Abstract

While it appears that respect for autonomy has become the fundamental principle in medical ethics, it is not clear what various authors have in mind when they use the term "autonomy." Accounts range from an equation of autonomy with negative freedom to a Kantian emphasis on self-governance. ;My goal here is to characterize that status in persons which we call autonomy and which demands our respect in such applied settings as medicine. What types of behavior must be present for us to honor persons' decisions as autonomous? And what kinds of factors can constrain that behavior? ;My answer is that being autonomous means being as much responsible for one's life as the situation allows and warrants. In explaining what these various claims entail, I note that autonomy is an exercise concept and that it admits of degrees. Being autonomous requires more than simply having the capacity to engage in certain kinds of behaviors; the autonomous person exercises those capacities. Furthermore, persons are more or less autonomous in different situations, and different types of decisions demand varying levels of autonomous behavior in order to warrant our respect. ;In addition to explaining what it means to be autonomous, I discuss the broad range of factors which can constrain autonomy. I extend the traditional analyses of constraints and show how such factors as illness, socio-economic and institutional realities, and interpersonal communication can constrain persons' ability to be autonomous. ;I conclude with an argument that persons have an obligation to be autonomous. This argument is based both on a position of self-respect and on avoidance of harms to others