It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. According to a recent report of the United Nations (UN) High Commissioner for Human Rights, article 12 of the UN Convention on the Rights of (...) Persons with Disabilities (CRPD) presents a wholesale rejection of the competence model. The High Commissioner here adopts the interpretation of article 12 proposed by the Committee on the Rights of Persons with Disabilities. On this interpretation, CRPD article 12 renders it impermissible to deny persons with mental disabilities the right to make treatment decisions on the basis of impaired decision-making capacity and demands the replacement of all regimes of substitute decision-making by supported decision-making. In this paper, we explicate six adverse consequences of CRPD article 12 for persons with mental disabilities and propose an alternative way forward. The proposed model combines the strengths of the competence model and supported decision-making. (shrink)

Criminalisation of prostitution, and minority rights for disabled persons, are important contemporary political issues. The article examines their intersection by analysing the conditions and arguments for making a legal exception for disabled persons to a general prohibition against purchasing sexual services. It explores the badness of prostitution, focusing on and discussing the argument that prostitution harms prostitutes, considers forms of regulation and the arguments for and against with emphasis on a liberty-based objection to prohibition, and finally (...) presents and analyses three arguments for a legal exception, based on sexual rights, beneficence, and luck egalitarianism, respectively. It concludes that although the general case for and against criminalisation is complicated there is a good case for a legal exception. (shrink)

What is it for something to be a disability? Elizabeth Barnes, focusing on physical disabilities, argues that disability is a social category. It depends on the rules undergirding the judgements of the disability rights movement. Barnes’ account may strike many as implausible. I articulate the unease, in the form of three worries about Barnes’ account. It does not fully explain why the disability rights movement is constituted in such a way that it only picks out paradigmatic disability traits, nor why (...) only the traits identified by the movement as constituting experiences of social and political constraint count as disability. It also leaves out the contribution of people other than disability activists, to the definition of disability. I develop Barnes’ account. On my account, a person is disabled if she is in some state which is constitutive of some constraint on her legitimate interests. This state must be the subject of legitimate medical interest and be picked out by the disability rights movement as among the traits for which they are seeking to promote progress and change. My account addresses the worries about Barnes’ account. It is also able to include all disabilities, rather than only physical ones. (shrink)

One challenge in providing an adequate definition of physical disability is unifying the heterogeneous bodily conditions that count as disabilities. We examine recent proposals by Elizabeth Barnes (2016), and Dana Howard and Sean Aas (2018), and show how this debate has reached an impasse. Barnes’ account struggles to deliver principled unification of the category of disability, whilst Howard and Aas’ account risks inappropriately sidelining the body. We argue that this impasse can be broken using a novel concept: marginalised functioning. Marginalised (...) functioning concerns the relationship between a person’s bodily capacities and their social world: specifically, their ability to function in line with the default norms about how people can typically physically function that influence the structuring of social space. We argue that attending to marginalised functioning allows us to develop, not one, but three different models of disability, all of which—whilst having different strengths and weaknesses—unify the category of disability without sidelining the body. (shrink)

Much academic work (in philosophy, economics, law, etc.), as well as common sense, assumes that ill health reduces well-being. It is bad for a person to become sick, injured, disabled, etc. Empirical research, however, shows that people living with health problems report surprisingly high levels of well-being - in some cases as high as the self-reported well-being of healthy people. In this chapter, I explore the relationship between health and well-being. I argue that although we have good reason to (...) believe that health problems causing pain and death typically do reduce well-being, health problems that limit capabilities probably don't reduce well-being nearly as much as most people suppose. I then briefly explore the consequences of this conclusion for political philosophy and ethics. If many health problems don't significantly reduce well-being, why should governments go to great expense to prevent or treat them? Why should parents be obliged to ensure the health of their children? (shrink)

Many people view disabilities as misfortunes, call this the standard view. In this paper, I examine one criticism that has been launched against the Standard View. Rather than determine in advance whether having a disability is good or bad for a person, some critics argue that the Standard View is reflective of and brings about inappropriate emotional responses toward people with disabilities and their circumstances. For instance, philosophers have recently argued that in holding the standard view, we become prone to (...) a destructive kind of unwarranted pity or that the view leads us to hold certain untenable or inappropriate hopes for our children and for our society. I think this sort of challenge to the Standard View has a lot of appeal, but I worry that if it is not properly articulated, the approach is vulnerable to what has been known as “The Wrong Kind of Reason” problem. The paper highlights and addresses this worry. (shrink)

