Autonomie et demence I Pour une conception de l'autonomie dementia friendly Autonomy and dementia Part I: Propositions for a dementia frendly conception
In the course of centuries, the value of autonomy has been greatly emphasized, though the content of the concept has varied. Between various meanings it has taken, which one does allow to retain it amongst the care objectives as long as possible during the dementia process? A critical examination of the philosophical and medico social literature shows that the different meanings of autonomy can be organized according to two poles. The first one, the canonical one, is the most usual, and regards autonomy as a matter of internal competences of the subject (such as rationality, reflexivity, memory) Subjects with dementia are therefore more or less rapidly excluded from the access to autonomy. The second one is relational and refers to external conditions. Do the relationships, the institu tions in which the demented person is included, and the policies on which he depends allow him the opportunity to act autonomously? In this meaning, others people are considered as a potential resource to identify the goals and means appropriate for the subject. There fore, this relational pole recognises the possibility for the demented subject to be longer autonomous than according to the canonical pole because his autonomy does not depend only on himself but on all those who care for him directly or indirectly. In this meaning, he can exercise his autonomy in more domains.