Disability

In the essay “Cézanne’s Doubt,” Merleau-Ponty explores the relationship between Paul Cézanne’s art and his embodiment. The doubt in question is ultimately about the meaning of his disabilities. Should Cézanne’s disabilities or impairments shape how we interpret his art or should they instead be treated as incidental, as a mere biographical datum? Although Merleau-Ponty's essay isn’t intended to be phenomenological, its line of questioning is as much about lived experience as it is about art, art history, and aesthetics. I here (...) offer a reading of “Cézanne’s Doubt” as an exploration of one of the more fundamental issues for phenomenological methodology: the relationship between normality and the normate. I first defend this phenomenological and disability-centric or crip reading of the essay. I then argue that insofar as one takes oneself to be “normal” and insofar as doing so underwrites phenomenological inquiry, the problematic of the normate, not just that of normality, is central to phenomenology. (shrink)

Tamamlayıcı ve alternatif tıp (TAT) uygulamaları temel tıbbi tedaviye ek ya da temel tıbbi tedavinin yerine kullanılan, uygulamaları genelde konvansiyonel tıp tarafından tedavi olarak kabul edilmeyen çeşitli tıbbi ve sağlık bakım sistemi, pratikleri ve ürünleri olarak tanımlanmaktadır (Hossein et al., 2014, Amira ve Okubadejo, 2007; National Institutes of Health [NIH], 2018). TAT konusunda yapılan araştırmalar Afrika, Asya ve Latin Amerika gibi gelişmemiş ya da gelişmekte olan ülkelerde hastaların bazı tedavi ihtiyaçlarını karşılamak amacıyla geleneksel uygulamalara başvurmaları doğrultusunda geleneksel tıp teriminin tamamlayıcı (...) ve alternatif tıpa karşılık gelecek şekilde kullanıldığını da göstermektedir. (shrink)

ABSTRACT In this article, I indicate how the naturalized and individualized conception of disability that prevails in philosophy informs the indifference of philosophers to the predictable COVID-19 tragedy that has unfolded in nursing homes, supported living centers, psychiatric institutions, and other institutions in which elders and younger disabled people are placed. I maintain that, insofar as feminist and other discourses represent these institutions as sites of care and love, they enact structural gaslighting. I argue, therefore, that philosophers must engage in (...) conceptual engineering with respect to how disability and these institutions are understood and represented. To substantiate my argument, I trace the sequence of catastrophic events that have occurred in nursing homes in Canada and in the Canadian province of Ontario in particular during the pandemic, tying these events to other past and current eugenic practices produced in the Canadian context. The crux of the article is that the COVID-19 pandemic has thrown into vivid relief the carceral character of nursing homes and other congregate settings in which elders and younger disabled people are confined. -/- KEYWORDS carceral, conceptual engineering, nursing home-industrial-complex, philosophy of disability, structural gaslighting. (shrink)

Ethical debates about liberal eugenics frequently focus on the supposed unnaturalness of its means and possible harm to autonomy. I present a Nietzsche-inspired critique focusing on intention rather than means and harm to abilities rather than to autonomy. I first critique subjective eugenics, the selection of extrinsically valuable traits, drawing on Nietzsche’s notion of ‘slavish’ values reducible to the negation of another’s good. Subjective eugenics slavishly evaluates traits relative to a negatively evaluated norm (eg, above-average intelligence), disguising a harmful intention (...) to diminish the relative value of that norm. I then argue there is no objective form of eugenics on the Nietzschean ground that abilities are not valuable intrinsically; they are valuable only if one possesses the relative power to exercise them. Abilities frustrated by conflict with other abilities or environment are harmful, while disabilities that empower one’s other abilities are beneficial. Consequently, all forms of eugenics are subject to the prior ethical critique of subjective eugenics. (shrink)

This commentary continues an exchange on eugenics in Monash Bioethics Review between Anomaly (2018), Wilson (2019), and Veit, Anomaly, Agar, Singer, Fleischman, and Minerva (2021). The eponymous question, “Can ‘Eugenics’ be Defended?”, is multiply ambiguous and does not receive a clear answer from Veit et al.. Despite their stated desire to move beyond mere semantics to matters of substance, Veit et al. concentrate on several uses of the term “eugenics” that pull in opposite directions. I argue, first, that Veit et (...) al. (2021) makes much the same error as does Anomaly (2018) in characterizing eugenics; second, that the paper misunderstands the relationship between eugenics and enhancement; and third, that it distorts the views expressed in my “Eugenics Undefended”. (shrink)

This is the introduction to the inaugural issue of The Journal of Philosophy of Disability.

