The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analysed in this perceptive work. The author argues that the standard view of autonomy as non-interference and independence has limited applicability for long term care. He offers an account of `actual autonomy' in which individuals are perceived to be interdependent with others and the world. Hence, actual autonomy stresses the developmental and social nature of the individual. Through a phenomenological analysis of long term care, the author develops an ethical framework for it by showing how autonomy is actually manifest in certain structural features of the social world of long term care. The work concludes wuth a discussion of the advantages associated with phenomenologically inspired treatment of actual autonomy for the ethics of long term care. Drawing on the rich sociological and anthropological literature on ageing and long term care, this timely work is essential reading for all biomedical ethicists and professionals providing long term care.