What do we mean when we talk about autonomy?

She was admitted to the hospital just before Christmas after swallowing a lethal dose of Tylenol, but she survived with medical intervention. Her reason? She was tired of being chronically sick, worried about her impaired mobility, afraid that she would have to leave her home. She felt that this was her best option for having some control over her last months. After she was stable, she was placed involuntarily on a psych hold, awaiting a court date to see if she could--as we say--be released safely back into the community. In the hospital for more than 4 weeks, she had a number of typical complications, including a foul case of antibiotic-induced diarrhea. She was pretty miserable, but sharp as a tack. She had had an interesting life, but most of her friends were dead, and she was not in touch with any family. She had paid her rent through the end of March, her hedge-bet in favor of going back home. Her medical problems qualified her for hospice care, but she was afraid to even talk about hospice, as she felt "they might hold it against me". She felt ashamed and inhibited, eager to talk about her life, but hesitant to express her present state of distress. She was released to a nursing home on January 19th , court date still looming over her.

A social worker visited her at the facility, felt that she was depressed and recommended ongoing counseling. He based this assessment in part on a self-administered survey in which she circled yes to "feeling lonely, sad, blue, or depressed"; "anxious or worried"; and "having thoughts of dying or committing suicide." She also assented to the following: "feeling like something bad is going to happen". This was on January 22. She died of chronic heart and lung disease on January 24th in the nursing home. Thankfully, her advance directive was honored.

On February 2, this note was placed in the medical record: "Request that the restrictive order be dismissed. Patient has expired."