Individuals suffering from anorexia-nervosa experience dysmorphic perceptions of their body and desire to act on these perceptions by refusing food. In some cases, anorexics want to refuse food to the point of death. In this paper, I answer this question: if an anorexic, A, wants to refuse food when the food would either be life-saving or prevent serious bodily harm, can A’s refusal be valid? I argue that there is compelling reason to think that anorexics can validly refuse food, even (...) in these extreme circumstances. (shrink)

[Releases May 27]. Introductory and advanced textbooks in bioethics focus almost entirely on issues that disproportionately affect disabled people and that centrally deal with becoming or being disabled. However, such textbooks typically omit critical philosophical reflection on disability, lack engagement with decades of empirical and theoretical scholarship spanning the social sciences and humanities in the multidisciplinary field of disability studies, and avoid serious consideration of the history of disability activism in shaping social, legal, political, and medical understandings of disability over (...) the last fifty years. For example, longstanding discussions on topics such as euthanasia, physician aid-in-dying, pre-implantation genetic diagnosis, prenatal testing, selective abortion, enhancement, patient autonomy, beneficence, non-maleficence, and health care rationing all tend to be premised on shared and implicit assumptions regarding disability, especially in relation to quality of life, yet with too little recognition of the way that “disability” is itself a topic of substantial research and scholarly disagreement across multiple fields. This is not merely a concern for academic and medical education; as an applied field tied to one of the largest economic sectors of most industrialized nations, bioethics has a direct impact on healthcare education, practice, policy, and, thereby, the health outcomes of existing and future populations. It is in light of these pressing issues that the Disability Bioethics Reader is the first reader to introduce students to core bioethical issues and concepts through the lens of critical disability studies and philosophy of disability. The Disability Bioethics Reader will include over thirty-five chapters covering key areas such as: critical histories and state-of-the-field analyses of modern medicine, bioethics, disability studies, and philosophy of medicine; methods in bioethics; concerns at the edge- and end-of-life; enhancement; disability, quality of life, and well-being; prenatal testing and abortion; invisible disabilities; chronic illness; healthcare justice; genetics and genomics; intellectual disability and neurodiversity; ethics and diagnosis; and epistemic injustice in healthcare. (shrink)

The Middles Ages are often portrayed as a time in which people with physical disabilities in the Latin West were ostracized, on the grounds that such conditions demonstrated personal sin and/or God’s judgment. This was undoubtedly the dominant response to disability in various times and places during the fifth through fifteenth centuries, but the total range of medieval responses is much broader and more interesting. In particular, the 13th-15th century treatment of three groups (martyrs, mothers, and mystics - whose physical (...) ‘defects’ were often understood as signs of special connection to God in this life, and who were often represented as retaining these signs in the life to come) challenge standard notions of beauty, disfigurement, and bodily perfection, particularly as the notion is applied to eternal life and our ultimate end. (shrink)

The morality of abortion is a longstanding controversy. One may wonder whether it’s even possible to make significant progress on an issue over which so much ink has already been split and there is such polarizing disagreement (Boyle 1994). The papers in this issue show that this progress is possible—there is more to be said about abortion and other crucial beginning-of-life issues. They do so largely by applying contemporary philosophical tools to moral questions involving life’s beginning. The first two papers (...) defend the pro-life view from recent objections involving miscarriage and abortion doctors. The third shows how the social model of disability and the concept of transformative experience applies to classic debates like abortion and euthanasia. The final two papers address how rights and harms apply to children and to beings that do not yet exist. All five papers make a noteworthy contribution to the moral issues that arise at the beginning of life. (shrink)