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is being used to argue for wider recognition of the legal capacity of people with mental disabilities. This raises a question about the implications of the Convention for attributions of criminal responsibility. The present paper works towards an answer by analysing the relationship between legal capacity in relation to personal decisions and criminal acts. Its central argument is that because moral and political considerations play an essential role (...) in setting the relevant standards, legal capacity in the context of personal decisions and criminal acts should not be thought of as two sides of the same coin. The implications of particular moral or political norms are likely to be different in these two legal contexts, and this may justify asymmetries in the relevant standards for legal capacity. However, the analysis highlights a fundamental question about how much weight moral or political considerations should be given in setting these standards, and this is used to frame a challenge to those calling for significantly wider recognition of the legal capacity of people with mental disabilities on the basis of the Convention. (shrink)

There is much that Christian churches can learn from relevant secularapproaches and adapt to support integration and participation within ourcongregations for adults with impairments. One of these approaches isSocial Role Valorization developed by Dr. Wolf Wolfensberger. In thisapproach, one considers the relevance of image and competency of deval-ued individuals and how these two areas impact access to “the good thingsof life.” This article applies these principles to the inclusion of vulnerablecongregational members into the life of the Christian church, asking thequestion, (...) “What would be better?” as a prompt for those in leadership toreflect on their current practices with an eye toward maturity in their prac-tices as they intersect the lives of devalued people. (shrink)

Research and practice about self-determination in the context of disability has centred on teaching skills and providing support to help people with impairments to be independent. However, limited research exists about the impact of Information and Communication Technologies, in particular social media and mobile devices, on the development of self-determination skills among people with disabilities. This paper presents the findings of a qualitative study which collected data from observations, a researcher diary, focus groups, individual interviews and data from social media. (...) The focus of the study was on young people with vision impairments who were transitioning to university life. The study found that the participants developed self-determination skills by using and adapting collaborative and interactive online tools and mobile devices according to their transition needs. This finding expands the understanding of the implications of new technologies for young people with disabilities’ personal development and the enhancement of self-determination. (shrink)

The leading models of disability struggle to fully encompass all aspects of “disability.” This difficulty arises, the author argues, because the models fundamentally misunderstand the nature of disability. Current theoretical approaches to disability can be understood as “nounal,” in that they understand disability as a thing that is caused or embodied. In contrast, this paper presents an adverbial perspective on disability, which shows that disability is experienced as a personally irremediable impediment to daily-living tasks or goals-like-ours. The picture theory of (...) disability technically constitutes a species of relational approach because its analysis references the interplay between an individual and their environment; it differs from other relational accounts, however, by interpreting disability as a certain kind of negative experience—rather than a function of that relationship. This purely descriptive theory makes no normative claims about disability and operates as both a mechanism for the evaluation of the experience of disability and a heuristic device for the proper interpretation of disability. When disability is reframed in this way, the theory offers a particularist perspective which shows if, when, where, and how disability is experienced. (shrink)

Disability has been a topic of heightened philosophical interest in the last 30 years. Disability theory has enriched a broad range of sub-specializations in philosophy. The call for papers for this issue welcomed papers addressing questions on normalcy, medical ethics, public health, philosophy of education, aesthetics, philosophy of sport, philosophy of religion, and theories of knowledge. This issue of Essays in Philosophy includes nine essays that approach the philosophy of disability in three distinct ways: The first set of three essays (...) provide a careful analysis of John Rawls, and the application of his work in ethics and justice to societies in which persons with disabilities, especially cognitive disabilities, can take active part in the processes of civil society. The second set of three essays branch out into continental philosophy, and are especially engaged with issues of community membership, communication, translation, and hermeneutics. The third set of three essays address disability specifically through the arts and aesthetics; asking questions on the portrayal of disabled persons in the arts and its implications for normalcy, sexuality, beauty, and the sublime. (shrink)

Disability laws are crucial in ensuring a life of dignity for persons with disabilities. However, they remain limited and ineffective in the absence of adequate knowledge and awareness of the experiences with disability. The limitedness of disability laws has been spoken of in cases where the full realization of rights is subject to technological, philosophical, and market dynamics. In many cases, the law is also weakened by negative cultural beliefs and social perceptions of disability. And then there are cases (...) where disability laws perpetuate or tolerate oppression and violence. Despite their limitedness, disability laws offer normative content to facilitate engagement and critique for reform. In terms of what disability laws ‘ought’ to be, scholars write, that they should be about disabled people and the meanings provided by them. This objective has and can be fulfilled with the aid of disability studies that go beyond the inquiries of law with the right kind of research tools to theorize and re-theorize concepts and meanings about disability. Disability studies, in other words, represent the living conditions of disabled persons and the questions of how disability and/or impairment should be defined. This chapter examines the interaction between disability law and disability studies through the prism of the Convention on the Rights of Persons with Disabilities (CRPD). While discussing the models of disability (medical, social, human rights, and relational-community models) and agendas for reforming the CRPD, the chapter highlights the importance of new concepts and approaches. Further, the potential of disability laws, CRPD in particular, has been discussed keeping in mind the application of its core principles across different sectors (with a special focus on the Marrakesh treaty and copyright laws). (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)

