Cultivating autonomy

There exists in every person a desire to control events, to be master of the life that surrounds him, to engage the world autonomously. This article argues that this desire is peculiarly blind to the intrusion of the uncontrollable or unexpected in life, and, when religiously applied, derives from the character ofhubris.     

Hysterectomy and autonomy

Hysterectomy (or hysterectomy with oophorectomy) is the most frequently performed major surgery in the United States, affecting approximately 700,000 women each year (Easterday, 1983). There has long been interest in the psychological effects of these surgeries. However, apart from the concern that some hysterectomies may be unnecessary (Pearse, 1976), there has been little attention to bioethical issues relating to hysterectomy. Physicians and nurses are ethically obligated to respect the woman who may have a hysterectomy by treating her as an autonomous agent. Informed consent within the context of a decision for hysterectomy should include balanced information and supportive exploration of the woman's values, goals, and life plan. Care of the patient should assist her adjustment, thereby also promoting her autonomy. Physician attitudes toward hysterectomy and the hysterectomy patient can have a major influence on patient self-determination.     

A measure of autonomy

This article reports the development of a measure of indicidual differences in autonomous rule compliance. The autonomy scale (a short, easily administered CPI based test) was developed within the framework of a multidimensional, role-theoretical model of moral development. Five samples were used in the construction of the scale. Two of the samples (total n = 111) were used to derive the autonomy scale. The items for the scale were derived through the sequential use of two common item selection stategies: criterion keying and factor analysis. An initial set of 55 CPI items were derived using an "ideal" autonomy Q-sort profile as a selection criterion, and an Alpha factor solution was used to reduce this initial pool to a final set of 25 items. Several analyses were conducted using three additional samples (total n = 245) to estimate the reliability of the scale and determine its validity. The results of these analyses provide initial evidence for the content, criterion-realted, and construct validity of the scale and indicate that the measure has an adequate reliability.     

Individual autonomy in organizations

This paper attempts to quantify the notion of an individual's desire for autonomy in an organization. It is shown that the basis for this concept can be formulated axiomatically, and a numerical function constituting the “degree” of autonomy can be derived. The relations between the individual's basic preferences, his/her feelings of autonomy, and the individual's performance as an organization member, are also studied. In this connection the loyalty of the member to the organization becomes important, and this notion is also developed axiomatically.     

Prior autonomy frustration facilitates persistent behavior: The moderating role of autonomy causality orientation

Motivation and Emotion - Satisfaction of the basic psychological need of autonomy is essential for one’s optimal functioning and well-being. Recent studies consistently demonstrated that...     

Precedent autonomy and personal identity

Debates on precedent autonomy and some forms of paternalistic interventions, which are related to questions of personal identity, are analyzed. The discussion is based on the distinction between personal identity as persistence and as biographical identity. It first is shown that categorical objections to advance directives and "Ulysses contracts" are based on false assumptions about personal identity that conflate persistence and biographical identity. Therefore, advance directives and "Ulysses contracts" are ethically acceptable tools for prolonging one's autonomy. The notions of personality and biographical identity are used to analyze the ethically relevant features. Thereby, it is shown that these concepts are operative in and useful for thinking in biomedical ethics. The overall conclusion is that categorical arguments against precedent autonomy or "Ulysses contracts" are based on misleading theories of personal identity and that advance directives are an ethically respectable tool for prolonging individuals' autonomy in cases of dementia and mental illness.     

The many faces of autonomy

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, in which actions are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training.