This chapter canvases a number of ways that issues surrounding disability intersect with social epistemology, particularly how dominate norms concerning communication and ability can epistemically disadvantage some disabled individuals. We begin with a discussion of how social epistemology as a field and debates concerning epistemic injustice in particular fail to take the problem of ableism seriously. In section two, we analyze the concept of an individual’s “knowledge capacity,” arguing that it can easily misconstrue the extended, social nature of both knowledge (...) and capacity/ability. In section three, we turn to issues of testimony and their relation to debates concerning disability and well-being. We address how the regular lack of uptake of disabled people’s testimony can lead to a number of structural rather than merely individual epistemic injustices, and we also consider how the very nature of some disabilities make testimonial issues more complicated. In our fourth and final section, we discuss various norms of social interaction and how they can systematically disadvantage Autistic people in particular. (shrink)

for The Deweyan Task Before Us: The New Global Paradigm for Philosophy, Education, and Democracy Emerging from the Pandemic (2021 edited volume under review) John Dewey proposed soon after the atomic bombings of Hiroshima and Nagasaki that citizens of techno-industrial nations suffer from "cultural lag" (LW 15:199-200; cf. LW 4:203-28). He had in mind a sort of moral jet lag, a condition in which most of the basic alternatives we have on hand to think and talk about moral and political (...) life, from customary moralizing to sophisticated theorizing, were developed, canned, and pickled on a shelf so long ago that they now lag far behind the multi-faceted problems that our values must speak to. The failure of many countries, most visibly the United States, to effectively navigate climate change and the Covid-19 global pandemic exemplifies our moral jet lag. Our collective responses to the new normal of global disruptions are, in William James’s words in Pragmatism, “out of plumb and out of key and out of ‘whack’” (1907, 37). The American philosophical tradition that includes James and Dewey has long sought to compensate for the excesses of America’s hyper-individualism and its anti-naturalistic distrust of experimental intelligence. In this brief analysis of our morally jet lagged response to the Covid-19 pandemic, we draw heavily on two highly articulated intellectual resources for America’s moral, political, and educational recovery: Jane Addams’s social ethics and Dewey’s deeply democratic theory of moral and political deliberation. (shrink)

This paper explores the relationship between eugenics, disability, and dehumanization, with a focus on forms of eugenics beyond Nazi eugenics.

This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four primary (...) mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice. (shrink)

On 26 July 2016, Satoshi Uematsu murdered 19 and injured 26 at a caregiving facility in Sagamihara, Japan, making it the country’s worst mass killing since WWII. In this article, I offer an analysis of the Sagamihara 19 massacre. I draw on the work of Julia Kristeva and Emmanuel Levinas to argue that claims about disability experience are insufficient to justify normative projects. In short, disability is normatively ambiguous.

Cancer research is experiencing ‘paradigm instability’, since there are two rival theories of carcinogenesis which confront themselves, namely the somatic mutation theory and the tissue organization field theory. Despite this theoretical uncertainty, a huge quantity of data is available thanks to the improvement of genome sequencing techniques. Some authors think that the development of new statistical tools will be able to overcome the lack of a shared theoretical perspective on cancer by amalgamating as many data as possible. We think instead (...) that a deeper understanding of cancer can be achieved by means of more theoretical work, rather than by merely accumulating more data. To support our thesis, we introduce the analytic view of theory development, which rests on the concept of plausibility, and make clear in what sense plausibility and probability are distinct concepts. Then, the concept of plausibility is used to point out the ineliminable role played by the epistemic subject in the development of statistical tools and in the process of theory assessment. We then move to address a central issue in cancer research, namely the relevance of computational tools developed by bioinformaticists to detect driver mutations in the debate between the two main rival theories of carcinogenesis. Finally, we briefly extend our considerations on the role that plausibility plays in evidence amalgamation from cancer research to the more general issue of the divergences between frequentists and Bayesians in the philosophy of medicine and statistics. We argue that taking into account plausibility-based considerations can lead to clarify some epistemological shortcomings that afflict both these perspectives. (shrink)

