Edit: Having read the story, the spoons are a metaphor for units of personal energy required to do a basic everyday task, and the choices, as used in above quote, are compromises you have to make when you have too little spoons to do everything you'd like.
Edit2: man, it's easy to get downvoted in this thread. Do I come off as unsympathetic or something? I've been depressed for most of my life, so spoon-shortage isn't exactly new ground for me.
For what it's worth, I think that while freedom is everyone's ultimate goal, whether they comprehend it or not, it's not necessary for happiness (and not the same as happiness). Happiness is about accepting what is (whatever it might be). Unhappiness is about rejecting what is. To say that happiness depends on what you can do, is to project your internal rejection onto the external "capability", thus retreating to the comfort of not owning your own feelings.
Of course, if someone said "take this pill and you'll be able to do everything" I'd down the whole bottle, but that's because I'd rather circumvent the symptom, than face my own addiction to powerlessness.
Hard choices. The "Should I do X, or it will hurt me?", "Is it worth feeling bad for doing Y?" related to the disease and its impact.
It's not about choice as in a healthy person having a selection of 10 fun sports to decice which to play in a sunny day.
It's about difficult choices, like "I want to do this sport activity today, but should I do it and feel depleted for the rest of my day? I should double think about doing this"
In other words, we could say that healthy people have more options, but sick people (of the variety of the article, not somebody in a come e.g.), have more hard choices on what to do each day, even simple things (e.g. play with the kids).
A choice I might make is: will I go out for a short walk with the rest of the family? By doing so, I'll hurt even more, and will need to sleep when I get back - so extra pain for me, and the kids miss out on playing with me later for an hour or two.