Reconsidering the ‘self’ in self‐management of chronic illness: Lessons from relational autonomy

Abstract

Self‐management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self‐management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self‐interested, and self‐governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of self‐management and the traditional individualistic view of autonomy. I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self‐management will be valuable in guiding its progression and elaborate ways in which self‐management research and practice could benefit from incorporating a relational approach to autonomy.

Considering Social Determinants of Health: A Case for the Just Treatment of Vulnerable Adolescent Mental Health Inpatients

“…Relational autonomy is a perspective that frames individuals as socially embedded agents who develop a sense of self through the context of social relationships; it proposes that people are inherently interdependent and interconnected. These social relationships are shaped by the intersection of SDH (19). It is a notion of autonomy that is sensitive to issues of social justice and is socially grounded.…”

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland

“…Several studies have found that the social context of a person's life determines not only the risk of exposure and the degree of susceptibility but also the course and outcome of a disease depending on the capability to cope with the disease ( 8 , 17 , 18 ). However self-management of CHC is too often discussed from a purely individualistic perspective, ignoring the social and cultural context in which this process happens ( 19 , 20 ). “Central to these critiques is a hyper-individualistic conception of patients as autonomous self-regulating subjects making self-serving decisions” ( 19 ).…”

“…However self-management of CHC is too often discussed from a purely individualistic perspective, ignoring the social and cultural context in which this process happens ( 19 , 20 ). “Central to these critiques is a hyper-individualistic conception of patients as autonomous self-regulating subjects making self-serving decisions” ( 19 ).…”

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Elderly People with Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

“…Several studies have found that the social context of a person's life determines not only the risk of exposure and the degree of susceptibility but also the course and outcome of a disease depending on the capability to cope with the disease [7]. However self-management of CHC is too often discussed from a purely individualistic perspective, ignoring the social and cultural context in which this process happens [14,15]. "Central to these critiques is a hyper-individualistic conception of patients as autonomous self-regulating subjects making self-serving decisions" [14].…”

“…However self-management of CHC is too often discussed from a purely individualistic perspective, ignoring the social and cultural context in which this process happens [14,15]. "Central to these critiques is a hyper-individualistic conception of patients as autonomous self-regulating subjects making self-serving decisions" [14].…”