Introduction

This introductory chapter, by volume editors Adam Cureton and David Wasserman, provides an overview of the Handbook. Its first section covers the history of philosophical thinking about disability, from the 19th century to the disability rights movements of the 20th century and present-day. Following this is an outline of the purpose of the book, discussing how disability raises some of the deepest conceptual and normative issues about human embodiment and well-being; dignity, respect, justice and equality; and personal and social identity. Chapters will cover these as well as pressing practical questions for educational, health, reproductive, and technology policy, and confront controversial questions about the scope and direction of the human and civil rights movements. The introduction concludes with chapter summaries.

Why Inflicting Disability is Wrong: The Mere-Difference View and the Causation-Based Objection

In her widely known paper “Valuing Disability, Causing Disability” Elizabeth Barnes defends the view that disability is a mere difference (Mere-Difference View, or MDV). Her paper is a response to critics who argue that the MDV implies the permissibility of inflicting disability. Barnes defends the view that inflicting disability is nevertheless morally wrong because of (1) the transition costs of becoming disabled, and (2) the Principle of Non-Interference (PNI). This chapter argues that although Barnes is right in affirming that inflicting disability is morally wrong, the arguments she provides in support of this conclusion are unsuccessful in a number of cases. Absent better defense, the MDV remains susceptible to permitting the infliction of disability.

Beyond Instrumental Value: Respecting The Will of Others and Deciding On Their Behalf

This chapter explores the ethical responsibilities of those who make medical decisions on behalf of individuals with intellectual and/or developmental disabilities that result in lifelong decisional incapacity. Standard accounts argue that because these patients have never had the capacity to make their own decisions, surrogates should make decisions based solely on what best promotes the patients’ welfare. On such accounts, the preferences, values, and decisions of those with impaired consent capacity are still relevant to decision making but only instrumentally: to the extent that soliciting them is conducive to or can provide an indicator of the patients’ general interests. Such accounts fail to ensure that such patients are properly respected. Rather than emphasize the importance of respect for autonomy, this chapter explores the more inclusive question of how decision making can be done in a way that does not insult the existent agential capacities of individuals. Trustees need to recognize that a patient’s unique evaluative perspective possesses intrinsic normative significance, and giving moral weight to their preferences, values, and decisions provides a way to respect that perspective.

Causing Disability, Causing Non-Disability: What’s the Moral Difference?

It may seem obvious that causing disability in another person is morally problematic in a way that removing or preventing a disability is not. This suggests that there is a moral asymmetry between causing disability and causing non-disability. This chapter investigates whether there are any differences between these two types of actions that might explain the existence of a general moral asymmetry. After setting aside the possibility that having a disability is almost always bad or harmful for a person (a view that we have critiqued at length elsewhere), seven putative differences are considered. Ultimately, it is concluded that none of these seven factors can ground a general moral asymmetry between causing disability and causing non-disability, though each factor can provide some moral reason to avoid causing disability in certain particular cases.

Fair Difference of Opportunity

According to Rawls, Fair Equality of Opportunity requires that those who have the same native abilities and motivations have the same chance of securing offices and positions, regardless of their social class of origin, family background or other social circumstances. Despite its name, this principle does not guarantee equal opportunity for everyone because it allows people with various kinds of physical and psychological impairments and diseases to have lower chances at securing those positions once the adverse influences of their social circumstances have been corrected for. Our alternative principle is partially inspired by Rawls’ Difference Principle. What we call Fair Difference of Opportunity says that the default position should be true equality of opportunity, but if there are ways to improve the opportunities of all by allowing more and better opportunities to some, without violating the other principles of justice, then such arrangements would be just. Fair Difference of Opportunity, we argue, is more faithful to Rawls’s basic framework and more friendly to disabled people than Fair Equality of Opportunity.

Neurodiversity, Autism, and Psychiatric Disability

Neurodiversity advocates apply the same kind of critiques to psychiatric conditions such as autism that disability theory has long applied to somatic conditions. Yet these critiques have received little attention from philosophy of psychiatry. Although the arguments of neurodiversity advocates often are undeveloped, they raise critical issues about psychiatric diagnosis and classification. This chapter uses Jerome Wakefield’s “harmful dysfunction analysis” of the concept of mental disorder to reconstruct and evaluate neurodiversity arguments that autism is a normal variation, not a mental disorder. We argue that because of the heterogeneity of “autism,” these arguments are more plausible for some subgroups than others. We find support for a moderate neurodiversity position that objects to psychiatric overreach without denying the reality of some forms of autistic disorder.

Care and Disability: Friends or Foes

This chapter argues that critical disability theory and an ethics of care, rather than offering opposing ways to think about disability, can be allies in crafting a theoretical foundation for providing care and assistance for disabled people. It recognizes the importance of taking seriously objections to care theory and to thinking of disabled people as dependents. Yet it urges that disability theorists forgo adopting the dominant liberal conceptions of the value of independence and the stigma of dependence and embrace a robust fully normative ethic of care that is compatible with the rights and dignity of disabled people.

In Pursuit of Justice for Disability: Model Neutrality Revisited

This chapter addresses confusions that contribute to seemingly essential conceptual contestation about whether being disabled is not just being different but is inescapably bad. There are two generally accepted main functions for which models of disability are formulated and used: (1) categorizing individuals as being disabled or not and (2) explaining why people experience limitations due to disability. Conceptualizing disability as a “term of art” is the currently common, but narrowly useful, approach to engaging with the first function. The broader second function is explored by considering a flawed model of disability constructed for policy purposes and discovering how modeling disability for explanatory purposes can go wrong. Finally, the chapter shows what goes wrong for aspirational and epistemic justice when a more controversial third function, modeling disability appraisively, is pursued to advance the claim that being disabled is not merely a difference but is inveterately, even if not definitively, bad.

Disability and Disadvantage in the Capabilities Approach

This chapter argues that within the realm of justice, not all goods or opportunities are the same—a failure to secure some goods results in mere disadvantage, while a failure to secure other goods results in corrosive disadvantage. If a disadvantage adversely impacts one’s ability to secure other goods or opportunities, we should regard it as being corrosive in nature and thus give it higher priority within a theory of distributive justice. This chapter suggests that with respect to the capabilities approach, an understanding of disadvantage that recognizes the often-corrosive nature of the experience of disability would require us to prioritize some capabilities over others. More pointedly, a capability theorist’s refusal to acknowledge the need to prioritize some capabilities over others is a failing of basic justice and would result in the compounding of injustice against people with disabilities.

Disability Liberation Theology

This chapter considers the ways images of disability liberation might reimagine the question of how we should live as people with disabilities. To do so, it offers a version of disability liberation theology that draws together the visual iconography of the mid-twentieth-century civil and human liberation movements and the theological tradition of the Catholic Marian tradition. To support this explication of disability liberation theology, the chapter reviews the history of liberty as a sociopolitical concept, the cultural work of images, the disability theology critique of Biblical healing narratives, the critique of a medical model of disability, disability liberation theology, and care ethics. The chapter concludes by putting forward images of interdependent bodily care in the early Marian tradition as potentially liberatory and a possible guide to disability justice. By portraying acts of bodily care as sacred rituals, these images suggest a theoretical armature to consider intimate body care as an affirmation rather than a diminishment of human dignity.