An account of personal autonomy for people living with dementia
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: People living with dementia see autonomy as central to their well-being, and loss of autonomy is one of the things people diagnosed with dementia fear the most. Effective support of autonomy requires us to understand carefully what autonomy is and to structure care plans and health policy in accordance with that understanding. Many recent social scientific studies of autonomy in people with dementia do not carefully operationalize the term "autonomy." This is problematic because autonomy is a highly ambiguous term that points to a complex reality. We distill from the relevant philosophical and empirical literatures a conceptually clear and empirically informed account that is relevant to the experience of people living with dementia. RESEARCH DESIGN AND METHODS: We present a general account of the concept of personal autonomy, drawing on existing philosophical literature. We then test the relevance of this account via a scoping review of empirical research reporting on the experience of personal autonomy in persons living with dementia. RESULTS: With the assumption that adequate relational supports are in place, all aspects of our philosophically informed account of personal autonomy (decisional autonomy, authenticity, and executional autonomy) are compatible with the experience of persons living with dementia. DISCUSSION AND IMPLICATIONS: With adequate relational support, personal autonomy remains an achievable goal even in contexts of moderate to severe dementia. A conception of personal autonomy that is both theoretically and empirically informed can help guide efforts to study and support personal autonomy in persons living with dementia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.004 | 0.025 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.001 | 0.007 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".