In the United States, efforts to secure “patient autonomy” grew from the 1960s onward. Dying persons became, concomitantly, more “managed” than ever by increasingly comprehensive forms of medicine. Medical autonomy, conceived as “patient choice” proved a politically expedient way of getting along in a pluralistic society, but I argue that this thin understanding of autonomy proved philosophically incoherent and psychologically naïve. This work in constructive Christian ethics is a defense of “mature autonomy” which I take to include moral, socially-activated psychological, and spiritual components. Through the practical theologies of Don S. Browning (1934-2010) and Karl Rahner (1904-1984), this work grapples with the disintegrating features of contemporary culture that make it difficult to conclude one’s life with freedom and responsibility. I argue that when rightly understood, autonomy fuses these deep forms of freedom and responsibility which are at the heart of Christian life. I argue that Browning, who draws on the work of Erik Erikson, offers a psychoanalytically sophisticated ethics of the life cycle, as well as a potent defense of the role of the congregation in bringing loving and self-giving persons to maturity. Rahner is more existentially attuned to the contemporary demands of freedom and responsibility imposed upon the modern individual; by recovering the Spiritual Exercises of Ignatius of Loyola, he attends to the necessity of personal spiritual development which may culminate in an “individual ethics” capable of meeting the present situation. I synthesize a vision of mature autonomy that relates the highly socially-activated nature of the autonomy that comes through Browning’s work with the individual-existential autonomy present in Rahner’s. While affirming the inalienable freedom and responsibility that an individual has for his or her life before God, I argue for the significance of vital basic communities and for the forms of love that awaken personal freedom and responsibility, as well as for the vital communal ritualization that scaffolds and sustains mature autonomy throughout the lifespan.