This article attempts to clarify the concept of disability by
explaining the ways in which it has been applied, and defined, by both
philosophers and disability scholars. Conceptual approaches to
disability can be divided into two main categories: the individualistic
and the social approaches. In the individualistic framework, disability
is seen as an individual condition that results in a disadvantaged
position regarding civic, economic, and personal flourishing. This is
the dominant view of disability in bioethics. According to the social
approaches, disability is seen as a result of the oppressive material
arrangements in existing societies, or as a corollary of the prevailing
cultural values, ideas, attitudes, and language that produce and shape
human reality. I argue that disability is essentially a normative
concept that reflects the idea of what kind of beings humans ought to
be, or, how society ought to be constructed to treat its members
equally. In other words, the essential core of the concept of
disability is ethical, and this implies that ethical examination is
needed to provide a fuller picture of disability as a physical,
psychological, and social phenomenon.
Seen from the viewpoint of moral philosophy, disabilities are
intriguing entities. This applies especially to intellectual
disabilities. Traditional ethical theories consist of assumptions and
norms about what makes us distinctively human. For example, in
philosophy the concept of a “moral being” denotes a being
that merits moral rights and is capable of acting morally. It has been
argued that only rational beings can be moral, which implies that
nonhuman animals as well as some people with severe cognitive
impairment, mental illness, or brain damage are “amoral”
beings. Their behavior, even if harmful or otherwise undesirable, is
not seen as immoral, but merely as a regrettable, unavoidable
consequence of their not knowing better. In everyday morality and in
moral philosophy (at least in the works of such classics as Plato,
Aristotle, Kant, and Mill), rationality and practical reason are
attributed to adult human beings whose intelligence is
“normal.”1
Sapontzis SF. Are
animals moral beings? American Philosophical Quarterly
1980;17:45–52.
It can reasonably be argued that people with disabilities are, in the
light of ethical theories, marginal human beings.2
See: Silvers A. Formal justice. In: Silvers A, Wasserman D,
Mahowald MB, eds. Disability, Difference, Discrimination:
Perspectives on Justice in Bioethics and Public Policy. Lanham,
Md.: Rowman and Littlefield; 1998:1–145, at 3.
This
leaves us with three alternatives. The first is to accept the tenets of
Western moral philosophy and admit that people with disabilities
are morally less human than others. The second alternative is
to reject altogether these ethical theories that marginalize, both
socially and morally, people with impairments.
The third option is to question and revise, in the light of
disability, these theories that are, after all, supposed to say
something essential about all kinds of human life. Philosophical
studies of humanity naturally include studies of human disability.
Likewise, by examining marginal humanity we inevitably examine humanity
in general because by defining what is marginal and abnormal we also
define dichotomically typicality and normality; to define inferiority,
is to define superiority. The definition of deviance and difference is
thus always a dialogical process producing a dual reality.
The aim of this paper is to clarify the concept of disability by
explaining the ways in which it has been applied, and defined, by both
philosophers and disability scholars.
Individualistic Approaches to
Disability3 It should be noted that the
division put forward here regarding different approaches to disability
resembles that of presented by many other disability scholars. See note
2, Silvers 1998; see also: Hahn H. The politics of physical
differences: disability and discrimination. Journal of Social
Issues 1988;44:39–47; Priestley M. Constructions and
creations: idealism, materialism, and disability theory. Disability
and Society 1998;13:75–94; Rioux MH. Disability: the place
of judgement in a world of fact. Journal of Intellectual Disability
Research 1997;41:102–11.
In many traditional cultures and religions, disability has been seen
as a sign of the moral flaws of an individual or her progenitors. This
means that an infant's impairment is the result of her
parents' moral offenses. If a person is impaired later in life,
his impairment can be explained by his own moral failures. This view is
called the moral model of disability. According to this
position, disability is a disadvantageous state, usually a visible
impairment, visited on an individual as retribution.4
See note 2, Silvers 1998:56–9.
In the modern era, impairments have been explained by scientific
methods and reduced to an individual's physiological or mental
deficiencies. This medical model of disability places the
responsibility of the individual's deficits to her bad luck (e.g.,
accidents), to her inadequate health practices (e.g., smoking, bad
diet), or to her genes. This position sees disability as the inevitable
product of the individual's biological defects, illnesses, or
characteristics. Disability is a personal tragedy that results from the
individual's pathological condition.5
See note 2, Silvers 1998; see note 3, Priestley 1998; see
also: Oliver M. The Politics of Disablement. London:
Macmillan; 1990; Oliver M. Understanding Disability: From Theory to
Practice. London: Macmillan; 1996.
