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Chapter 2: Literature Review
Hofland (1994) states that the issue of personal autonomy has dominated healthcare
ethics debates for decades.Many philosophers have debated the true meaning of
autonomy and most agree that it is difficult to define or fully explain (Atkins, 2006;
Doyal and Gough, 1991; Feinberg, 1989; Gillon, 1995; Kant, 1989; Meyers, 1989;
Mill, 1975). Attempts to explain autonomy have focused on relating it to other
concepts or identifying its related terms.
The literature review also revealed that the defining terms for autonomy varied. The
terms used by dictionaries to explain autonomy include, “freedom”, “independence”,
“self-determination” and “self-government”. The Collins English Dictionary defines
is as “Freedom to determine one’s own actions and behaviour” (2010, pp.103), but
Gillon (1995) states that autonomy must be distinguished from freedom. Freedom
concerns the ability to act without external or internal constraints, while autonomy
concerns the independence and authenticity of the desires that move one to act in the
first place. Similarly, the Oxford English Dictionary explains that the “freedom” in
autonomy is that which is independent of external control or influence from others
and that the “independence” (in Kantian moral philosophy) is the capacity of an
agent to act in accordance with objective morality rather than under the influence of
others’ desires. Thus an understanding of autonomy focused on freedom of the will
alone is inadequate (Atkins, 2006). Blackwell’s Dictionary of Nursing (2010: 73)
also uses the term “independence” to define autonomy, but refers to functional
independence and states that autonomy is about “having the ability to function
independently”. The realisation that autonomy could be explained as independent of
external control or influence from others (social power, organisational power and
individual power) has led authors to suggest that the autonomous individual is free
from power and that outsiders who may possess power over another person are
exercising illegitimate power, with the autonomous person being the only one with
authority to determine what governs their lives (Atkins, 2006;Manley and
McCormack, 2003; Burkhardt and Nathaniel, 2002; McCormack, 2001; Quill and
Brody, 1996; Beauchamp and Childress, 1994; Gillon, 1995;Mill, 1975).
Furthermore, Mill (1975) had previously stated that being autonomous is about being
able to enjoy productive and enabling relations with others rather than being
subjected to the deleterious effects of power.