Le processus d'autonomisation des patient.es qui s'opéra en France au cours du XXe siècle peut, artificiellement, être divisé en trois grandes périodes marquées par les principes de solidarité, d'agentivité et d'autorité. Cette tripartition permet de mieux saisir les enjeux de ce mouvement et de comprendre en quoi l'avènement de la démocratie sanitaire, auquel il a abouti au début du XXIe siècle, consiste, par sa dépolitisation des enjeux d'autonomie, au renvoi des patient.es vers une forme de subalternité qu'incarnent, paradoxalement, les nouvelles figures de patient expert ou partenaire.

In the context of demographic aging, preventing autonomy loss is a major issue. Adapting care systems to help keep seniors at home is a daily challenge. “La Mutualité Française”, a national mutual insurance company, has implemented in one of its healthcare services an innovative program to strengthen well-being: “The Well-Being Autonomy Pole.” This program comprises five Prevention and Support Care components and hypothesizes that strengthening the well-being of elderly people already suffering from physical limitations would prevent their autonomy decline. The originality of this program is its focus on elderly people who have rarely been studied in terms of preventing autonomy loss, given their existing functional limitations. A first evaluation was carried out over three months to verify the methodological feasibility of an impact assessment and to provide preliminary results on the effectiveness of the program. Key findings suggest improved levels of self-esteem, physical well-being, psychological autonomy and decreased anxiety. Methodological limitations of this first feasibility assessment and perspectives for future research are discussed.

Indigenous scholars and leaders have long been interested in reducing the role of the Canadian state in their political, economic, and social lives. This paper explores the extent to which digital currencies, such as Bitcoin or MazaCoin, might be used to facilitate Indigenous self-determination, political autonomy, and economic prosperity. Based on our review of the literature, we argue that cryptocurrencies demonstrate some potential for advancing these goals but that there are a number of potential roadblocks as well. Future research should investigate how Indigenous communities might use digital currencies and other related technologies to further their political, economic, and social goals.

New surveillance technologies like those included in ambient assisted living – such as body-worn and passive environmental sensors, smart interfaces, and communications networks – are being developed to improve the security and safety of “at risk” older people, but ethical questions have been raised about the extent to which they compromise the rights and privacy of the people being monitored. The qualitative study we conducted was designed to help us understand the ways these novel surveillance technologies would influence individuals’ everyday experiences of home. Participants felt new forms of surveillance would influence their sense of security, autonomy, and self-confidence, and would alter perceptions of home. The findings emphasize the need to improve our understanding of how ambient assisted living will affect the lives of those being monitored.

Les concepts de compétence, d'autonomie et d'authenticité sont examinés. Diverses définitions du terme « autonomie » sont distinguées, et les auteurs prétendent que deux d'entre elles n'englobent aucun concept différent de la compétence mentale (la capacité de prendre des décisions) et de l'authenticité. L'accent est mis sur la distinction des questions de capacité et de compétence, et sur des cas où une intervention salutaire est justifiée.

Studies on informal caregiving in institutional settings are rare. The impact on their burden of 197 caregivers' perceptions of their elderly dependents' autonomy was investigated. The results of previous research on caregivers' burden in non-institutional contexts were used to provide an empirical starting point for the research. The results of regression analysis show that help for bathing and concurrent demands have an impact on objective burden, but caregivers' perceptions of their elderly dependents and the social support they receive affect subjective burden.

In the shift from inpatient to outpatient care that the province of Quebec is presently experiencing, the prompt assistance offered to older persons in then-domestic environment, is the kind of help that needs to be examined. The pilot project “Vie autonome chez soi” was intended to offer this type of service. The project took place in Montreal during 1990 and offered three services: a warden, a home security system and a telephone service (24–7). The objective of this evaluative study which uses a qualitative methodology is to discuss the implementation and functioning of the pilot project as well as to discover if some of the intended effects had been achieved through the services. Use of the alarm system had a positive impact on security for most of the participants who were still active in the project at the time of the evaluation. The warden services and the 24' security.

The value that the elderly put on being autonomous is an intrinsic characteristic of the aging population that can have a decisive influence on their motivation to maintain or recover their autonomy. This study was designed to examine the importance that elderly people who have lost their autonomy put on the ability to perform themselves five activities of daily living: eating, washing, dressing, eliminating and moving around. It also explores the influence of age, sex, place of residence, level of physical autonomy, feeling of well-being and socio-economic status on the value put on autonomy. A non-probabilistic sample of 68 elderly subjects was interviewed and the value put on autonomy was evaluated using two instruments: Osgood, Suci and Tannenbaum's differential semantic, and Torrance's time trade-off technique. The results suggest that the subjects consider physical autonomy very important. Educational level and the degree of physical autonomy were the main factors linked to importance. However, no link with age or place of residence (institution vs. home) was found.

In this paper it is argued that the voluntariness of decisions by older adults concerning future levels of health care should be viewed with scepticism, since such decisions are made in contexts of broad coercion. Broad coercion exists where there are asymmetries of power and dependency between groups, where social expectations unduly influence decisions, or where negative stereotyping results in low self esteem. Parallel cases, where broad coercion is acknowledged, are presented. Rather than conclude that older adults can never make voluntary decisions, however, it is suggested that scepticism may be removed by establishing the authenticity of the desires behind their health care choices. Three theories of authentic desire are examined and found inadequate, but a fourth alternative – the “autobiographical approach,” which requires us to uncover the personal metaphors of life and aging of older adults – is found to be more promising.

Efforts to address the “paradox of autonomy in long-term care” attempt to salvage an ethic of autonomy by redefining the central concept, and then applying it to the long-term care environment. Such attempts are critiqued, and an alternative ethic of dignity for long-term care is developed. Autonomy, it is argued, is crucial to certain aspects of dignity, but should not be confused with the whole of it. Indeed, long after the capacity for autonomy has diminished or vanished, basic dignity continues to exert normative force.

In response to the contradictions appearing between, on the one hand, government promotion of family caregiving for elderly parents and, on the other, the rise of autonomist values (as documented in the literature), we surveyed a number of elderly people living with disabilities about the kind of assistance they would like to receive. The present qualitative, thematic analysis is based on the accounts given by 19 elderly people who receive assistance. The findings show that the position of elderly people with respect to their desire to receive (or not receive) substantial assistance from their family rests on a set of values, wishes, and/or fears – including, particularly, adherence to the value of autonomy, the desire to respect freedom (one's own as well as that of others), adherence to norms of familial duty, attachment to one's home, the value placed on solitude and privacy, and the degree of emotional closeness between the elderly and their children. Access to quality formal services also stands out as a factor enabling elderly people to actualize the desire for care which they elicited within the framework of this analysis.