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Autonomy

AUTONOMY

Autonomy expresses the idea that persons should direct their own actions and be free from coercion or undue influences by others on their actions and deliberations. The concept of autonomy has touched all areas of social life and has had a pronounced effect on medical ethics and medical practice. Patient autonomy emerged in the 1960s and 1970s in the great social movement that created a diverse range of civil rights, some constitutionally protected, including expanded individual rights in health care, such as access to abortion, end-of-life decision making, and privacy. The clearest expression of autonomy in medicine is the doctrine of informed consent.

Informed consent defines a set of patient rights and reciprocal obligations for health professionals. Informed consent means that patients have a right to make autonomous choices about their medical care. To do so, they must be given information about their medical condition, treatment alternatives, and the burdens and benefits associated with the recommended treatment and its alternatives. Since this information is largely in the hands of physicians, the doctrine of informed consent creates the obligation that physicians disclose information to patients and allow patients to make their own medical decisions. An implication of informed consent is that patients can refuse treatment.

The right to refuse treatment, including life-saving or life-sustaining treatments, has come to be firmly established in law. Recognizing that patients sometimes lack the ability to make their own medical decisions, legislatures created advance directives. Advance directives empower patients to direct their future medical care even when they have lost the ability to make their own medical decisions. These ideas have radically transformed late twentieth-century medicine. In a similar vein, the concept of autonomy has affected our understanding of aging and being old as well.

On the positive side, autonomy has supported criticisms of ageism and other social attitudes and practices that limited the freedom of elders or that relegated elders to a secondary social status. Autonomy has also supported the elimination or modification of age-based discrimination, such as a mandatory retirement age or the proscription of the use of age in employment decisions. Autonomy is also at work in the idea that elders in retirement should remain active and engaged. Their social function is to enjoy an earned leisure and to maintain independence from the responsibilities characteristic of their preretirement lives. The principle of autonomy has thus introduced into gerontology a focus on the individual who is regarded independent of other individuals or social structures like the family. It has highlighted a certain understanding of the autonomous individual as one who has the capacities for self-directed and independent action, deliberation, and decision-making, and it has made these values preeminent. These assumptions demarcate a standard view of autonomy that has important implications for aging.

Key features

Four features of this view of autonomy are particularly significant for aging. First, the autonomous person is regarded outside a developmental framework and is assumed to fully possess all autonomy-related faculties. Thus, the standard view of autonomy has no ready way to accommodate incapacity. Second, autonomy implies independence and self-direction. States of dependence are regarded as problematic for true autonomy. Third, autonomy focuses on the individual in abstraction from social structures like the family, so the aged individual is seen as possessing value, purpose, and rights separate from the social and personal relationships that provide everyday support and assistance. Fourth, the standard view of autonomy incorporates a simplifying assumption that freedom of choice or decision-making expresses the most important dimension of being autonomous. Each of these features of autonomy creates a range of problems in the context of aging.

Standard treatments of autonomy focus on individual action and choice without regard for the medical, psychological, or social context of the individual whose autonomy is at issue. This creates special problems for thinking about those processes of aging that create dependencies or compromise the capacities of the elder. In these situations, autonomy and its corollary of rights cannot fundamentally aid elders whose struggle is not against oppression, but to maintain a personal sense of worth and dignity in the face of loss. In stressing the robust exercise of freedom, autonomy can distort the complex phenomenology of aging by vastly oversimplifying what being autonomous involves as one grows old.

Actual expressions of autonomy throughout the life span are always subject to a wide range of circumstances and conditions. For example, metabolic states can induce confusion and alter one's ability to think clearly or to carry out intended choices. Psychological states can distort one's ability to perceive reality accurately and can affect decision-making. Social factors also influence the ways in which one experiences the world and the choices that one practically envisions.

A society that prizes an idealized view of individual action and choice and that values independence, self-direction, and self-control understandably tends to disvalue conditions that compromise action or involve decisional impairments or states of dependence. The paradox of autonomy in aging is that the ideal of autonomy expressed in the robust independent decision maker is incongruent with some of the realities of loss that are associated with growing old. This raises the question: How can the ideals of autonomy be reconciled with the realities of aging?