The emerging field of the philosophy of dance, as suggested by Aili Bresnahan, increasingly recognizes the problem that (especially pre‐modern) dance has historically focused on bodily perfection, which privileges abled bodies as those that can best make and perform dance as art. One might expect that the philosophy of dance, given the critical and analytical powers of philosophy, might be helpful in illuminating and suggesting ameliorations for this tendency in dance. But this is particularly a difficult task since the analytic (...) philosophy of dance is too young to have achieved a comprehensive treatment of dance per se, let alone to update such a treatment in line with the demands of social justice. As a step in that direction, the present article (a) summarizes dance theorists on disabled dance (as opposed to the dance of the temporarily able‐bodied, or TAB) and then applies (b) the philosophy of art and dance to disability, (c) the philosophy of disability to dance, (d) interdisciplinary disability theory to dance, and (e) my own Figuration philosophy of dance to disability, as inspired in part by John Dewey. (shrink)

The purpose of this paper is to contribute to the ongoing analyses that aim to confront the problem of marked variation. Negatively marked differences are those natural variations that are used to cleave human beings into different categories (e.g., of disablement, of medicalized pathology, of subnormalcy, or of deviance). The problem of marked variation is: Why are some rather than other variations marked as epistemically or culturally significant or as a diagnostic of pathology, and What is the epistemic background that (...) makes these—rather than other variations—marked as subnormal? For Wilson (2018a), critical examination of the problem of marked variation is central to understanding the epistemology of medicalized pathology that made the history of eugenics possible. My aim is to explore the role marked variation plays in eugenic and other problematic classifications and the inferences they appear to license. I pay particular attention to the normative valuations of marked variations, how these valuations affect the inferences that are made by others about those possessing the variation, and how those possessing the variation perceive themselves. In the final sections, I illustrate this by critically discussing three putative kinship conceptions of race. I rely on these to extend the scope of the puzzle of marked variation from the context of historic and current markings of an individual’s variation as disability in the eugenics movement to historic and current markings for assigning putative racial ascriptions to individuals and groups. Lastly, I suggest that the problem of marked variation is a problem that looms over any epistemic account that is dependent upon sorting or classifying. (shrink)

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as its concrete practice, (...) I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

Selection against embryos that are predisposed to develop disabilities is one of the less controversial uses of embryo selection technologies. Many bio-conservatives argue that while the use of ESTs to select for non-disease-related traits, such as height and eye-colour, should be banned, their use to avoid disease and disability should be permitted. Nevertheless, there remains significant opposition, particularly from the disability rights movement, to the use of ESTs to select against disability. In this article we examine whether and why the (...) state could be justified in restricting the use of ESTs to select against disability. We first outline the challenge posed by proponents of ‘liberal eugenics’. Liberal eugenicists challenge those who defend restrictions on the use of ESTs to show why the use of these technologies would create a harm of the type and magnitude required to justify coercive measures. We argue that this challenge could be met by adverting to the risk of harms to future persons that would result from a loss of certain forms of cognitive diversity. We suggest that this risk establishes a pro tanto case for restricting selection against some disabilities, including dyslexia and Asperger's syndrome. (shrink)

Guy Kahane and Julian Savulescu respond to my paper “Valuing Disability, Causing Disability” by arguing that my assessment of objections to the mere-difference view of disability is unconvincing and fails to explain their conviction that it is impermissible to cause disability. In reply, I argue that their response misconstrues, somewhat radically, both what I say in my paper and the commitments of the mere-difference view more generally. It also fails to adequately appreciate the unique epistemic factors present in philosophical discussions (...) of disability. (shrink)

