A significant problem with most liberal-inspired accounts of autonomy is the inadequacy of the underlying political model, namely, state sovereignty, for understanding personal autonomy. On the political model, the person is understood by analogy with an ideally autonomous political unit that is characterized by independence from the laws and governance of other states. To be autonomous in this sense is to be sovereign within a specific political domain. Influenced by this idea, many naturally think of the autonomy of the individual as analogously involving independence from the authority of others (state, institutions, or other individuals). Autonomy is thus defined privately as negative freedom in terms of that absence of coercion or dependence (Berlin 1969: 122; Young 1986: 3). This view of autonomy as negative freedom, though dominant, presents an intractable problem for long-term care only if it proves impossible to develop a complementary positive account that can accommodate the concrete character of autonomous action under conditions of dependence.

Most commentators agree that autonomy is a richly ambiguous and multi-textured concept that refers to a wide range of positively regarded attributes. This wide range of usage suggests that it is unlikely that any essential definition could unify these various usages (Dworkin 1988: 6). The central concepts involved in discussions of autonomy, such as consent, paternalism, or respect for persons, have such widely varying meanings partly because of their employment in different ethical theories (O'Neill 1984: 173).