Implications for aging

Frail elders who have experienced medically related incapacity often receive medical care in home with assistance from family members, neighbors, or friends. They sometimes rely on others for assistance in securing health care, filling prescriptions, or in complying with recommended medical regimens. Respecting the actual autonomy of such an elder entails more than respecting the right of informed consent or confidentiality. Respecting the actual autonomy of the elder requires that health professionals carefully examine the ways that the standard delivery of health care services can compromise an already impaired autonomy. For example, if elders require assistance in receiving health care services because they have hearing or visual impairments, assistive hearing devices or large-type patient information material or prescription medicine instructions can minimize or eliminate the direct reliance of some elders on others for the most basic elements of medical care.

Emphasizing informed consent can be problematic whenever elders are inclined to defer to authority figures. Such elders are more inclined to accept physician advice than are people in their middle years. For these elders, the right to informed consent is less meaningful than is the opportunity to receive authoritative advice from a physician. Because these elders would prefer to be told what to do rather than being provided with an array of choices, the challenge for physicians involves identifying the basic values or beliefs of patients and incorporating them into a treatment plan.

When physical infirmity associated with aging reduces a person's ability to act independently, it may not alter the person's decisional capacity. Focusing on independence of action may obscure the fact that actual expressions of autonomy always involve two distinct elements, a decisional and an executional element. A person may be autonomous in the sense of being able to make his or her own decisions, but may not be able to carry them out. Hence, autonomy is not lost when a person is unable to carry out a decision because of frailty or physical infirmity. To respect such a person's autonomy requires more than simply allowing them to make choices. It creates the obligation to assist them in carrying out their choices. Thus, respecting actual autonomy in the domain of choice entails that we assist elders in realizing their choices. This can be a formidable challenge in some instances, but in other circumstances minor accommodations are all that is needed.

Assistive devices ranging from hearing aids or wheelchairs to direct assistance in carrying out activities of daily living can serve to sustain the reality of autonomy in a frail elder. Autonomous choice in abstraction from the existential setting of choice is meaningless if the conditions required for its execution cannot be fulfilled. Autonomy that is impaired somewhat by executional inabilities can become a significant problem if the material means for providing executional assistance are not available. For this reason, poverty directly impairs one's autonomy, yet is a condition that is seldom regarded as infringing freedom. Although limitations in executional abilities occur throughout life, they are more significant as one ages and suffers the disabilities associated with growing old. Analogously, decisional impairments associated with dementia or Alzheimer's disease does not obliterate autonomy, but does create challenges for how autonomy of such persons is to be respected.

Because a person can no longer make autonomous choices, it does not mean that their autonomy cannot be respected. All autonomous choices are based on the person's preferences or values that are developed, often over a lifetime. The beliefs and values that guide a person's life is thus the key to respecting their autonomy whenever one's decisional capacity is impaired. In the absence of formal advance directives, these beliefs and values can provide a basis for respecting an elder's autonomy. To do so, however, one needs to know who the elder is. This requirement creates resource demands on caregivers and on a system of care that focuses on respecting patients' choices without regard for the background values or reasons that guide the choice.

Loss of independence is often regarded as the most serious impairment of autonomy. This view creates unrealistic expectations in the context of growing old. In America, ownership or occupancy of one's own home is a cultural value epitomized in the phrase that one's home is one's castle. It is no wonder, then, that living independently at home has become the last stand for elders struggling to maintain their self-respect and sense of dignity. Unfortunately, the requirements for assistance in daily living can become so great that elders cannot provide for themselves in the home. Hence, a struggle ensues between protecting the welfare of the elder and maintaining the elder's sense of identity and independence. Ironically, this struggle exists because we have not taken the demands of autonomy seriously enough.

Social considerations

As a society, we have ignored the material and social conditions that are required for autonomy to flourish. We have allowed autonomythwarting institutions to dominate the care of the infirm and sick old. Rather than building autonomy-sustaining institutions, long-term care of elders has accepted a medical paradigm of the delivery of services rather than a paradigm of providing an environment suitable for sustaining a compromised autonomy.

The nursing home in America has become the icon of the loss of independence. The nursing home often is a setting in which the individual is subject to impersonal institutional rules rather than self-control. Even when elders do not require skilled care, the medical model that dominates nursing homes creates a hierarchical and professionally dominated setting that forces residents to live under significant restrictions. In this context, it is understandable that reformers have used the concept of autonomy as a watchword for reform, but reforms that feature increased choices or rights cannot address the personal loss of dignity that elders experience.