Ableist attitudes and structures regarding disability are increasingly recognized across all sectors of healthcare delivery. After Dobbs, novel questions arose in the USA concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. As a case study, we examine the Louisiana’s Department of Public Health August 1st Emergency Declaration, “List of Conditions that shall deem an Unborn Child ‘Medically Futile.’” We raise a number of medical, ethical, and public health concerns that lead us (...) to argue the declaration should be rescinded. The ethically objectionable declaration provides valuable lessons concerning how to uphold both reproductive and disability justice in a post-Dobbs landscape. (shrink)

Luck egalitarianism’s commitment to neutralizing brute luck inequalities is thought to imply that the elimination of disabilities is an appropriate way to eliminate the unchosen disadvantage that often accompanies disabilities. This implication is not only intuitively objectionable to some, especially those concerned with disability justice, but is subject to objections from relational egalitarians that should be taken seriously. This paper defends the claim that disability elimination is not a natural implication of luck egalitarian theories of justice and that luck egalitarians (...) can avoid the related relational egalitarian objections. I take this to be the case because luck egalitarians can consistently endorse three commitments that, together, take disability elimination off the menu of possible ways to redress the disadvantage of persons with disabilities. These three commitments are: i) the rejection of the view that disability intrinsically makes a person worse off; ii) the endorsement of the fundamental equality of all persons; and iii) the view that luck egalitarianism advances a theory about the arrangement of social institutions. (shrink)

We współczesnej polityce rynku pracy udział biorą nie tylko takie podmioty publiczne, jak urzędy pracy, lecz także niepubliczne agencje zatrudnienia prowadzone przez podmioty komercyjne i organizacje pozarządowe. Agencje zatrudnienia, mając zróżnicowane cele, struktury i formy zarządzania, podejmują w znacznej mierze działalność aktywizacyjną, zaadresowaną do grup znajdujących się w szczególnej sytuacji na rynku pracy, w tym do osób niepełnosprawnych. Opracowanie ma na celu przybliżenie potencjału krajowych agencji zatrudnienia osób niepełnosprawnych, które są prowadzone przez organizacje pozarządowe. Artykuł zwraca uwagę na teoretyczne koncepcje (...) współpracy publicznych i niepublicznych służb zatrudnienia na poziomie lokalnym i regionalnym. Przybliżono także wybrane wyniki badania własnego, w którym przeprowadzono analizę źródeł wtórnych i indywidualne telefoniczne wywiady kwestionariuszowe. W podsumowaniu przedstawiono rekomendacje praktyczne i potencjalne kierunki dalszych badań. ** Contemporary labor market policy involves not only the public sector as labour offices, but also private employment agencies run by commercial entities and non-governmental organizations. Employment agencies have different objectives, structures and forms of management. They take a large extent of activation services addressed to people in a specific situation on the labor market, including disabled persons. Article aims to introduce the capacity of national employment agencies for disabled people, which are run by non-governmental organizations. Article draws attention to theoretical concepts of cooperation between public and private employment services at local and regional. The chapter also shows selected results of research conducted on the basis of an analysis of secondary sources and individual questionnaire telephone interviews. Summary contains practical recommendations and possible directions for further research. (shrink)

The COVID-19 (Coronavirus disease of 2019) pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation pools and that (...) triage protocols should be immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

The medical and social model of disability is discussed and debated among researchers, scholars, activists, and people in general. It is common to hold a mixed view and believe that some disabled people suffer more from social obstacles and others more from medical problems inherent in their bodies or minds. Rachel Cooper discusses possible ‘test environments’, making explicit an idea which likely plays an implicit part in many disability discussions. We place or imagine placing the disabled person in (...) a range of different environments. If there is a relevant test environment in which they do fine, their problem was societal/external; if there is not, it was medical/internal. Cooper admits that deciding on the appropriate range of test environments is an ethical and political question. In this chapter, I argue that we often ought to widen our scope when discussing psychiatric disabilities. (shrink)

