People in the counseling profession make some profound assumptions about the freedom that all people have (or seem to have). From the moment that each counselor began counselor training, the notion that people are able to generally choose and make decisions for themselves has been associated with the dominant process models of the profession. As a result, it is often difficult to imagine that some people as they grow older lose their freedom to make choices about their lives. Autonomy has been said to be similar to notions of self-determination, freedom, independence, etc. Autonomy gives a sense of well-being, but the older person may decrease his or her expectation of freedom of choice in order to retain a measure of life satisfaction. Situations in which individuals can lose their autonomy as they grow older include the diagnosis of cancer and nursing home placement and residency. The diagnosis of cancer may cause a person (or family) to surrender to the forces of medicine without considering the choices that are available. Another potential source for the loss of autonomy in adult life occurs with nursing home placement and residency. The nursing home carries with it images of the "last stop," a place where the poor, the frail, and the demented elderly go to wait to die. Counselors who work with persons in later life must constantly ask themselves what is truly best for the individual and consider too what allows them the most autonomy. (ABL)