Autonomy has traditionally supported liberation. In the nursing home, a patient rights' movement has developed that insists that residents of nursing homes be accorded basic rights, including degrees of self-governance and, most importantly, preservation of the rights that they possessed outside the nursing home. Liberating elders from an oppressive system, however, is not feasible if the elders truly need the supportive services that the nursing home provides.

While autonomy is an important value, respect for autonomy is a remarkably abstract formula for expressing the complex range of ethical obligations associated with respecting elderly persons. Persons deserve respect not only because they are capable of self-determination, but also because they are persons. In actuality, persons exhibit varying degrees and kinds of autonomy. Unfortunately, emphasizing the ideals of independence and unfettered decision-making that dominates most treatments of autonomy cannot be developmentally sustained throughout the life span. In contrast, respect for actual autonomy means that society must address the concrete actuality of the persons in question.

To respect autonomy thus requires that we develop policies and procedures that move beyond a focus on individual choice or decision-making to take into account developed personality and the limitations that actually define people as they age. The challenge of autonomy in aging is the challenge of respecting elders' actual expressions of autonomy in the face of compromised capacities without losing the protections afforded by the rights associated with traditional readings of the principle of autonomy.

George J. Agich

See also Advance Directives for Health Care; Age Discrimination; Life Span Theory of Control; Refusing and Withdrawing Medical Attention.

BIBLIOGRAPHY

Agich, G. J. Autonomy in Long-Term Care. New York: Oxford University Press, 1990.

Gamroth, L. M.; Semradek, J.; and Tornquist, E. M., eds. Enhancing Autonomy in Long Term Care: Concepts and Strategies. New York: Springer Publishing Company, 1995.

McCullough, L. B., and Wilson, N. L., eds. Long-Term Care Decisions: Ethical and Conceptual Dimensions. Baltimore and London: John Hopkins University Press, 1995.

Moody, H. R. Aging: Concepts and Controversies. Baltimore and London: John Hopkins University Press, 1998.

Schneewind, J. B. The Invention of Autonomy: A History of Modern Moral Philosophy. Cambridge: Cambridge University Press, 1997.

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Autonomy

AUTONOMY.

Autonomy was first used by the ancient Greeks to describe city-states that had the power to legislate their own laws and direct the course of their own affairs. The etymology (auto [self] nomos [law]) suggests self-governance or the imposition of law on oneself. The original implication of autonomy was pejorative when applied to the individual. When, for example, in Sophocles' tragedy, the chorus uses the word autonomos to describe the actions of Antigone, the audience is meant to understand that she has placed her own judgments above the laws of the citya clear violation of Greek norms.

By the seventeenth or eighteenth century, however, people as well as governments came to be viewed as autonomous agents. If human reason is able to discern the difference between right and wrong, each person can formulate his or her own conception of how to live without relying on religious or secular authorities.

This idea had a decisive impact on liberal political philosophies, which claimed that each person is sovereign over himself, so that the only way governments can exercise control over their citizens is on the basis of consent, implicit or actual. In this way, authority flows not from the ruler downwards but from the citizensconceived as free rational agents with an equal share in societyupwards. Along these lines, Jean-Jacques Rousseau (17121778) argues that freedom for the individual consists in obedience to self-imposed law, and the sovereignty of the state derives from laws that the people, as expressed in the general will, impose on themselves.

It is generally agreed that the classic formulation of the doctrine of autonomy occurs in Immanuel Kant (17241804). While God or a national leader can command certain actions and threaten punishment if we do not obey, each person is responsible for the actions he performs. In fact, Kant took this idea to its logical conclusion: every moral agent is both an end in itself and a being capable of legislating morality for itself.

Suppose God or a political leader orders us to do something. Why should we obey? No one doubts that life will be uncomfortable if we do not. But the question is not "What is it in our interest to do?" but "What are we obliged to do?" Kant's point is that obligation must derive from within: no external source can create obligation for us. Rather than say, "Do this" and "Don't do that," a person in authority must allow us to see for ourselves what is right. Not to do so is patronizing or degrading.