Australia, Canada, and New Zealand currently apply health requirements to prospective immigrants, denying residency to those with health conditions that are likely to impose an “excessive demand” on their publicly funded health and social service programs. In this paper, I investigate the charge that such policies are wrongfully discriminatory against persons with disabilities. I first provide a freedom-based account of the wrongness of discrimination according to which discrimination is wrong when and because it involves disadvantaging people in the exercise (...) of their freedom on the basis of morally arbitrary features of their identity. Discrimination is permissible, I suggest, when it is necessary to advance a valuable exercise of the discriminating agent’s freedom. I then apply this account to the case of social cost health requirements. Against critics of these requirements, I argue that it is sometimes permissible for states to discriminate against prospective immigrants with disabilities. States may do so, I suggest, when such discriminatory treatment is necessary to prevent an increase in rates of mortality and/or morbidity amongst citizens. Alongside critics of social cost health requirements however, I argue that existing policies are likely a form of wrongful discrimination insofar as they are too broad to satisfy this standard. (shrink)

This article engages with debates concerning the moral worth of human beings with profound intellectual and multiple disabilities (PIMDs). Some argue that those with such disabilities are morally less valuable than so-called normal human beings, whereas others argue that all human beings have equal moral value and so each group of humans ought to be treated with equal concern. We will argue in favor of a reconciliatory view that takes points from opposing camps in the debates about the moral worth (...) of humans with PIMDs. The view in question, roughly, is this: most humans with PIMDs are persons in the morally significant sense and so deserve equal moral consideration to so-called normal human beings. Some humans with PIMD may not, however, be persons, but nevertheless deserve equal moral consideration to persons because they stand in a special relation to persons. (shrink)

Unlike his theory of justice as fairness, John Rawls’s political liberalism has generally been spared from critiques regarding what is due to the disabled. This paper demonstrates that, due to the account of the basic ideas of society and persons provided by Rawls, political liberalism requires that the interests of numerous individuals with disabilities should be put aside when the most fundamental issues of justice are settled. The aim is to accommodate within public reason the due concern for (...) the disabled while upholding political liberalism. To achieve this aim, a revision of the basic ideas of persons and society is proposed. The idea of persons should be regarded as more fundamental than that of social cooperation, and persons should be defined in terms of minimal moral powers. (shrink)

Marilyn Adams rightly pointed out that there are many kinds of evil, some of which are horrendous. I claim that one species of horrendous evil is what I call horrendous-difference disabilities. I distinguish two subspecies of horrendous-difference disabilities based in part on the temporal relation between one’s rational moral wishing for a certain human function F and its being thwarted by intrinsic and extrinsic conditions. Next, I offer a theodicy for each subspecies of horrendous-difference disability. Although I appeal to some (...) claims made by Marilyn Adams for this theodicy, I reject one particular claim. I deny that one must be aware that one participates in a horrendous evil when the horrific event occurs. To develop this point and its relevance for a theodicy for horrendous-difference disabilities, I engage with Andrew Chignell’s work on infant suffering. In doing so, I show that what partly motivates the claim is a time-bias, i.e., near-bias. By rejecting this time-bias, I show how it is possible, given post-mortem life, for persons with profound cognitive disabilities to participate in horrendous evils and how these might be defeated by God. (shrink)

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which can be (...) instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

The privation theory of evil (PTE) states that evil is the absence of some good that is supposed to be present. For example, if vision is an intrinsic good, and if human beings are supposed to have vision, then PTE implies that a human being’s lacking vision is an evil, or a bad state of affairs. The mere-difference view of disability (MDD) states that disabilities like blindness are not inherently bad. Therefore, it would seem that lacking sight is not a (...) bad state of affairs. Thus PTE and MDD seem to be in tension. This essay discusses that apparent tension and explains how it might be resolved without doing violence to either view. Given the prominence of PTE in the history of Christian theology, and the wide support for MDD among disability theorists, it is worth finding a way to harmonize these two views. (shrink)

This thesis argues that the nature of disability is, currently, fundamentally misunderstood. Current approaches to disability are nounal and seek to determine the locus of disability with the intention of better understanding the phenomenon of disability. In contrast, this thesis offers an adverbial perspective on disability and shows how disability is experienced as an increased and personally irremediable impediment to daily-living tasks or broader goals. This thesis holds that impediment is not a function of either biological individuality or the Social, (...) but of a specific relation between the individual and their environment. The following delineates the Picture Theory of Disability — a mechanism for the evaluation of the experience of disability and a heuristic device for the proper interpretation of disability. The theory is born of Humean sentimentalism and elements of Wittgenstein’s Picture Theory of Language, and shows when, where, and how disability is experienced. (shrink)

How have and how might philosophers contribute to linking disability and activism in these peri-COVID-19 times, especially in forms of public engagement that go beyond podcasted talks and articles aimed at a public audience? How do we harness philosophical thinking to contribute positively to those living with disability whose vulnerabilities are heightened by this pandemic and the ableism highlighted by collective responses to it?

