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In developmental psychology and moral, political, and bioethical philosophy, autonomy 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. Autonomy is a term that is also widely used in the field of medicine â personal autonomy is greatly recognized and valued in health care.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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).