Another individualistic approach to disability, which I will take the
liberty of calling the intersubjective model of disability, is
the view that emphasizes cognitive interaction and affective experience
as the basis of disablement. Disability is the product of personal
experience and negotiation of social roles between individuals. This
means that a person is disabled if he feels so, and it also means that
the subjective experience of disablement is an elementary constituent
of his self-understanding. The process is largely determined by how the
individual positions himself in relation to other people, their
identities, and characteristics.6
See note
3, Priestley 1998; see also: French S. Disability, impairment, or
something in between? In: Swain J, Finkelstein V, French S, Oliver M,
eds. Disabling Barriers—Enabling Environments. London:
Sage; 1993:17–25; Morris J. Pride against Prejudice.
London: Women's Press; 1991.
A distinguishing feature of the philosophical arguments concerning
disability is that they are almost exclusively based on individualistic
premises; disability is represented primarily as an unfortunate
individual condition. At first, disability emerged in bioethics in the
abortion debate in the late 1960s and the early 1970s. The arguments
that set criteria to those beings that have the right to a continued
existence, and what the proper indicators of humanhood are, have
implications to disability as well. The moral justification of abortion
has been largely based on the concept of “person.” It has
been argued that fetuses, and even infants, are not persons, hence not
the sort of entities to which it is proper to ascribe full moral
rights. The concept “person” has been defined in a manner
that emphasizes mental faculties, which can be seen to result in a
position where the personhood of some individuals with severe cognitive
impairments is questionable.7
Fletcher J.
Indicators of humanhood: a tentative profile of man. Hastings
Center Report 1972;2(5):1–4; Tooley M. Abortion and
infanticide. Philosophy and Public Affairs 1972;2:37–65;
Tooley M. Abortion and Infanticide. Oxford: Clarendon Press;
1983; Warren MA. On the moral and legal status of abortion.
Monist 1973;57:43–61.
The concept of personhood
with its emphasis on mental faculties, combined with views that
impairments are a bad thing for the individual in question, has formed
a basis for normative judgments regarding the moral significance of
disability. It has been argued, for example, that impairments can be
relevant reasons for withdrawing life-saving medical treatment,
terminating pregnancies, avoiding conception, and acquiring genetic
information to prevent the birth of a disabled child.
8 Buchanan A, Brock DW, Daniels N, Wikler D. From Chance
to Choice: Genetics and Justice. New York: Cambridge University
Press; 2000; Davis DS. Genetic dilemmas and the child's right to
an open future. Hastings Center Report 1997;27:7–15;
Glover J. Causing Death and Saving Lives. Baltimore, Md.:
Penguin; 1977; Harris J. Is there a coherent social conception of
disability? Journal of Medical Ethics 2000;26:95–100;
Hudson J. What kinds of people should we create? Journal of Applied
Philosophy 2000;17:131–43; Kuhse H, Singer P. Should the
Baby Live? The Problem of Handicapped Infants. New York: Oxford
University Press; 1985.
Disabilities have also been discussed in philosophical bioethics in
the context of justice. Robert Veatch9
Veatch RM. The Foundations of Justice: Why the Retarded
and the Rest of Us Have Claims to Equality. New York: Oxford
University Press; 1986.
and Allen Buchanan et al.
10 See note 8, Buchanan et al.
2000:61–103, 258–303.
have applied, in a revised
form, the egalitarian theory of John Rawls
11 Rawls J. A Theory of Justice. New York: Oxford
University Press; 1972.
in their examinations of the social
and moral status of disabled people. They share the common belief that
having mental or physical impairments is an unfortunate state of
affairs. Disabled people have lost in the natural lottery, which means
that the surrounding society is obliged to compensate for their
misfortune. Thus, whatever the particular topic discussed is,
disabilities are widely and mainly regarded as individual conditions
that result in a disadvantaged position regarding civic, economic, and
personal flourishing.
Social Approaches to Disability
According to many disability scholars, individualistic approaches
(especially the medical model) are biased and lead to practices and
social arrangements that oppress disabled people. Interventions are
aimed solely at the “abnormal” individual, whereas the
surrounding community is left intact. Resources are not directed to
changing the environment but to, for example, medical treatments with
the aim to “improve” the impaired individual. This leads to
a social and moral marginalization of disabled people and gives
permission to debar them from full participation in society.12
See note 5, Oliver 1990; see note 2,
Silvers 1998.
