Autonomy (Encyclopedia of Public Health)
The core idea of personal autonomy is to have personal rule of the self while remaining free from controlling interference by others. The autonomous person acts in accordance with a freely self-chosen and informed plan. A person of diminished autonomy, by contrast, is in at least some respects controlled by others or is incapable of deliberating or acting on the basis of his or her own plans. For example, institutionalized persons, such as prisoners or the mentally retarded, may have diminished autonomy.
In public health, the concept of autonomous decision making is related to informed consent. Virtually all medical and research codes of ethics now hold that physicians and researchers must obtain the informed consent of patients and research subjects before undertaking procedures. These consent measures have been designed to enable autonomous choice by patients and subjects, but they serve other purposes as well, including the protection of patients and subjects against harm and the encouragement of medical professionals to act responsibly in their interaction with patients and subjects.
There is growing international appreciation of the importance of ethical review of research involving human subjects. Ethical review committees carry the primary responsibility for ensuring that research is scientifically sound, and that informed consent is obtained from research subjects in ways that respect their autonomy and ensure an appropriate balance of risks and benefits.
While informed consent can be obtained in more advanced societies in ways that can be assessed by ethical review committees in terms of subjects being well informed and the consent being understood and responded to by the subject without coercion or intimidation, the situation may be different in developing countries. The informed consent process could be very different in a cultural situation in which the subject is illiterate and the process of seeking consent involves obtaining overall permission from community leadership in addition to individual consent from research subjects. In such situations the challenge is to respect local culture and its processes, while at the same time respecting the autonomous rights of each research subject.
JOHN H. BRYANT
(SEE ALSO: Cultural Appropriateness; Epidemiology; Informed Consent; Paternalism)
Beauchamp, T. L., and Childress, J. F. (1989). Principles of Biomedical Ethics, 3rd edition. New York: Oxford University Press.
Council of International Organizations for Medical Science (2000). Biomedical Research Ethics: Updating International Guidelines. Geneva: Author.
Autonomy (Encyclopedia of Management)
Autonomy is the degree to which a job provides an employee with the discretion and independence to schedule their work and determine how it is to be done. Higher levels of autonomy on the job have been shown to increase job satisfaction, and in some cases, motivation to perform the job. In traditional organizations, only those employees at higher levels had autonomy. However, new organizational structures, such as flatter organizations, have resulted in increased autonomy at lower levels. Additionally, many companies now make use of autonomous work teams. Autonomy in the workplace can have benefits for employees, teams, managers, and the company as a whole, but it also may have drawbacks. Information regarding both the pros and cons of autonomy for these groups is discussed below.
According to job design theories, increased autonomy should make employees feel a greater responsibility for the outcomes of their work, and therefore have increased work motivation. Research indicates that when employees have greater levels of autonomy, their personality traits (specifically conscientiousness and extroversion) have a stronger impact on job performance. Thus, by giving employees more autonomy, they are better able to use their personal attributes to contribute to job performance.
Unfortunately, too much autonomy can lead to employee dissatisfaction. Each individual has a different level of need for autonomy in their job. Some workers prefer more direction from a manager and feel uncomfortable with autonomy; they may not want to exert effort or take the responsibility of having their name solely associated with a task, project, or product. Additionally, if employees are not well-equippedither in training or in personalityo exercise autonomy, it may result in workplace tension and poor performance. Finally, when given autonomy, workers may believe that they have authority somewhat equal to that of their direct supervisor. This may cause them to resent the extra responsibility or feel that their pay should be increased. A related concern is that managers may feel marginalized when employee autonomy increases, particularly when there is a change to a traditional work environment. Managers may feel that by giving employees autonomy, they no longer contribute as much to the organization or that their jobs may be at stake.
Managers tend to have increased autonomy in organizations that are more decentralized. In such organizations, managers have more latitude to make decisions regarding the work of employees and even personnel decisions. For example, managers with increased autonomy may be able to assign merit raises to the employees in their unit at their discretion. As with employee autonomy, this freedom can result in feelings of motivation and satisfaction for the manager, who may be in a better position to reward and motivate employees. However, as with employee autonomy, managers who have autonomy may not be equipped to handle it. If managers make poor decisions, this may be harmful to employees and the organization as a whole. Using the example of autonomy in deciding pay raises, a manager may give merit pay increases that are significantly higher than those in other work units, which may cause problems across the organization.
In recent years, many organizations have made use of teams in the workplace, many of which operate autonomously. Self-managed work teams are those in which a supervisor gives little direction to the team, and the team members manage themselves. The success of such teams depends greatly on the team members, including their professional capabilities and their ability to work together. Oftentimes, such autonomous teams can greatly enhance an organization's ability to be creative, flexible, and innovative. However, as with individuals, too much autonomy in a team can reduce productivity. When individuals work too independently, their lack of communication and monitoring of one another may result in poor team performance. Additionally, without supervision the team may pursue goals that are different from those of the organization. Thus, periodic meetings and supervision from a manager may be necessary to avoid problems associated with too much autonomy.
AUTONOMY AND THE ORGANIZATION
The autonomy of employees and managers is often dictated by an organization's structure and culture; traditional, bureaucratic organizations often have little autonomy, but newer, more organic structures rely on autonomy, empowerment, and participation to succeed. Employee autonomy is believed to have minimized some of the relational barriers between superiors and subordinates. Therefore, autonomy may improve workplace functions through the ideas and suggestions of employees, and foster relationships with a greater degree of trust between management and employees. However, increased autonomy in the organization also may create disparity among units through different work practices and rules. In the worst case, increased autonomy may allow some employees to engage in unethical behavior. Thus, a certain amount of oversight is necessary in organizations to prevent wrongdoing that may go unnoticed when there are high levels of autonomy.
In conclusion, autonomy generally is a positive attribute for employees, managers, teams, and organizations as a whole. Employees typically desire autonomy, and its introduction can increase motivation and satisfaction. However, because too much autonomy can have organizational drawbacks, care should be taken when increasing it.
Gómez-Mejía, Luis R., David B. Balkin, and Robert L. Cardy. Managing Human Resources. 4th ed. Upper Saddle River, NJ: Prentice Hall, 2004.
Hackman, J.R., and G.R. Oldham. "Motivation through the Design of Work: Test of a Theory." Organizational Behavior and Human Performance 16 (1976): 25079.