Kant therefore proclaims: "The will is thus not merely subject to the law but is subject in such a way that it must be regarded also as legislating for itself and only on this account as being subject to the law, of which it can regard itself as the author" (p. 38). Once we can regard ourselves as authors, reward and punishment no longer matter. The only thing that matters is whether we are convinced our action is right.

Even for as vocal a critic of Kant as John Stuart Mill (18061873), autonomy plays a central role. The best way to maximize the happiness of the greatest segment of society is to restrict the authority society can exercise over the individual and grant the individual sovereignty over his thought and person. The only warrant society has for interfering with this sovereignty is if the actions of one person impinge on the rights of another. Barring that, each person has the right to pursue his own happiness in whatever way he judges best.

Finally, one can find the doctrine of autonomy in the thought of John Rawls (19212002), for whom a just society is one which free and equal agents would choose for themselves if they had to take a place in that society but did not know what place they would be assignedrich or poor, gifted or challenged, religious believer or atheist. This is simply a modern way of expressing the idea of implicit consent and saying that each person has the right to formulate and pursue his or her own conception of the good life.

Common Misconceptions

It is worth noting that, for Kant, autonomy does not permit me to do as I please. If it is degrading for someone to deny me the status of a moral agent, it is equally degrading to deny someone else that status. In Kant's view, the only law I can impose on myself in a coherent fashion is one that simultaneously upholds the dignity of others.

A second misconception concerns authorship. To say that I must regard myself as the author of something is not to say that I am the author in fact. Consider the Fifth Amendment to the U.S. Constitution. Although I was not present when the founders drafted it, by prohibiting torture it articulates a principle to which I am strongly committed. So I can take responsibility for it even if I had to learn about it in a civics class.

Finally, there is the question of scope. Although Kant defines autonomy as rational self-legislation, this does not mean it is based on an intelligence test. By rationality he simply means the ability to recognize that moral agents have obligations; as such, autonomy applies to all of humanity regardless of education or social standing.

Objections

Though it is often said that Kant's conception of autonomy leads to atheism, there is no reason why this has to be so. I can obey God as long as my reason for doing so is that the commandment to obey is morally valid; what I cannot do is obey blindly. The same is true of the government. Rather than urging obedience to legitimate authority, autonomy rejects the claim that legitimacy is irrelevant to authority: "Right or wrong, it's my country, my religion, my family, and so on."

Another objection claims that emphasizing individual sovereignty undermines virtues like trust, friendship, and cooperation. It doesif that means it is possible, in principle, for one person to be right and the rest of society wrong. But it hardly follows that one should go through life disregarding the advice of others and avoiding intimate relationships. To say that I should take responsibility for my actions is not to say that I must become a citadel. To live up to my obligations and fulfill myself as a person, I need the help of family, friends, and a host of institutions. All autonomy demands is that these groups or institutions respect my dignity as a free and rational agent (as well as respecting the dignity of others). At bottom, what autonomy denies is any form of political, religious, or moral tyranny.

See also Enlightenment ; Kantianism ; Reason, Practical and Theoretical ; Responsibility .

bibliography

Allison, Henry E. Kant's Theory of Freedom. Cambridge, U.K.: Cambridge University Press, 1990.

Dworkin, Gerald. The Theory and Practice of Autonomy. Cambridge, U.K.: Cambridge University Press, 1988.

Kant, Immanuel. Grounding for the Metaphysics of Morals. 3rd ed. Translated by James W. Ellington. Indianapolis: Hackett, 1993.

Korsgaard, Christine M. The Sources of Normativity. Cambridge, U.K.: Cambridge University Press, 1996.

Mill, John Stuart. On Liberty. Indianapolis: Hackett, 1978.

Rousseau, Jean-Jacques. Discourse on Political Economy and the Social Contract. Translated by Christopher Betts. Oxford and New York: Oxford University Press, 1994.

Schneewind, J. B. The Invention of Autonomy. Cambridge, U.K.: Cambridge University Press, 1998.