This criticism has been presented by a large number of theorists who
take a social approach to defining disability. Some of them claim that
disability is the result of oppressive material arrangements in
society.13
See note 5, Oliver 1990;
Oliver 1996; see also: Barnes C. Theories of disability and the origins
of the oppression of disabled people in western society. In: Barton L,
ed. Disability and Society: Emerging Issues and Insights.
London: Longman; 1996:43–60.
This position (developed
mainly in the United Kingdom) is called the
social creationist view
of disability. In this perspective, it is essential to grasp the
distinction between physical impairments and the social situation,
called “disability,” of people with impairments. Impairment
is defined as “lacking all or part of a limb, or having a
defective limb, organism, or mechanism of the body,” whereas
disability is “the disadvantage or restriction of activity caused
by a contemporary social organisation which takes little or no account
of people who have physical impairments and thus excludes them from
participation in the mainstream of social activities.”
14 See note 5, Oliver 1996:22.
The
core idea of the social creationist view is that disabled people are an
oppressed social group. Their inferior status is not a natural effect
of their impairment, but it is produced by unjust social arrangements.
Disability is seen as the material product of socioeconomic relations
developed within a specific historical context. In this approach, the
main attention is directed to the disabling barriers and material
relations of power.
15 See note 3,
Priestley 1998; see also: Shakespeare T, Watson N. The social model of
disability: an outdated ideology? Research in Social Science and
Disability 2001;2:9–28.
In North America, theorists have developed the social
constructionist perspective to disability, which sees disabilities
as social constructs. This approach emphasizes the significance of
ideas, attitudes, and language that, it is argued, produce and shape
reality. Words do not merely or primarily represent reality but
construct and create it. The concept of mental retardation, for
example, exists in the minds of those who use it as a term to describe
the cognitive states of other people. It is assumed to be a term
expressing an objective, existing state of reality, whereas, in fact,
it is a socially created category that primarily reflects the state of
mind of those people who use the concept, not of those to whom the
concept is applied. This view does not deny that there are differences,
either physical or mental, between people, but it states that the
nature and significance of these differences depend on how we view and
interpret them.16
Bogdan R, Taylor SJ.
The Social Meaning of Mental Retardation: Two Life Stories.
New York: Teachers College Press; 1994; Linton S. Claiming
Disability: Knowledge and Identity. New York: New York University
Press; 1998; Taylor S. Disability studies and mental retardation.
Disability Studies Quarterly 1996;16(3):4–13; Wendell S.
The Rejected Body: Feminist Philosophical Reflections on
Disability. London: Routledge; 1996.
Another social approach to disability—the postmodernist
perspective—is based on a critique of the hegemony of
scientific knowledge, which is seen to work as the foundation
justifying both epistemologically and morally the categories of special
and ordinary needs. Science, in other words, justifies defining people
as “normal” or “mentally retarded.” Disability
scholars who have assumed the postmodern approach question the validity
of science and its hegemony in providing objective truths—there
are no such things as objective truths in the first place.17
Danforth S. On what basis hope? modern
progress and postmodern possibilities. Mental Retardation
1997a;35:93–106; Danforth S. Power and language in research
texts: a rejoinder to Kleinert and Biklen. Mental Retardation
1997b;35:391–7; Danforth S. What can the field of developmental
disabilities learn from Michel Foucault? Mental Retardation
2000;38:364–9; Danforth S, Rhodes WC. Deconstructing disability:
a philosophy for inclusion. Remedial and Special Education
1997;18:357–66; Skrtic TM. Behind Special Education: A
Critical Analysis of Professional Culture and School Organization.
Denver: Love Publishing; 1991.
Postmodernists emphasize the
significance of language that constructs reality. The present
vocabulary of, for example, mental retardation is seen as demeaning and
oppressive to those people who have been labeled as mentally retarded.
Distinctions such as ability versus disability that are based on
“scientific” knowledge should be deconstructed and replaced
by a language that does not classify some people as “other”
(that is, deviating from “normal” and “full”
humanity). This could be achieved through an open dialogue where
especially those voices that do not speak the language of science
(i.e., individuals with disabilities and their loved ones) were taken
into account.
18 See note 17, Danforth
1997a; Danforth 2000.