A crucial question in relation to support designed to enable the legal capacity of people with mental disabilities concerns when support constitutes undue influence. This article addresses this question in order to facilitate the development of law and policy in England and Wales, by providing a normative analysis of the different approaches to undue influence across decisions about property, contracts, health, finances, and accommodation. These are all potential contexts for supporting legal capacity, and, in doing so, the article compares approaches (...) to undue influence that are rarely considered together. -/- Drawing on the UN Convention on the Rights of Persons with Disabilities, third sector and public body documents, and law in England and Wales, the analysis identifies six models that conceptualise undue influence in terms of: modes of influence; an overborne will; an inference from the situation; an overborne will understood as a mental incapacity; an overborne will in connection with vulnerability; and impaired discursive control. This final approach is a novel proposal for understanding undue influence. The analysis highlights key policy-relevant issues that distinguish the models, and generates a deliberative framework for navigating them, with the ‘overborne will’, ‘inference-based’, and ‘discursive control’ models identified as potentially fitting for the support context. (shrink)

In this article, I aim to demonstrate that moral responsibility theory produces, legitimates, and even magnifies the considerable social injustice that accrues to disabled people insofar as it implicitly and explicitly promotes a depoliticized ontology of disability that construes disability as a naturally disadvantageous personal characteristic or deleterious property of individuals rather than identifies it as an effect of power, an apparatus. In particular, I argue that the methodological tools of “analytic” philosophy that philosophers of moral responsibility theory employ (...) to establish the philosophical domain in which they engage have distinctly detrimental effects on disabled people. (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)

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)

Amos Yong claims that persons with disabilities like Down Syndrome will retain their disability at the resurrection. In section I, I will make some preliminary remarks in order to properly frame the discussion. In section II, I will lay out Yong ’s account of the resurrection and offer some difficulties along the way. Section III will examine what appears to be the main source of justification for Yong ’s claim. It is what I shall call Stanley Hauerwas’ dictum which (...) states that to ‘eliminate the disability means to eliminate the subject.’ In this section, I shall draw out three sets of bizarre entailments and difficulties that arise from Hauerwas’ dictum. Section IV will offer some concluding remarks and suggestions for further development on the doctrine of the resurrection from a disability perspective. (shrink)

Autism is a psychopathological condition around which there is still much prejudice and stigma. The discrepancy between third-person and first-person accounts of autistic behavior creates a chasm between autistic and neurotypical (non-autistic) people. Epistemic injustice suffered by these individuals is great, and a fruitful strategy out of this predicament is much needed. I will propose that through the appropriation and implementation of methods and concepts from phenomenology and ecological-enactive cognitive science, we can acquire powerful tools to work towards greater epistemic (...) justice for autistic individuals. I will use the resources found in the skilled intentionality framework, integrated with various phenomenological theories. From these approaches, we can view autistic impairments and disability relationally and how epistemic enablement and disablement form. Phenomenology and its methods help us learn more about the perceptual and social experiences of autistic individuals. The voices of the autistics themselves will be of the greatest importance here. I will show that, through restructuring our landscape of affordances and with a greater phenomenological understanding of the autistic inner world, we can devise new strategies that afford greater epistemic enablement and epistemic justice. (shrink)

We notice a number of interesting overlaps between the views on personhood of Ifeanyi Menkiti and Marya Schechtman. Both philosophers distance their views from the individualistic ones standard in western thought and foreground the importance of extrinsic or relational features to personhood. For Menkiti, it is ‘the community which defines the person as person’; for Schechtman, being a person is to have a place in person-space, which involves being seen as a person by others. But there are also striking differences. (...) Schechtman sees this aspect as expanding the scope of personhood to infants and those who are severely mentally disabled. Menkiti thinks that there is a line to be drawn at some point between those humans that are persons and those who are not. We consider the cases offered in questioning how the dispute between the two views should be resolved. (shrink)

Feelings of marginalisation impact the lives of LGBT+ people in a fundamental way, but for those who have an intellectual disability, and are gay, there is a heightened sense of alienation. This article examines the unique oppression faced by these individuals in a heteronormative and ableist world, where a long history of extreme control of sexual intimacy has resulted in harsh forms of social exclusion. Although moves have been made to empower service users who are intellectually disabled and identify (...) as LGBT+ to participate fully in life, there is also a need to assess the relationship between rights, responsibility, and risk. This article further explores whether by drawing upon government social policy, barriers are being dismantled through the development of innovative local strategies that aim to deliver non-discriminatory person-centred services. (shrink)

