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Practical Insights for Busy Caregivers

Why autonomy matters – a personal reflection


September 12, 2016, by Pat Morden, Caregiver Exchange

When my mother was failing physically and cognitively, I could see quite clearly that she needed to move from her apartment. She dug in her heels, and my brother supported her. I was frustrated – after all, I knew she would eat better, have more social contact, and be safer in a retirement home.

I was right about that. But I was also very wrong. Being a caregiver doesn’t mean you get to make all the decisions. And being old or ill doesn’t, or shouldn’t, mean giving up your autonomy.

What is autonomy? According to the dictionary it’s “the right or condition of self-government.” As people get older, health declines and they become more dependent on others for many things. But they don’t give up the desire, or the right, to govern themselves.

Research shows that seniors with high levels of autonomy have better mental health, independence and quality of life. They are less likely to experience depression and are at lower risk for abuse and neglect.

As caregivers we sometimes focus on safety at the expense of autonomy. Recently I watched a remarkable video that included footage of an 85-year-old man skydiving.  Not the safest activity, and opposed by his loving family, but it was apparently the one thing he longed to achieve. He was being his authentic self and making his own choices.

As author Atul Gawande says in his book Being Mortal, “. . . the chance to shape one’s story is essential to sustaining meaning in life.”

Skydiving is not an option for most of the people we care for. Sometimes autonomy is choosing when to get up in the morning, what to wear or what to eat. Sometimes it’s taking a physical risk. As caregivers we must find a balance between safety and autonomy. Perhaps in the end, it’s a question of treating others as we would want to be treated ourselves.