Reconsidering the 'self' in self-management of chronic illness: Lessons from relational autonomy.

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.