the patient, this can very easily interfere with autonomy. Through the therapeutic relationship, a thoughtful dialogue between the client and the physician may lead to better outcomes for the client, as he or she is more of a participant in decision-making.
There are many different definitions of autonomy, many of which place the individual in a social context. See also: relational autonomy, which suggests that a person is defined through their relationships with others, and "supported autonomy" which suggests that in specific circumstances it may be necessary to temporarily compromise the autonomy of the person in the short term in order to preserve their autonomy in the long-term. Other definitions of the autonomy imagine the person as a contained and self-sufficient being whose rights should not be compromised under any circumstance.
There are also differing views with regard to whether modern health care systems should be shifting to greater patient autonomy or a more paternalistic approach. For example, there are such arguments that suggest the current patient autonomy practiced is plagued by flaws such as misconceptions of treatment and cultural differences, and that health care systems should be shifting to greater paternalism on the part of the physician given their expertise. On the other hand, other approaches suggest that there simply needs to be an increase in relational understanding between patients and health practitioners to improve patient autonomy.
One argument in favor of greater patient autonomy and its benefits is by Dave deBronkart, who believes that in the technological advancement age, patients are capable of doing a lot of their research on medical issues from their home. According to deBronkart, this helps to promote better discussions between patients and physicians during hospital visits, ultimately easing up the workload of physicians. deBronkart argues that this leads to greater patient empowerment and a more educative health care system. In opposition to this view, technological advancements can sometimes be viewed as an unfavorable way of promoting patient autonomy. For example, self-testing medical procedures which have become increasingly common are argued by Greaney et al. to increase patient autonomy, however, may not be promoting what is best for the patient. In this argument, contrary to deBronkart, the current perceptions of patient autonomy are excessively over-selling the benefits of individual autonomy, and is not the most suitable way to go about treating patients. Instead, a more inclusive form of autonomy should be implemented, relational autonomy, which factors into consideration those close to the patient as well as the physician. These different concepts of autonomy can be troublesome as the acting physician is faced with deciding which concept he/she will implement into their clinical practice.
Autonomy varies and some patients find it overwhelming especially the minors when faced with emergency situations. Issues arise in emergency room situations where there may not be time to consider the principle of patient autonomy. Various ethical challenges are faced in these situations when time is critical, and patient consciousness may be limited. However, in such settings where informed consent may be compromised, the working physician evaluates each individual case to make the most professional and ethically sound decision. For example, it is believed that neurosurgeons in such situations, should generally do everything they can to respect patient autonomy. In the situation in which a patient is unable to make an autonomous decision, the neurosurgeon should discuss with the surrogate decision maker in order to aid in the decision making process. Performing surgery on a patient without informed consent is in general thought to only be ethically justified when the neurosurgeon and his/her team render the patient to not have the capacity to make autonomous decisions. If the patient is capable of making an autonomous decision, these situations are generally less ethically strenuous as the decision is typically respected.
It is important to note that not every patient is capable of making an autonomous decision. For example, a commonly proposed question is at what age children should be partaking in treatment decisions. This question arises as children develop differently, therefore making it difficult to establish a standard age at which children should become more autonomous. Those who are unable to make the decisions prompt a challenge to medical practitioners since it becomes difficult to determine the ability of a patient to make a decision. To some extent, it has been said that emphasis of autonomy in health care has undermined the practice of health care practitioners to improve the health of their patient as necessary. The scenario has led to tension in the relationship between a patient and a health care practitioner. This is because as much as a physician wants to prevent a patient from suffering, he or she still has to respect autonomy. Beneficence is a principle allowing physicians to act responsibly in their practice and in the best interests of their patients, which may involve overlooking autonomy. However, the gap between a patient and a physician has led to problems because in other cases, the patients have complained of not being adequately informed.
The seven elements of informed consent (as defined by Beauchamp and Childress) include threshold elements (competence and voluntariness), information elements (disclosure, recommendation, and understanding) and consent elements (decision and authorization). Some philosophers such as Harry Frankfurt consider Beauchamp and Childress criteria insufficient. They claim that an action can only be considered autonomous if it involves the exercise of the capacity to form higher-order values about desires when acting intentionally. What this means is that patients may understand their situation and choices but would not be autonomous unless the patient is able to form value judgements about their reasons for choosing treatment options they would not be acting autonomously.
In certain unique circumstances, government may have the right to temporarily override the right to bodily integrity in order to preserve the life and well-being of the person. Such action can be described using the principle of "supported autonomy", a concept that was developed to describe unique situations in mental health (examples include the forced feeding of a person dying from the eating disorder anorexia nervosa, or the temporary treatment of a person living with a psychotic disorder with antipsychotic medication). While controversial, the principle of supported autonomy aligns with the role of government to protect the life and liberty of its citizens. Terrence F. Ackerman has highlighted problems with these situations, he claims that by undertaking this course of action physician or governments run the risk of misinterpreting a conflict of values as a constraining effect of illness on a patient's autonomy.