Kenneth Seeskin

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Autonomy

Autonomy

BIBLIOGRAPHY

Since the Enlightenment, the concept of autonomy has implied the capacity for self-regulation, and as a corollary of this capacity, the right to self-determination. Although many early thinkers from both the East and the West espoused the idea of self-regulation in some form, including Tertullian (second and third centuries), Thomas Aquinas (thirteenth century) and the Chinese philosopher Lao-tzu (sixth century bce), it is generally associated with the development of Kantian philosophy and with the liberalism of the English philosophers John Stuart Mill (1806-1873) and John Locke (1632-1704), as well as the Scottish economist Adam Smith (1723-1790).

The most significant figure in the development of autonomy as a grounding concept of moral philosophy is undoubtedly Immanuel Kant (1724-1804), whose critical philosophy rests on the presumption that all human beings are rational beings and that reason is defined by the capacity for self-regulation. Reason, in Kants analysis, is a faculty that permits individuals to subject themselves to law, not merely because it is their desire to do so, but because moral law, as the product of reason rather than empirical deduction, has a quality of necessity that is independent of any question of ends and, hence, of the desires felt by individual subjects. A crucial aspect of Kants moral philosophy, one that was later developed by Karl Marx (1818-1883), was the notion that reason and desire could be opposed to one another, and indeed, that the autonomy of moral law implies the independence of reason from desire.

Like Jean-Jacques Rousseau (1712-1778), who influenced him greatly, Kant felt that the implications of moral autonomy extended to the political realm: The development of individual capacities for self-regulation required freedom from restraint by those forces that might otherwise cultivate desire against reason. Accordingly, he is often interpreted as an advocate of limited governmentthough his conception of what constituted limited government should not be confused with that of the political liberals following Mill and Locke, or the Smithian economists.

Mill in particular shared with Kant a sense that the opposite of moral autonomy is servile dependence. Significantly, then, it was not society per se so much as the hierarchy of obligation and indebtedness that threatened the autonomy of the individual and his or her capacity to make free judgments. In the political realm, Mills theory implied that individuals exercise their freedoms in relation to other individuals, and it is this cooperation that provides the means by which consensual governments are constituted.

It fell to Adam Smith to explicate the processes by which individual freedom and the complex organization of society could be accommodated and sustained independently of any legislative authority. He theorized a natural tendency to truck, barter, and exchange as the ground of those processes by which the division of labor develops naturally. In the forms of economic liberalism that owe their debt to Smith, the idea of autonomy was thus closely linked to one of spontaneous self-order. And it was used to legitimate arguments against governmental intervention in markets and other forms of economic life.

Kant was never fully able to extend the formalism of his own argument to all persons (he withheld the faculty of reason from Africans and aboriginals, and he doubted the capacities of women or servants to exercise free judgment). Moreover, the formalism that was intrinsic to his argument also encouraged a conflation between the presumption of a universal faculty (reason) and the universal equality of all to exercise this faculty of judgment in the actual social sphere. Smiths argument, like that of the liberal political economists who followed him, presumed that government exercises a more coercive and inhibiting influence on individuals than do other social forces, such as capital or organized labor. This presumptionthat only states (through their legislative bodies) interfere with individual autonomyhas been one of the major objects of critique within radical political philosophy, from Marx forward. The crux of such critique has been a recognition of the complex social determinants of the very consciousness within which reason appears as a faculty, and a value as such. Even within liberal traditions, there is disagreement as to whether individual autonomy is better served by a government that regulates capital and other social institutions, or by one that allows corporations (including not only economic but also religious institutions) to be considered as individuals, and hence as entities whose regulation would constitute a violation of their rights.

Politically, the concept of autonomy no longer applies exclusively to the relationship between individuals and social institutions; it also describes the status of recognized minority communities within larger social contexts, and particularly state formations. In this case, autonomy is closely linked to the idea of a collective right to self-determination, and as such is provided for by the United Nations under the terms of the International Covenant on Economic, Social and Cultural Rights (adopted in 1966 and entered into force in 1976). This covenant not only provides for a right to self-determination, but also recognizes the right of all peoples to freely dispose of their natural wealth and resources. However, just as liberal theory is conflicted in its assertion of the rights of individuals while it insists that these rights cease to exist when they intrude upon the rights of another individual, the rights of peoples may conflict with the perceived prerogatives of states. This is especially likely when such states comprise several distinct ethnolinguistic communities, and when one or another community dominates numerically, economically, or historically through the exercise of force. The structure by which states grant autonomy to regions within their territorial jurisdiction expresses the ambivalence of this concept of autonomy.

