An agent’s preferences are sometimes formed as a result of her options or, more precisely, her beliefs about her options. It is sometimes claimed that such adaptive preferences are not autonomous, and that, therefore, actions on the basis of such preferences are not autonomous either. Through the examination of some accounts of autonomy and adaptive preferences, I show that the claim that adaptive preferences are not autonomous is highly ambiguous. I argue for a favored interpretation of the claim that adaptive preferences are autonomous, and show that adaptive preferences and the actions that result from them can be fully autonomous in the sense that should concern us. I connect this discussion to debates about life-extending technologies, by applying the analysis I endorse of autonomy to the question whether the preference to extend one’s life would be autonomous and to the question whether preferences one would have within a significantly extended human life would be autonomous. I argue that such preferences, even though they would be adaptive, would be perfectly autonomous in the relevant sense, provided that the agent who held them displayed a certain sort of dialogical reflectiveness with regard to the content of those preferences.