The paper considers whether psychiatric kinds can be natural kinds and concludes that they can. This depends, however, on a particular conception of ‘natural kind’. We briefly describe and reject two standard accounts – what we call the ‘stipulative account’ (according to which apparently a priori criteria, such as the possession of intrinsic essences, are laid down for natural kindhood) and the ‘Kripkean account’ (according to which the natural kinds are just those kinds that obey Kripkean semantics). We then rehearse (...) a more permissive account: Richard Boyd’s ‘homeostatic property cluster’ (HPC) account. We argue that psychiatric kinds can in principle count as natural kinds on the HPC account. Moreover, specific psychiatric kinds (Tourette’s, schizophrenia, etc.) can be natural kinds even if the category psychiatric disorder is not itself a natural kind. (shrink)

Jaspers’s binary distinction between understanding and explanation has given way first to a proliferation of explanatory levels and now, in John Campbell’s recent work, to a conception of explanation with no distinct levels of explanation and no inbuilt rationality requirement. I argue that there is still a role for understanding in psychiatry and that is to demystify the assumption that the states it concerns are mental. This role can be fulfilled by placing rationality at the heart of understanding without a (...) commitment to the attempt to use rationality to shed light on interpretation and mindedness as though from outside those notions. Delusions still present a significant challenge to philosophical attempts at understanding, but this merely reflects the genuine clinical difficulties such states present. (shrink)

This paper argues that luck egalitarianism, especially in the guise of equality of opportunity for welfare, is in tension with the ideal of fair equality of opportunity in three ways. First, equal opportunity for welfare is compatible with a caste system in employment that is inconsistent with open competition for positions. Second, luck egalitarianism does not support hiring on the basis of qualifications. Third, amending luck egalitarianism to repair this problem requires abandoning fair access to qualifications. Insofar as luck egalitarianism (...) cannot support fair equality of opportunity, it cannot do justice to the claims of the disabled. Indeed, in the absence of fair equality of opportunity, disabled people are likely to be marginalized. (shrink)

In my essay I consider the imaginary case of a future mother who refuses to undergo genetic alteration on her germline although she knows that her, as yet unconceived, child will have a serious genetic disorder. I analyze the good and bad points of two branches of arguments directed against her decision, consequentialist and rights-based. Then I discuss whether accepting one line of these arguments or the other makes a difference in moral assessment. I conclude that, although from the preanalytical (...) perspective we strongly oppose the refusal of genetic treatment in my imaginary case, it is probably impossible to construct one coherent theory which embraces all possible moral dilemmas triggered by our actions which affect the number and the identity of future people. (shrink)

A History of Intelligence and “Intellectual Disability” examines how the concepts of intellectual ability and disability became part of psychology, medicine and biology. Focusing on the period between the Protestant Reform and 1700, this book shows that in many cases it has been accepted without scientific and psychological foundations that intelligence and disability describe natural or trans-historical realities.

This essay investigates the demands on adult children to provide care for their elderly/ill parents from a socio-moral perspective. In order to narrow the examination, the question pursued here is agent-relative: What social and moral complexities are involved for the adult child when her parent(s) need care? First, this article examines our society’s expectation that adult children are morally obligated to provide care for their parents. Second, the essay articulates how transgressing against this normative expectation can inure significant moral criticism. (...) The final sections present these tensions within the context of disability. (shrink)

The question I want to answer is if and how the recognition approach, taken from the works of Axel Honneth, could be an adequate framework for addressing the problems of global justice and poverty. My thesis is that such a globalization of the recognition approach rests on the dialectic of relative and absolute elements of recognition. (1) First, I will discuss the relativism of the recognition approach, that it understands recognition as being relative to a certain society or a set (...) of institutions. The same is true for various forms of disrespect such as denigration or exclusion. The recognition approach is a form of internal reconstructive critique, which does not want to refer to absolute or ahistorical standards. (2) Second, I show that this relative understanding of recognition and disrespect rests on an absolute core of recognition, which transcends any given society. In short, this core is the possibility of undistorted self-realization, which is the main and universal element of a good life. Such an absolute core is necessary for distinguishing between justified and unjustified claims of relative recognition. It also serves as the normative benchmark for any society. (3) Finally, I will discuss the relation of these relative and absolute elements of recognition against the background of global justice. Claims of recognition can refer to this absolute core and demand that intersubjective conditions and social relations should change in order to make undistorted self-realization possible. This is the main point of reference for a recognition-based concept of global justice. (shrink)

