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Chapter 2: Literature Review
characteristics, such as values, physical traits and relations to others. Atkins (2006)
subsequently analysed the contrasting elements of subjective autonomy and
objective autonomy. Atkins (2006) did not agree that one type of autonomy
(subjective) should be in opposition to another (objective), and also commended
Meyers’ (1989) view that autonomy is relational and practical, consisting of a set of
socially acquired practical competencies in self-discovery, self-definition, self-
knowledge and self-direction. Atkins (2006) stated that one must possess a minimal
understanding of how one’s motives, values, beliefs, emotional disposition, desires
and weaknesses can be related together and how they might influence one’s choice
and attitudes. Meyers (1989) had previously argued that this is a basic requirement
for comprehending and negotiating one’s needs, wants, and responsibilities (self-
government) in the many different circumstances one faces in life.
Thus there is no clear, succinct definition of autonomy, but related terms include
freedom, independence, power, self-government and self-determination. Several
authors have tried to explain autonomy by defining its opposite concept –
paternalism - and by illustrating and describing different “types” of autonomy,
which include “basic and ideal, subjective and objective”. Agich (1990) stated that
while action, speech and thought are important elements of autonomy, it must be
remembered that these associations with autonomy date back to seventeenth-century
political and legal debates, and hence the understanding of the concept of autonomy
needs newer associations. He further stated that definitions of autonomy that focus
only on action and choice are idealistic, and that a concrete definition of autonomy
should include a daily living account of the person who engages with meaningful
options (meaningful to the older person). Agich (1990) rationalised that autonomy is
socially conditioned and contextually situated and thus expressions of autonomy are
unique to each individual.
2.2.1 Determinants of Autonomy
Further to definitions of autonomy, the literature revealed many determinants of
autonomy that are useful in defining and understanding the term. Many authors
describe “capacity” as an integral ingredient/element of one’s autonomy and they use
descriptions of capacity to explain the essence or meaning of autonomy (Boyle,
2008; Harnett and Greaney, 2008; Gillon, 1995; Beauchamp and Childress, 1994;