BIBLIOGRAPHY

Kant, Emmanuel. 1998. Critique of Pure Reason. Trans. and ed. Paul Guyer and Allen W. Wood. Cambridge, U.K.: Cambridge University Press.

Mill, John Stuart. 2002. The Basic Writings of John Stuart Mill. Ed. J. B. Schneewing, with notes by Dale E. Miller. New York: Modern Library.

Rousseau, Jean-Jacques. 1994. Discourse on Political Economy; and The Social Contract. Trans. Christopher Betts. Oxford, U.K., and New York: Oxford University Press.

Schneewind, J. B. 1992. Autonomy, Obligation, and Virtue: An Overview of Kants Moral Philosophy. In The Cambridge Companion to Kant, ed. Paul Guyer, 309-341. Cambridge, U.K.: Cambridge University Press.

Smith, Adam. 1976. An Inquiry into the Nature and Causes of the Wealth of Nations. Ed. W. B. Todd. Oxford: Clarendon Press.

United Nations. 1966. International Covenant on Economic, Social, and Cultural Rights. http://www.unhchr.ch/html/menu3/b/a_cescr.htm.

Rosalind C. Morris

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Autonomy

Autonomy

Autonomy is the degree to which a job provides an employee with the discretion and independence to schedule his or her work and determine how it is to be done. Higher levels of autonomy on the job have been shown to increase job satisfaction, and in some cases, motivation to

perform the job. In traditional organizations, only those employees at higher levels had autonomy. However, new organizational structures, such as flatter organizations, have resulted in increased autonomy at lower levels. Additionally, many companies now make use of autonomous work teams. Autonomy in the workplace can have benefits for employees, teams, managers, and the company as a whole, but it also may have drawbacks. Information regarding both the pros and cons of autonomy for these groups is discussed below.

EMPLOYEE AUTONOMY

According to job design theories, increased autonomy should make employees feel a greater responsibility for the outcomes of their work, and therefore have increased work motivation. Research indicates that when employees have greater levels of autonomy, their personality traits (specifically conscientiousness and extroversion) have a stronger impact on job performance. Thus, by giving employees more autonomy, they are better able to use their personal attributes to contribute to job performance. Additionally, human resource research has shown that greater autonomy in the workplace leads to a broader self-definition held by workers. The same study found that this broader definition of role makes it more likely that workers will integrate more tasks into their role.

Unfortunately, too much autonomy can lead to employee dissatisfaction. Each individual has a different level of need for autonomy in his or her job. Some workers prefer more direction from a manager and feel uncomfortable with autonomy; they may not want to exert effort or take the responsibility of having their name solely associated with a task, project, or product. Additionally, if employees are not well-equippedeither in training or in personalityto exercise autonomy, it may result in workplace tension and poor performance. Finally, when given autonomy, workers may believe that they have authority somewhat equal to that of their direct supervisor. This may cause them to resent the extra responsibility or feel that their pay should be increased. A related concern is that managers may feel marginalized when employee autonomy increases, particularly when there is a change to a traditional work environment. Managers may feel that by giving employees autonomy, they no longer contribute as much to the organization or that their jobs may be at stake.

MANAGERIAL AUTONOMY

Managers tend to have increased autonomy in organizations that are more decentralized. In such organizations, managers have more latitude to make decisions regarding the work of employees and even personnel decisions. For example, managers with increased autonomy may be able to assign merit raises to the employees in their unit at their discretion. As with employee autonomy, this freedom can result in feelings of motivation and satisfaction for the manager, who may be in a better position to reward and motivate employees. However, as with employee autonomy, managers who have autonomy may not be equipped to handle it. If managers make poor decisions, this may be harmful to employees and the organization as a whole. Using the example of autonomy in deciding pay raises, a manager may give merit pay increases that are significantly higher than those in other work units, which may cause problems across the organization.