The high prevalence of brain injury incidents in adolescence and adulthood demands effective models for re-learning lost cognitive abilities. Impairment in brain injury survivors’ higher-level cognitive functions is common and a negative predictor for long-term outcome. We conducted two small-scale interventions (N = 12; 33.33% female) with persons with acquired brain injuries in two municipalities in Sweden. Age ranged from 17 to 65 years (M = 51.17, SD = 14.53). The interventions were dialogic, inquiry-based, and inspired by the Philosophy (...) for Children Programme, a participatory thinking skills approach with documented higher-order cognitive outcomes, such as developed argumentation skills, in other target groups. Philosophical dialogues were conducted once a week in the two groups, totalling 12 dialogues per group. Group argumentation development was measured through compared scores from structured observations of filmed dialogues early and late in the intervention. Large positive changes in mean scores from early to late in the intervention, together with constantly high facilitator quality, suggest argumentation development in the sample due to the intervention. (shrink)

Comparative valuation of different policy interventions often requires interpersonal comparability of benefit. In the field of health economics, the metric commonly used for such comparison, quality adjusted life years (QALYs) gained, has been criticized for failing to respect the equality of all persons’ intrinsic worth, including particularly those with disabilities. A methodology is proposed that interprets ‘full quality of life’ as the best health prospect that is achievable for the particular individual within the relevant budget constraint. This calibration is (...) challenging both conceptually and operationally as it shifts dramatically when technology or budget developments alter what can be achieved for incapacitated individuals. The proposal nevertheless ensures that the maximal achievable satisfaction of one person’s preferences can carry no more intrinsic value than that of another. This approach, which can be applied to other domains of social valuation, thus prevents implicit discrimination against the elderly and those with irremediable incapacities. (shrink)

In this paper, we describe technological advances for supporting persons with aphasia in philosophical dialogues about personally relevant and contestable questions. A computer game-based application for iPads is developed and researched through Living Lab inspired workshops in order to promote the target group’s communicative participation during group argumentation. We outline some central parts of the background theory of the application and some of its main features, which are related to needs of the target group. Methodological issues connected to the (...) design and use of Living Labs with persons with aphasia are discussed. We describe a few problems with researching development of communicative participation during group argumentation using an app assisted intervention for the target group and suggest some possible solutions. (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)

This is basically a paper about artistic evaluation and how multiple interpretations can give rise to inconsistent and conflicting meanings. Images like Joel-Peter Witkin’s First Casting for Milo (2004) challenge the viewer to look closely, understand the formal properties at work, and then extract a meaning that ultimately asks, Is the model exploited or empowered? Is Karen Duffy, pictured here, vulnerable and “enfreaked” or is she potentially subversive, transgressive, and perhaps self-empowered? I will offer an argument in agreement with artist/author/ (...) performer Ann Millett-Gallant that favors the latter interpretation, but will augment and complicate the issue by also introducing a pointed question or two taken from a recent analysis by Cynthia Freeland on objectification. I judge the works by photographer Joel-Peter Witkin to be representations of disabled persons who are empowered through agency and pride, but I also worry about the risk of multiple, conflicting interpretations on the part of viewers who do not, or cannot, entertain such enlightened readings. Like second wave feminist views about pornography that depicted women in demeaning ways, or feminist critiques of Judy Chicago’s The Dinner Party , Witkin’s photos can be judged as potentially offensive. But they are also objects of beauty—both in terms of aesthetic properties (they are magnificent studies in black and white, shadows, the human body, with many classical references) and because of the feeling of beauty and pride felt by the posers, who become performers of their own beauty and pride. I argue that beauty trumps offensiveness. Pride wins. But I’m not sure that everyone will agree. (shrink)

Does disability make a person worse off? I argue that the best answer is yes AND no, because we can be worse off in two conceptually distinct ways. Disabilities usually make us worse off in one way (typified by facing hassles) but not in the other (typified by facing loneliness). Acknowledging two conceptually distinct ways to be worse off has fundamental implications for philosophical theories of well-being. (This paper won the APA’s Routledge, Taylor & Francis Prize in 2017.).