Decisional capacity evaluations (DCEs) occur in clinical settings where it is unclear whether a consumer of medical services has the capacity to make an informed decision about the relevant medical options. DCEs are localized interventions, not the global loss of competence, that assign a surrogate decision maker to make the decision on behalf of the medical consumer. We maintain that one important necessary condition for a DCE to be morally justified, in cases of medical necessity, is that the health care (...) consumer under evaluation is incapable of expressing a preference for a certain outcome. (shrink)

Theorists of health have, to this point, focused exclusively on trying to define a state—health—that an organism might be in. I argue that they have overlooked the possibility of a comparativist theory of health, which would begin by defining a relation—healthier than—that holds between two organisms or two possible states of the same organism. I show that a comparativist approach to health has a number of attractive features, and has important implications for philosophers of medicine, bioethicists, health economists, and policy (...) makers. (shrink)

It is usually appropriate for adults to make significant decisions, such as about what kinds of medical treatment to undergo, for themselves. But sometimes impairments are suffered - either temporary or permanent - which render an individual unable to make such decisions. The Mental Capacity Act 2005 sets out the conditions under which it is appropriate to regard an individual as lacking the capacity to make a particular decision (and when provisions should be made for a decision on their behalf). (...) -/- To what extent does having capacity require the endorsement of certain values? Drawing on Owens et al (2009), I assess the extent to which understanding relevant information and weighing it in coming to a decision requires certain evaluative commitments. With reference to literature on anorexia nervosa and decisions informed by religious beliefs, I argue that it is difficult to avoid the conclusion that the conditions for capacity are value-laden, and that if this is so it is important to open discussion about which patterns of distorted valuing undermine capacity, and why. (shrink)

The question of why group-differentiated rights might be a requirement of justice has been a central focus of identity politics in recent decades. I attempt to bring some clarity to this discussion by proposing a typology to track the various ways in which individuals can be harmed or benefited as a consequence of their membership in social groups. It is the well-being of individuals that group-differentiated rights should be understood as protecting, and so clarity on the relationship between group membership (...) and well-being is vital. One of the problems with the way in which such justifications have often been formulated in the past has been that they inadvertently position the group as a handicap to be overcome, rather than a value to be protected. I seek to overcome this limitation by clearly specifying the circumstances under which group membership is a liability, and the circumstances under which it has value. While this distinction is important, in both cases there is a relevant interest at stake, and thus the groundwork can be laid for a defence of group-differentiated rights. (shrink)

A computer can come to understand natural language the same way Helen Keller did: by using “syntactic semantics”—a theory of how syntax can suffice for semantics, i.e., how semantics for natural language can be provided by means of computational symbol manipulation. This essay considers real-life approximations of Chinese Rooms, focusing on Helen Keller’s experiences growing up deaf and blind, locked in a sort of Chinese Room yet learning how to communicate with the outside world. Using the SNePS computational knowledge-representation system, (...) the essay analyzes Keller’s belief that learning that “everything has a name” was the key to her success, enabling her to “partition” her mental concepts into mental representations of: words, objects, and the naming relations between them. It next looks at Herbert Terrace’s theory of naming, which is akin to Keller’s, and which only humans are supposed to be capable of. The essay suggests that computers at least, and perhaps non-human primates, are also capable of this kind of naming. (shrink)

The International Classification of Functioning, Disability and Health provides a classification of human bodily functions, which, while exhibiting non-conformance to many formal ontological principles, provides an insight into which basic functions such a classification should include. Its evaluation is an important first step towards such an adequate ontology of this domain. Presented at the 13th Annual North American WHO Collaborating Center Conference on the ICF, 2007.

