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Autonomy: the be all and end all in rehabilitation

In their paper Cardol et al. argue that the consideration of autonomy adds a personal perspective to rehabilitation. this, they feel, is a concept that should be used to understand how a person experiences his or her social existence, together with measures of impairment, activity, participation and quality of life. They further suggest that the individualist-liberal view of autonomy has limitations as it equates autonomy with physical independence, it does not recognize that individuals are social beings, and that inter-dependence is a characteristic of human life not an aberration of illness or disability. Cardol and colleagues say that rehabilitation workers can guide the individual in determining options and strategies, provide meaningful information, allow time and create an environment in which autonomy is respected and encourage the extent of the individual’s abilities or wishes. They conclude that the ultimate aim of rehabilitation is to regain and retain the highest level of autonomy, in order to maximize participation. Whilst this is a noble aim, not all those who engage in rehabilitation, either in rehabilitation centres or in the community, are able or willing to be autonomous. Further, there are problems with focussing on autonomy as the end result of rehabilitation, if there are no resources in place to meet these expectations. This commentary will aim to address these issues.