In recent history, the Social Model has crucially contributed to an emancipatory perspective on disability, not least as a rebuttal to deficit oriented views focused on suffering. Several overstated notions of “social construction“ this family of models relies on, however, presently threaten to unduly narrow reflections on “disability”-situations and the self-reflection of disabled people. These notions tend to obscure social and ecological issues an emerging just social order will need to address. The roots of any sociocultural formation in external (...) (physical) reality thus remain underrecognised. -/- This paper adumbrates an alternative approach rooted in (External) Realism. The argument is based on a critique of social constructivist notions employed in models of disability overemphasising sociocultural elements, and capitalises on work by T. Shakespeare and S. Vehmas.. Implications of the proposed approach for debates on 1.) social issues and issues of human(e) interaction, especially personal assistance- relationships and 2.) ecological issues and human dealings with nature, are briefly explored. -/- (Paper in German, long version with examples from two domains and additional explanations. Originally presented at DisKo18.). (shrink)

Discussions on the impact and future directions of technology often proceed from an empirical point of view that seems to presume that the ebb and flow of technological developments is beyond the control of humankind, so that all that humanity can do is adjust to it. However, such an approach easily neglects several crucial normative considerations that could enhance the standing of individual human beings and whole communities as rational users of technology rather than its slaves. Besides, more often than (...) not, technological products are designed in ways that neglect the needs of persons with disabilities, thereby perpetuating their exclusion from society. Consequently, this article proposes four normative considerations to guide the initiatives of African societies in their deployment of the technologies of the Fourth Industrial Revolution, namely, inclusiveness to meet the needs of all human beings, affordability to bridge the digital divide, respect for cultural identity to guard against cultural imperialism, and an ethical orientation as the overarching guide to building a truly human society. (shrink)

In my paper I discuss the argument that the absence of the legal possibility to contract same-sex marriages is discriminatory. I argue that there is no analogy between the legal situation of same-sex couples and African-Americans, women or disabled persons in the nineteenth century. There are important natural differences between same-sex and different-sex couples that are good reasons for the legal disparities between them. The probability of having and raising children is one of them. Therefore, demanding that same-sex (...) couples have rights similar to those that married couples currently have in Poland and justifying that claim by alleged discrimination is neither correct nor fair. (shrink)

A curious and comparatively neglected element of death penalty jurisprudence in America is my target in this paper. That element concerns the circumstances under which severely mentally disabled persons, incarcerated on death row, may have their sentences carried out. Those circumstances are expressed in a part of the law which turns out to be indefensible. This legal doctrine—competence-for-execution —holds that a condemned, death-row inmate may not be killed if, at the time of his scheduled execution, he lacks an (...) awareness of his impending death or the reasons for it. I argue that the law of CFE should be abandoned, along with the notion that it is permissible to kill the deeply disturbed just so long as they meet some narrow test of readiness to die. By adopting CFE, the courts have been forced to give independent conceptual and moral significance to a standard for competence that simply cannot bear the weight placed upon it. To be executable, CFE requires that a condemned prisoner meet a standard demonstrating an awareness of certain facts about his death. Yet this standard both leads to confusing and counter-intuitive results and is unsupported either by the reasons advanced by the courts on its behalf or by any of the standard theoretical justifications of criminal punishment. If executing the profoundly psychotic or delusional is wrong the law needs a better account of the wrong done when prisoners like Ford are killed. I suggest wherein that wrong might be located. (shrink)

In ‘What Makes Killing Wrong?’ Sinnott-Armstrong and Miller make the bold claim that killing in itself is not wrong, what is wrong is totally-disabling. In ‘After-Birth Abortion: Why Should the Baby Live?’ Giubilini and Minerva argue for allowing infanticide. Both papers challenge the stigma commonly associated with killing, and emphasize that killing is not wrong at some margins of life. In this paper, we first generalize the above claims to the thesis that there is nothing morally wrong with killing per (...) se, so long as it is instant and unannounced. Then, from the perspective of social evolution, we explain why people refrain from killing others, the general guideline being that it is unadvisable to kill someone with whom you associate a Second Person Perspective (SPP). Finally, drawing from a seminal paper of Press and Dyson on the Iterated Prisoner’s Dilemma, we stress that an SPP without an SP (Second Person), or the other way around, can both lead to unwelcome results. (shrink)

