in europe the concepts of  functioning / disability and  autonomy / dependency deserve special interest from the point of view of medical ontology . while functioning / disability are concepts defined at the who international classification of functioning ( icf ) , the autonomy / dependency pair is not even mentioned at this classification system . the council of europe has defined  dependency as the condition related to the loss of autonomy and the need of support by a third person related to an impairment of activities of daily living , specially self - care . laws and care services for the elderly and for persons with severe disability have been developed following this paradigm in several eu countries . these concepts are based in the activities of daily living construct ( adls ) which divides these activities in basic and instrumental . this construct can not be linked to the who - icf paradigm as stated in the spanish law . who has defined personal autonomy as equivalent to self - direction , competence and self - empowerment , and there is no equivalent definition of function - related autonomy at the who family of classifications . the different background of these concept pairs had a significant impact on the development of health and social services in several european countries during the last decade . this is particularly important for those conditions where impairment is not related directly to basic adls but to other functional problems such as severe mental illness or intellectual disability . the ontological disparities need careful review to avoid inequity in access to care for severe disability in europe .