AGICH / SEEKING THE EVERYDAY MEANING OF AUTONOMY IN NEUROLOGIC DISORDERS ■ 295 © 2005 by The Johns Hopkins University Press George J. Agich Seeking the Everyday Meaning of Autonomy in Neurologic Disorders T HE SOCRATIC APHORISM that the unexam- ined life is not worth living and dictums like “Know thyself” remind us of the centrality of self-understanding in the history of philosophical reflections on autonomy. These tra- ditional concerns with autonomy may seem far removed from the neurologic impairments to which Joel Anderson and Warren Lux draw our attention. Nonetheless, Anderson and Lux have provided an important discussion that links the traditional philosophical commitment to self- knowledge with an account that parses these concepts in the context of neurologic disorders. Theirs is a potentially productive approach for improving our understanding of autonomy, one that Emilio Mordini and I advocated in a paper entitled, “Autonomy and the Ethics of Neurosur- gery” (Agich and Mordini 1998, 54). We argued that the focus of bioethics on issues such as informed consent misses the more challenging and potentially fruitful collaboration that neuro- surgery and neurology affords for advancing the philosophical understanding of the conditions of autonomy. The challenge is in the integration of concepts used in one context of meaning with other domains of discourse. A good example of the challenges embedded in pursuing this kind of project can be found in Anderson and Lux’s discussion of the concept of accurate self-assess- ment. Anderson and Lux argue that accurate self- assessment is a requirement for one to act auton- omously. On first hearing, this phrase sounds unsurprising and consistent with standard ap- proaches that assume a higher degree of aware- ness of one’s capacities. Their characterization, however, derives from their observations of cases involving severe neurologic impairments, which point to more basic processes than the reflective awareness or knowledge that is often assumed. Paradoxically, the language of accurate self-as- sessment sounds remarkably like an intellectual function. It appears to fall squarely within the traditional philosophical tendency to define au- tonomy in terms of ego-centered, intellectual func- tions involving relatively high-level reflective ca- pacities. Despite their terminology, Anderson and Lux stress that their account requires a type of reflexivity that is not the same as self-conscious reflection understood in the highest degree. They stress this in a number of places. For example, they see the neurologic concept of executive func- tion as involving basic feedback mechanisms that are “broadly isomorphic with capacities associ-