Patient autonomy for the management of chronic conditions: a two-component re-conceptualization

Am J Bioeth. 2009 Feb;9(2):23-30. doi: 10.1080/15265160802654111.


The clinical application of the concept of patient autonomy has centered on the ability to deliberate and make treatment decisions (decisional autonomy) to the virtual exclusion of the capacity to execute the treatment plan (executive autonomy). However, the one-component concept of autonomy is problematic in the context of multiple chronic conditions. Adherence to complex treatments commonly breaks down when patients have functional, educational, and cognitive barriers that impair their capacity to plan, sequence, and carry out tasks associated with chronic care. The purpose of this article is to call for a two-component re-conceptualization of autonomy and to argue that the clinical assessment of capacity for patients with chronic conditions should be expanded to include both autonomous decision-making and autonomous execution of the agreed-upon treatment plan. We explain how the concept of autonomy should be expanded to include both decisional and executive autonomy, describe the biopsychosocial correlates of the two-component concept of autonomy, and recommend diagnostic and treatment strategies to support patients with deficits in executive autonomy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living*
  • Chronic Disease* / therapy
  • Comprehension
  • Concept Formation
  • Decision Making*
  • Higher Nervous Activity
  • Humans
  • Informed Consent
  • Intention
  • Mental Competency
  • Mental Health
  • Motor Skills
  • Patient Compliance*
  • Patient Participation*
  • Personal Autonomy*
  • Psychomotor Performance*
  • Recurrence
  • Self Care*
  • Task Performance and Analysis
  • Volition