There appears to be a tension between two commitments in liberalism. The first is that citizens, as rational agents possessing dignity, are owed a justification for principles of justice. The second is that members of society who do not meet the requirements of rational agency are owed justice. These notions conflict because the first commitment is often expressed through the device of the social contract, which seems to confine the scope of justice to rational agents. So, contractarianism seems to ignore (...) the justice claims of the severely cognitively impaired. To solve this problem, Martha Nussbaum proposes the capabilities approach. The justifiability condition, on this approach, is met by the idea of overlapping consensus. This essay argues that overlapping consensus cannot meet liberalism’s justifiability condition, nor is it more inclusive of the cognitively impaired. Therefore, we have reason to retain the contract device and look for another way to ensure that liberalism respects the justice claims of all. (shrink)

Ethical debates about liberal eugenics frequently focus on the supposed unnaturalness of its means and its supposed harm to autonomy, an emphasis that leads into irresolvable disputes about human nature, free will, and identity. In this paper I draw on Nietzsche’s work to critique eugenics’ ends rather than its means, as harm to abilities, rather than to autonomy. I first critique subjective eugenics, the selection of extrinsically valuable traits, using Nietzsche’s notion of ‘slavish’ forms of evaluation: values reducible to the (...) negation of another’s good. Subjective eugenics slavishly evaluates traits in comparison to a negatively evaluated norm, disguising an intention to diminish the norm – for example, increasing one child’s intelligence by relatively decreasing everyone else’s. Even seemingly non-comparative selection of traits like eye color depend on negative comparison. Valued either for rarity or group identity, they devalue norm in its commonness or difference. Next, I argue there is no objective form of eugenics on the Nietzschean grounds that abilities are not valuable intrinsically, but only given the power to exercise them. Abilities frustrated by conflict with other abilities or one’s environment are harmful, while disabilities that empower one’s other abilities are beneficial. Consequently, all supposedly objective forms of eugenics are subject to the previous ethical critique of subjective eugenics. Because, like evolutionary fitness, the complementary fit of traits and environment that produces power is accidental and unpredictable, human wellbeing is maximized through the conservation of a diversity of types, rather than through active improvement. (shrink)

Until now, philosophical debate about human embryonic stem cell (hESC) research has largely been limited to its ethical dimensions and implications. Although the importance and urgency of these ethical debates should not be underestimated, the almost undivided attention that mainstream and feminist philosophers have paid to the ethical dimensions of hESC research suggests that the only philosophically interesting questions and concerns about it are by and large ethical in nature. My argument goes some distance to challenge the assumption that ethical (...) considerations alone must be foregrounded in philosophical discussions about hESC research by introducing a critical stance on the epistemological and ontological assumptions that underlie and condition it. A central aim of the paper is to show how Foucault's insights into knowledge-power, taken in combination with Hacking's claims about styles of reasoning, can make these assumptions evident, as well as cast light on their potentially deleterious implications for disabled people. Arguing in this way also enables me to draw out constitutive effects of research on stem cells, that is, to indicate how the discursive practices surrounding research on stem cells, as well as the technology itself, contribute to the constitution of impairment. (shrink)

Frontiers of Justice: Disability, Nationality, Species Membership, by Martha Nussbaum, Harvard University Press, 2006. How should we measure human development? The most popular method used to be to focus on wealth and income, as when international development agencies rank countries according to their per capita gross domestic product. Critics, however, have long noted shortcomings with this approach. Consider for example a wealthy person in a wheelchair: her problem is not a financial one, but a lack of access to public spaces. (...) Even if she were to hire porters to carry her in and out of stores and libraries, that would not really address her situation. There is a basic sense of dignity and self-respect that comes with being able to move around on one’s own. Even for a disabled millionaire, that will only be possible when public buildings are wheelchair accessible. To fully grasp what the handicapped need, we have to look beyond purely economic measures of well-being, and take into account the actual capabilities people can exercise in their daily lives. The example of the well-off person in a wheelchair illustrates what Martha Nussbaum calls the capabilities approach to human development. It was first pioneered in economics by Amartya Sen (who came up with the wheelchair example), and Nussbaum has for years been associated with a more philosophical variation, which uses the idea of capabilities to outline basic political principles. In Frontiers of Justice: Disability, Nationality, Species Membership Nussbaum takes this project even further, and applies the capabilities approach to issues of justice involving not only the disabled and the global poor, but animals as well.Yet for a philosophy called the capabilities approach, it is surprising how little theoretical work capabilities do in Nussbaum’s overall account. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