Since the 1960s, there have been attempts to increase patient autonomy including the requirement that physician's take bioethics courses during their time in medical school. Despite large-scale commitment to promoting patient autonomy, public mistrust of medicine in developed countries has remained. Onora O'Neill has ascribed this lack of trust to medical institutions and professionals introducing measures that benefit themselves, not the patient. O'Neill claims that this focus on autonomy promotion has been at the expense of issues like distribution of healthcare resources and public health. k
One proposal to increase patient autonomy is through the use of support staff. The use of support staff including medical assistants, physician assistants, nurse practitioners, nurses, and other staff that can promote patient interests and better patient care. Nurses especially can learn about patient beliefs and values in order to increase informed consent and possibly persuade the patient through logic and reason to entertain a certain treatment plan. This would promote both autonomy and beneficence, while keeping the physician's integrity intact. Furthermore, Humphreys asserts that nurses should have professional autonomy within their scope of practice (35-37). Humphreys argues that if nurses exercise their professional autonomy more, then there will be an increase in patient autonomy (35-37).
International human rights lawEdit
After the Second World War there was a push for international human rights that came in many waves. Autonomy as a basic human right started the building block in the beginning of these layers alongside liberty. The Universal declarations of Human rights of 1948 has made mention of autonomy or the legal protected right to individual self-determination in article 22.
Documents such as the United Nations Declaration on the Rights of Indigenous Peoples reconfirm international law in the aspect of human rights because those laws were already there, but it is also responsible for making sure that the laws highlighted when it comes to autonomy, cultural and integrity and land rights are made within an indigenous context by taking special attention to their historical and contemporary events
The United Nations Declaration on the Rights of Indigenous Peoples article 3 also through international law provides Human rights for Indigenous individuals through its third article by giving them a right to self-determination meaning they have all the liberties to choose their political status, and are capable to go and improve their economics social, and cultural statuses in society by developing it. Another example of this is article 4 of the same document which gives them autonomous rights when it comes to their internal or local affairs and how they can fund themselves in order to be able to self govern themselves.
Minorities in countries are also protected as well by international law; the 27th article of the United Nations International covenant on Civil and Political rights or the ICCPR does so by allowing these individuals to be able to enjoy their own culture or use their language. Minorities in that manner are people from ethnic religious or linguistic groups according to the document.
The European Court of Human rights, is an international court that has been created on behalf of the European Conventions of Human rights. However, when it comes to autonomy they did not explicitly state it when it comes to the rights that individuals have. The current article 8 has remedied to that when the case of Pretty v the United Nations which was a case in 2002 involving assisted suicide where autonomy was used as a legal right in law. It was where Autonomy was distinguished and its reach into law was marked as well making it the foundations for legal precedent in making case law originating from the European Court of Human rights
The Yogyakarta Principles, a document with no binding effect in international human rights law, contend that "self-determination" used as meaning of autonomy on one's own matters including informed consent or sexual and reproductive rights, is integral for one's self-defined or gender identity and refused any medical procedures as a requirement for legal recognition of the gender identity of transgender. If eventually accepted by the international community in a treaty, this would make these ideas human rights in the law. The Convention on the Rights of Persons with Disabilities also defines autonomy as principles of rights of a person with disability including "the freedom to make one's own choices, and independence of persons".
Celebrity culture on teenage autonomyEdit
A study conducted by David C. Giles and John Maltby conveyed that after age effecting factors were removed a high emotional autonomy was a significant predictor of celebrity interest, as well as high attachment to peers with a low attachment to parents. Patterns of intense personal interest in celebrities was found to be conjunction with low levels of closeness and security. Furthermore, the results suggested that adults with a secondary group of pseudo-friends during development from parental attachment, usually focus solely on one particular celebrity, which could be due to difficulties in making this transition.
Limits to autonomyEdit
Autonomy can be limited. For instance, by disabilities, civil society organizations may achieve a degree of autonomy albeit nested within––and relative to––formal bureaucratic and administrative regimes. Community partners can therefore assume a hybridity of capture and autonomy––or a mutuality––that is rather nuanced.
The term semi-autonomy (coined with prefix semi- / "half") designates partial or limited autonomy. As a relative term, it is usually applied to various semi-autonomous entities or processes that are substantially or functionally limited, in comparison to other fully autonomous entities or processes.
The term quasi-autonomy (coined with prefix quasi- / "resembling" or "appearing") designates formally acquired or proclaimed, but functionally limited or constrained autonomy. As a descriptive term, it is usually applied to various quasi-autonomous entities or processes that are formally designated or labeled as autonomous, but in reality remain functionally dependent or influenced by some other entity or process. An example for such use of the term can be seen in common designation for quasi-autonomous non-governmental organizations.