By Clarke, Charlotte Laura; Macfarlane, Ann; Reed, Jan (eds.)

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Collopy asserted that autonomy is not, as we said before, a straightforward aspect of care in which someone either does or does not have autonomy. He points to a number of dimensions of autonomy, such as decisions made about long- and short-term issues, or about both mundane and key issues. e. the freedom to make decisions), even if their ‘executional autonomy’ (the ability to act on these decisions) is compromised (Collopy, 1988: 12). 2 Fred lives alone since his wife died and he has been recently discharged from hospital having had a stroke.

This idea can clash with images of older people being passive and compliant which are often shown in culture. We have already pointed to some stereotypes of older people, and these can work against non-prejudicial thinking. The nurse then needs to think outside stereotypes and assumptions, and as Collopy (1988) says: ‘autonomy can be a source of persistent and serious ethical conflict between the frail elderly and those . . who provide care to them’ (p. 17). Taking on this conflict is often a brave and controversial course.

Autonomy then refers to a person’s capacity for self-determination or self-governance or self-rule; that is, the capacity to make decisions for oneself. However, while on the face of it this is a relatively easy concept to understand, in reality autonomy is complex and gives us much reason for reflection, particularly when linked to the idea of independence. This complexity will also arise and become clear in the final section of this chapter, where the implications for practice are discussed. If we start by exploring the similarities and differences between ‘independence’ and ‘autonomy’ then we can start to see the connections between them.

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