This paper defends “moral individualism” against various arguments that have been intended to show that membership in the human species or participation in our distinctively human form of life is a sufficient basis for a moral status higher than that of any animal. Among the arguments criticized are the “nature-of-the-kind argument,” which claims that it is the nature of all human beings to have certain higher psychological capacities, even if, contingently, some human beings lack them, and various versions of the (...) idea that there is a special form of life that all human beings share but of which no animal can be a full participant. The paper concludes that none of these arguments succeeds in demonstrating that there are moral reasons to permit animals to be treated less well than members of our own species whose psychological capacities and potential are no higher than those of the animals. (shrink)

Because contractarians see justice as mutual advantage, they hold that justice can be rationally grounded only when each can expect to gain from it. John Rawls seems to avoid this feature of contractarianism by fashioning the parties to the contract as Kantian agents whose personhood grounds their claims to justice. But Rawls also endorses the Humean idea that justice applies only if people are equal in ability. It would seem to follow from this idea that dependent persons (such as the (...) disabled) lack claims of justice. It appears, then, that the Kantian and Humean themes in Rawls conflict. I present a reading of Rawls that resolves this tension between the Kantian and Humean themes. The first theme, I argue, allows Rawls to maintain that persons as such are owed justice regardless of their ability to engage in social cooperation. The second theme, I argue, allows him to retain Hume's connection between justice and reciprocity, but confines the reciprocity condition to relations among nondependents. I conclude that Rawls's approach permits him to rebut recent criticisms leveled by disability theorists and others who claim that his theory excludes dependents. (shrink)

This paper argues that, with modification, Rawls's social contract theory can produce principles of distributive justice applying to the severely disabled. It is a response to critics who claim that Rawls's assumption that the parties in the original position represent fully cooperating citizens excludes the disabled from the social contract. I propose that this idealizing assumption should be dropped at the constitutional stage of the contract where the parties decide on a social minimum. Knowing that they might not be fully (...) capable of social cooperation, the parties will choose a social minimum that is as high and comprehensive as is compatible with the difference principle. This will ensure that the disabled have an adequate income. (shrink)

: This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to emerge in (...) the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body. (shrink)

Feminists have indicated the inadequacies of bioethical debates about human embryonic stem cell research, which have for the most part revolved around concerns about the moral status of the human embryo. Feminists have argued, for instance, that inquiry concerning the ethics and politics of human embryonic stem cell research should consider the relations of social power in which the research is embedded. My argument is that this feminist work on stem cells is itself inadequate, however, insofar as it has not (...) incorporated an analysis of disability into its considerations of the ethical and political issues that surround the phenomena. Thus, I consider claims that disability theorists and anti-disability activists have made about the research. I conclude by indicating that stem cell research must be situated within a cultural matrix that operates in the service of normalisation. (shrink)

[Releases May 17th] The Life Worth Living investigates the exclusion of and discrimination against disabled people across the history of Western moral philosophy. Building on decades of activism and scholarship, Reynolds shows how longstanding views of disability are misguided and unjust, and he lays out a vision for an anti-ableist moral future. The introduction and first chapter are available to download here. -/- Table of Contents: Introduction: The Ableist Conflation. Part I: Pain. 1. Theories of Pain. 2. A Phenomenology of (...) Chronic Pain. Part II: Disability. 3. Theories of Disability. 4. A Phenomenology of Multiple Sclerosis. Part III: Ability. 5. Theories of Ability. 6. A Phenomenology of Ability. Conclusion: An Anti-Ableist Future. Acknowledgments. Notes. Bibliography. Index. (shrink)