TEAM AUTONOMY

In recent years, many organizations have made use of teams in the workplace, many of which operate autonomously. Self-managed work teams are those in which a supervisor gives little direction to the team, and the team members manage themselves. The success of such teams depends greatly on the team members, including their professional capabilities and their ability to work together. Oftentimes, such autonomous teams can greatly enhance an organization's ability to be creative, flexible, and innovative. However, as with individuals, too much autonomy in a team can reduce productivity. When individuals work too independently, their lack of communication and monitoring of one another may result in poor team performance. Additionally, without supervision the team may pursue goals that are different from those of the organization. Thus, periodic meetings and supervision from a manager may be necessary to avoid problems associated with too much autonomy.

AUTONOMY AND THE ORGANIZATION

The autonomy of employees and managers is often dictated by an organization's structure and culture; traditional, bureaucratic organizations often have little autonomy, but newer, more organic structures rely on autonomy, empowerment, and participation to succeed. Employee autonomy is believed to have minimized some of the relational barriers between superiors and subordinates. Therefore, autonomy may improve workplace functions through the ideas and suggestions of employees, and foster relationships with a greater degree of trust between management and employees. However, increased autonomy in the organization also may create disparity among units through different work practices and rules. In the worst case, increased autonomy may allow some employees to engage in unethical behavior. Thus, a certain amount of oversight is necessary in

organizations to prevent wrongdoing that may go unnoticed when there are high levels of autonomy.

Autonomy generally is a positive attribute for employees, managers, teams, and organizations as a whole. Employees typically desire autonomy, and its introduction can increase motivation, overall job performance, and satisfaction. However, organizations should be careful when increasing autonomy, because too much autonomy can have organizational drawbacks.

SEE ALSO Empowerment

BIBLIOGRAPHY

Gómez-Mejía, Luis R., David B. Balkin, and Robert L. Cardy. Managing Human Resources. 4th ed. Upper Saddle River, NJ: Prentice Hall, 2004.

Hackman, J. Richard, and Greg R. Oldham. Motivation through the Design of Work: Test of a Theory. Organizational Behavior and Human Performance 16 (1976): 250279.

Morgeson, Frederick, Kelly Delaney-Klinger, and Monica Hemingway. The Importance of Job Autonomy, Cognitive Ability, and Job-Related Skill for Predicting Role Breadth and Job Performance. Journal of Applied Psychology. 90, No. 2 (2005): 399406.

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Autonomy

AUTONOMY

The core idea of personal autonomy is to have personal rule of the self while remaining free from controlling interference by others. The autonomous person acts in accordance with a freely self-chosen and informed plan. A person of diminished autonomy, by contrast, is in at least some respects controlled by others or is incapable of deliberating or acting on the basis of his or her own plans. For example, institutionalized persons, such as prisoners or the mentally retarded, may have diminished autonomy.

In public health, the concept of autonomous decision making is related to informed consent. Virtually all medical and research codes of ethics now hold that physicians and researchers must obtain the informed consent of patients and research subjects before undertaking procedures. These consent measures have been designed to enable autonomous choice by patients and subjects, but they serve other purposes as well, including the protection of patients and subjects against harm and the encouragement of medical professionals to act responsibly in their interaction with patients and subjects.

There is growing international appreciation of the importance of ethical review of research involving human subjects. Ethical review committees carry the primary responsibility for ensuring that research is scientifically sound, and that informed consent is obtained from research subjects in ways that respect their autonomy and ensure an appropriate balance of risks and benefits.

While informed consent can be obtained in more advanced societies in ways that can be assessed by ethical review committees in terms of subjects being well informed and the consent being understood and responded to by the subject without coercion or intimidation, the situation may be different in developing countries. The informed consent process could be very different in a cultural situation in which the subject is illiterate and the process of seeking consent involves obtaining overall permission from community leadership in addition to individual consent from research subjects. In such situations the challenge is to respect local culture and its processes, while at the same time respecting the autonomous rights of each research subject.

John H. Bryant

(see also: Cultural Appropriateness; Epidemiology; Informed Consent; Paternalism )

Bibliography

Beauchamp, T. L., and Childress, J. F. (1989). Principles of Biomedical Ethics, 3rd edition. New York: Oxford University Press.

Council of International Organizations for Medical Science (2000). Biomedical Research Ethics: Updating International Guidelines. Geneva: Author.

