Donchin criticized Engelhardt approach to autonomy and noted that the power and authority of physicians to act as gatekeepers selecting candidates for non-therapeutic elective procedures raised the different set of issues about limiting patient autonomy.
Tauber notes that patients lose their ability to make free choices because they are never fully informed. In his perception, by employing the term of adequate understanding, the patients themselves recognize the limits of their freedom and are more concerned with the process of healing and autonomy is rather the aspiration of the curing process. Verkerk and Keller analyzed patient autonomy in the context of care perspective or feministic approach. The patient care is focused on becoming more active and committed caregivers instead of adopting the non-interference attitude and respect of patient autonomy. The ideal of autonomy in terms of independence and self-sufficiency is criticized, while the idea of interdependence is emphasized. Dworkin, on the contrary, has covered the issue of autonomy from different perspectives starting with the Kantian concept of self-governance and ending with the feministic approach to autonomy.
Even though Dworkin does not use the word autonomy in his works, while discussing the idea of treating people equally he is arguing for the equal respect for the autonomy of people. For example, according to his liberal theory of equality, the political decisions should be free of any conception of the good life because the conceptions of people are different and the government will be unable to treat citizens as equals if one conception is prefer to other. Thus, autonomy is an equivalent of liberty, self-rule, integrity, individuality, and self-knowledge (6). Dworkin argues that autonomy is not the same concept as liberty. For example, if the doctor deceives the patient, he is interfering with patient's autonomy, but is not restricting his liberty. Moreover, he notes that the coercion and deception infringe upon the voluntary character of the individual's actions.
There is the tension between formal autonomy (when the patient decides on his own what is better for him) and substantive autonomy (where only certain decisions count as retaining autonomy whereas others count as forfeiting it). Thus, the person who decides to do what his community tells his to do is not autonomous. Autonomy is in conflict with emotional ties to others, with commitment to tradition or leadership (12). Dworkin notes that it is characteristic of humans to adopt attitudes towards their first-order desires and intentions. For example, the person may not just desire to smoke, but also desire that the other