Niepełnosprawność jest jedn¸a} z cech różnicuj¸a}cych jednostki i grupy we współczesnych społeczeństwach. Osoby o ograniczonej sprawności fizycznej, poznawczej i psychicznej s¸a} szczególnie narażone na dyskryminacjȩ oraz wykluczenie społeczne, gospodarcze i polityczne. Co istotne kwestia socjalna osób niepełnosprawnych na pocz¸a}tku XXI wieku zmienia siȩ wchodz¸ac w relacjȩ z procesem starzenia siȩ ludności. Artykuł ma na celu przybliżenie wybranych teoretycznych koncepcji działań na rzecz poprawy wizerunku niepełnosprawności i ograniczania barier doświadczanych przez osoby niepełnosprawne w dostȩpie do różnego rodzaju zasobów, przestrzeni i szans. (...) Krytyczna analiza literatury przedmiotu obejmuje wskazanie cech koncepcji polityki aktywizacji oraz zasad i celów polityki społecznej w holistycznym paradygmacie normalizacji. Podsumowanie zawiera możliwe dalsze kierunki badań i analiz. ** Disability is one of the features that differentiate individuals and groups in modern societies. People with reduced physical, cognitive and psychological efficiency are particularly exposed to discrimination and social, economic and political exclusion. What’s important social issue of people with disabilities in the early 21st century changes by entering into a relationship with the ageing of the population. Article aims to introduce some theoretical concepts efforts to improve the image of disability and reduce the barriers faced by persons with disabilities in access to different kinds of resources, spaces and opportunities. A critical analysis of the literature includes: description of the concept of activation policy as well as principles and objectives of social policy in a holistic paradigm of normalization. This summary contains possible future directions of research and analysis. (shrink)

Nelson et al.(2023) argue that the inclusion of personal experience in bioethical debates has significant benefits and liabilities, illustrating their claim with two examples: unproven medical treatments and disability bioethics. We believe that the benefits of including personal experience in disability bioethics far exceed its liabilities. The absence of participants with relevant experience impoverishes and biases bioethical debates, while the biases risked by their inclusion are hardly unique to personal experiences and are readily mitigated.

Background: Despite the at least decades long record of philosophical recognition and interest, the intricacy of the deceptively familiar appearing concepts of ‘disease’, ‘disorder’, ‘disability’, etc., has only recently begun showing itself with clarity in the popular discourse wherein its newly emerging prominence stems from the liberties and restrictions contingent upon it. Whether a person is deemed to be afflicted by a disease or a disorder governs their ability to access health care, be it free at the point of use (...) or provided by an insurer; it also influences the treatment of individuals by the judicial system and employers; it even affects one’s own perception of self. -/- Aims: All existing philosophical definitions of disease struggle with coherency, causing much confusion and strife, and leading to inconsistencies in real-world practice. Hence, there is a real need for an alternative. -/- Materials & Methods: In the present article I analyse the variety of contemporary views of disease, showing them all to be inadequate and lacking in firm philosophical foundations, and failing to meet the desideratum of patient driven care. -/- Results: Illuminated by the insights emanating from the said analysis, I introduce a novel approach with firm ethical foundations, which foundations are rooted in sentience, that is the subjective experience of sentient beings. -/- Discussion: I argue that the notion of disease is at best superfluous, and likely even harmful in the provision of compassionate and patient-centred care. -/- Conclusion: Using a series of presently contentious cases illustrate the power of the proposed framework which is capable of providing actionable and humane solutions to problems that leave the current theories confounded. (shrink)

What is so striking about Breaking Bad is how centrally impairment and disability feature in the lives of the characters of this series. It is unusual for a television series to cast characters with visible or invisible impairments. On the rare occasions that television shows do have characters with impairments, these characters serve no purpose other than to contribute to their ‘Otherness.’ Breaking Bad not only centralizes impairment, but impairment drives and sustains the story lines. I use three interrelated themes (...) from Disability Scholarship to analyze Breaking Bad. The first theme, Bodily Control, is that good bodies are controlled bodies and that uncontrolled, messy bodies are frightening, bad bodies. Indeed, the messiness of impairment and disability is so bad, that impaired and disabled individuals are excluded or shut out or excluded from many areas of public life. The second theme, Normalcy, is that the effect of hiding away impairment, of attempting to conceal disability, is that society becomes defined by, and structured around, the concept of normalcy. Normalcy, being normal, attaining and maintaining normalcy, is the preoccupation of most in society. To fail to be normal, or to fall from what is considered to be normal, is a source of tremendous anxiety for most people. These two themes, Bodily Control and Normalcy are conceptually connected: impairment, disease and dying are so feared because they are socially invisible and, therefore unknown and unknowable. They are the undiscussable taboos. The third theme, Bodily Realism, is that having a realistic view of the body, which would at minimum require accepting the fact that human bodies are fragile things, prone to disease and accident and are ultimately destined to die, makes one more at ease in the world, and able to live better lives and live as a better person. Indeed, so the argument goes, our lives would be richer, more rewarding—emotionally and morally—if we cared less about normalcy because of a dread of abnormalcy, but instead learned to accept if not positively value the physical variability of human existence. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)