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autonomy

autonomy In psychology, the maintenance of the integrity of the self, said to be lacking where (for example) the individual is excessively conformist or suffers from a behavioural disorder such as hysteria or multiple personality. In Kantian philosophy it refers to the doctrine that the human will carries within itself its own guiding principle. Political scientists use the term in reference to the right or power of self-government (for example an ‘autonomous state’). In sociology, it is usually applied in contexts where the writer has in mind a rational, self-determining social actor, who is not subject to some form of determinism but expresses his or her own goals and interests.

Research suggests that lack of autonomy at work is related to mortality and morbidity. For example, the ‘Whitehall Studies’ of British civil servants show that illness is grade-related—that is, people working in senior administrative jobs enjoy lower rates of sickness absence, lower susceptibility to ill-health, and lower risks of death from a wide variety of pathological conditions, than do those employed in routine clerical grades—and that ‘less sense of control over one's work, lower use of skills and less variety on the job’ are crucial to the explanation of these relationships (see Michael G. Marmot , ‘Social Differentials in Health within and between Populations’, Daedalus, 1994
). Similarly, the major cross-national comparative analysis of the relationships between social structure and personality undertaken by Melvin Kohn and his colleagues concludes that (among other things) the associations between social stratification, values, and orientations can be explained ‘largely in terms of the close relationship between social stratification and conditions of work that facilitate or restrict the exercise of occupational self-direction’, so that occupational self-direction (by which is meant ‘autonomy in the work-place’) forms the ‘crucial explanatory link between social structure and personality’ (see, for example, Melvin L. Kohn and and Kazimierz M. Slomczynski , Social Structure and Self-Direction, 1990
).

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autonomy

autonomy (ôtŏn´əmē) [Gr.,=self-rule], in a political sense, limited self-government, short of independence, of a political state or, more frequently, of a subdivision. The term is also used for other self-governing units, such as a parish, a corporation, or a religious sect. A test of autonomy is the recognition that the group may make the rules governing its internal affairs. Political autonomy is frequently based on cultural and ethnic differences. Autonomy within empires has frequently been a prelude to independence, as in the case of the evolution of the British Empire into the Commonwealth of Nations, containing both autonomous and completely sovereign states. Autonomy as in the former Soviet "autonomous" republics and regions in Russia, providing local control over cultural and economic affairs, often is perceived as inadequate by nationalists, who sometimes have demanded independence, as in Chechnya. The same has proven true in Slovakia, and provides impetus for terrorism by Basque, Corsican, and Welsh extremists.

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autonomy

au·ton·o·my / ôˈtänəmē/ • n. (pl. -mies) (of a country or region) the right or condition of self-government, esp. in a particular sphere. ∎  a self-governing country or region. ∎  freedom from external control or influence; independence: economic autonomy is still a long way off for many women. ∎  (in Kantian moral philosophy) the capacity of an agent to act in accordance with objective morality rather than under the influence of desires. DERIVATIVES: au·ton·o·mist / -mist/ n. & adj.

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autonomy

autonomy (aw-tonn-ŏmi) n. the right of personal freedom of action, said to be one of the characteristics of a profession. Respect for the autonomy of a patient usually takes the form of disclosing all necessary information and seeking consent for treatment and research.

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autonomy

autonomy XVII. — Gr. autonomíā, f. autós AUTO- + nómos (see -NOMY).
Hence autonomous XIX.

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autonomy

autonomyfumy, gloomy, plumy, rheumy, roomie, roomy, spumy •excuse-me • mushroomy • perfumy •Brummie, chummy, crumby, crummy, dummy, gummy, lumme, mummy, plummy, rummy, scrummy, scummy, slummy, tummy, yummy •academy • sodomy • blasphemy •infamy •bigamy, polygamy, trigamy •endogamy, exogamy, heterogamy, homogamy, misogamy, monogamy •hypergamy • alchemy • Ptolemy •anomie • antinomy •agronomy, astronomy, autonomy, bonhomie, Deuteronomy, economy, gastronomy, heteronomy, metonymy, physiognomy, taxonomy •thingummy • Laramie • sesame •blossomy •anatomy, atomy •hysterectomy, mastectomy, tonsillectomy, vasectomy •epitome •dichotomy, lobotomy, tracheotomy, trichotomy •colostomy • bosomy •squirmy, thermae, wormy •taxidermy

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