Freedom, autonomy, and responsibility

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.

Through analysis of four contemporary accounts I attempt to show the following. First, autonomy is distinguishable from negative freedom in that considerations which constrain one's ability to be autonomous (e.g., illness, institutional factors, social roles, etc.) do not constrain one's negative freedom. Second, the status of being autonomous admits of degrees; i.e., one can be more or less autonomous with respect to any given situation. Third, the characterization of being autonomous that best captures these points and that provides the most guidance for the applied ethicist is that of being dispositionally responsible for one's life. In making this third point I emphasize the agent's identification with significant aspects of his/her life.