Abstract This conceptual review examines how autonomy became the dominant moral grammar of late modern Western societies and how its expansion reshapes subjectivity, institutions, public life, and healthcare practice. A genealogy traces autonomy from Enlightenment duty bound self legislation and civic self rule, through liberal non interference, to later forms shaped by expressive individualism, therapeutic culture, and recognition based claims. The paper argues that autonomy’s normative achievements remain decisive, yet its cultural absolutization can generate a fragile subject who is highly expressive but insufficiently equipped for sustained responsibility. Five linked pathologies are analysed: autonomy as entitlement and boundary protection, transgression emptied by indeterminate norms, opinion transformed into performative positioning under hyperpluralism and platform surveillance, symbolic authority eroded across education and the professions, and duties devalued within a rights centred moral economy. In response, the paper proposes a reconstructive framework that redefines autonomy as ethical maturity, a formed capability sustained by responsibility, legitimate authority, deliberative practices of opinion, and duty. Particular attention is given to philosophy of medicine, where patient autonomy and professional autonomy illuminate the difference between supported agency and consumerist choice. Methodologically, the article combines genealogical reconstruction, phenomenological interpretation, and a purposive interdisciplinary synthesis of sociology, developmental psychology, philosophy of medicine, moral psychology, and media studies. Implications are sketched for education, healthcare, professional trust, and platform governance, with emphasis on proportional accountability and repair.
Madeira et al. (Mon,) studied this question.