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Table 2.1: Collopy’s (1988) six polarities of autonomy
Type of Meaning
Autonomy
Competent Refers to a person’s
capacity/ability to perform
an activity
Decisional Refers to a person making
decisions
Authentic Refers to a person’s past and
present values – their life
history – needs, values and
goals
Direct Refers to a person’s capacity
to exercise their own
decisions
Positive Refers to the process of
advocating for a patient
based on their expressed
needs
Immediate Refers to a person’s
autonomy at the present
moment in time
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Chapter 2: Literature Review
Collopy’s (1988) explanation of autonomy using 12 polarities (six pairs) reveals the
complexity of the concept of autonomy. However, it also helps to advance the
understanding of autonomy by placing it in context and making it applicable to
residential care by using terminology that is more universally understood, which
helps one to better understand the nature of autonomy.
2.2.2 Section Summary
Type of
Autonomy
Incompetent/
Incapacitated
Autonomy of
Execution
Meaning
Refers to a person’s lack of
capacity/inability to perform
an activity
Refers to a person being
prevented from implementing
their decisions
Inauthentic Refers to not recognising the
person’s past and present
values – their life history –
needs, values and goals
Delegated Refers to a person who does
not possess the capacity to
exercise an autonomous
decision
Negative Refers to the prevention of a
person expressing their needs
Long-range Refers to a person’s
autonomy in the future
In summary, many of the explanations and definitions of autonomy found in the
literature do not relate directly to autonomy for older people in residential care, as it
is only in recent times that publications have focused on this aspect of autonomy.
While a clear consensus on an explanation or definition of autonomy was not
apparent in the literature, attempts had been made to outline its key defining terms.
Several authors agreed that freedom, independence, self-determination and self-
government are key defining elements of autonomy (Agich, 2004; Horowitz,
Silverstone and Reinhardt, 1991; Mill, 1975). Others chose to explain the concept of
autonomy by demonstrating how capacity, decision-making, power and polar