The concept of ‘functional dependency’

INTRODUCTION: In Europe the concepts of ‘functioning/disability’ and ‘autonomy/dependency’ deserve special interest from the point of view of medical ontology. While Functioning/Disability are concepts defined at the WHO International Classification of Functioning (ICF), the autonomy/dependency pair is not even mentioned at this classification system. DESCRIPTION: The Council of Europe has defined ‘dependency’ as the condition related to the loss of autonomy and the need of support by a third person related to an impairment of activities of daily living, specially self-care. Laws and care services for the elderly and for persons with severe disability have been developed following this paradigm in several EU countries. These concepts are based in the Activities of Daily Living construct (ADLs) which divides these activities in basic and instrumental. This construct cannot be linked to the WHO-ICF paradigm as stated in the Spanish law. WHO has defined ‘personal autonomy’ as equivalent to self-direction, competence and self-empowerment, and there is no equivalent definition of function-related autonomy at the WHO Family of Classifications. CONCLUSION: The different background of these concept pairs had a significant impact on the development of health and social services in several European countries during the last decade. This is particularly important for those conditions where impairment is not related directly to basic ADLs but to other functional problems such as severe mental illness or intellectual disability. The ontological disparities need careful review to avoid inequity in access to care for severe disability in Europe.