It has been argued that some tenets of the social approach to
disability have become fixed truths that ought not to be
challenged.19
See note 15, Shakespeare,
Watson 2001; see note 6, French 1993; Morris 1991.
The social
views of disability originally challenged some traditional
individualistic assumptions and practices regarding
disability—they brought balance to discussions on disability by
providing differing views. Soon, however, the social approach
(especially the social creationist view in the United Kingdom) was no
longer a competing view; it became
the view that one ought to
adopt to be morally and politically among the “good ones.”
This process has led the social view on disablement to contradict one
of its original ideas: to respect the variety of individual experiences
and voices. To announce that one idea is the highest guiding principle,
and others are oppressive and wrong, potentially gives rise to other
forms of oppression. A monopolistic view on disability also denies the
variety of experiences of disablement—many people do suffer due
to their impairments and not all disabled people view themselves as
oppressed. To deny the significance of these voices, or to silence
them, would in fact be a form of objectification and oppression.
Toward an Ethical Model of Disability?
Disability is essentially a social phenomenon and concept. It is
construed in particular social contexts, and they determine the meaning
it carries. Disability is also a normative concept that reflects the
ideas concerning what kind of beings humans ought to be, both mentally
and physically, and how societies ought to be arranged to ensure the
equal treatment of their members. The term “disability”
implies that individuals with disabilities lack essential human
abilities or possibilities to qualify as persons (in a morally
significant sense) or to live a good life. Having a
“disability” implies an undesirable state of functioning or
being of an individual.
Physical and mental abilities are essential constituents of humanity,
not merely because these abilities differentiate us from most nonhuman
animals as individuals but because they make possible the communal and
relational aspects of human life. The concept of disability
implies that a disabled person lacks a certain ability, or possibility,
that could contribute to her personal well-being and enable her to be a
contributing member of society. Abilities and possibilities are
considered to be good and useful, whereas disabilities may be
impediments to human flourishing.
Sociological or psychological research, for example, can clarify how
the creation and definition of disabilities take place, but the
essential core of the concept of disability is ethical. The tenets of
the traditional individual approach to disability imply that disability
can be reduced to an individual's insufficient abilities. This
inevitably places the disabled individual into an unfortunate, and even
tragic, position. In the social approaches to disability, impairment
and disability are not linked together as strongly as in the individual
approach. Instead, it is emphasized that these two phenomena are
distinct. Proponents of the social views do not necessarily find that
impairments are undesirable conditions as such. Disability, however, is
seen as an undesirable state of functioning, or an undesirable
phenomenon, arising primarily or at least in part from unjust social
arrangements. Thus, all individualistic and social approaches to
disability contain a strong normative dimension that implies what is
good or bad for an individual and what is right or wrong with regard to
social arrangements.
The crucial point, then, is to examine the relevance and soundness of
the norms that cause us to define certain conditions and ways of
functioning as disabilities. The fundamental question is: What
individual conditions or ways of functioning can, on sound normative
grounds, be considered as disabilities? That is, can we define
plausible criteria for a morally desirable way of functioning and being
a human being? To develop an account that attempts to answer these
questions would have to be based on a view of good human functioning
and a conception of being human. In the words of Martha Nussbaum:
What are the features of our common humanity, features that
lead us to recognize certain others, however distant their location and
their forms of life, as humans and, on the other hand, to decide that
certain other beings who resemble us superficially could not possibly
be human? (p. 219)20
Nussbaum M.
Aristotelian social democracy. In: Douglas RB, Mara G, Richardson HS,
eds. Liberalism and the Good. London: Routledge,
1990:203–52.
Given that society plays an essential role in the creation and
construction of disability, the questions of definition cannot be
detached from the issue of how a just society ought to be arranged.
In other words, what is the core of humanity? Which individual
conditions can compromise the achievement of central elements in human
existence and well-being? If these questions are found relevant, there
are at least four alternative ways to construct accounts giving answers
to them: (1) a universal, objective theory of humanness that can
distinguish disabled people from the nondisabled; (2) a subjectivist
theory of disability that would make an individual's personal
experience the central, and the only relevant, criterion—that is,
if an individual feels or thinks that she is disabled, then she
is disabled; (3) a communitarian theory of disability in which
disability would be defined according to prevailing cultural traditions
and communal practices; and (4) an account that combines the three
foregoing alternatives. This last account could include some universal
norms, but it would also consider subjective experiences and interests,
as well as the social and cultural factors that influence the creation
and construction of disabilities.
To conclude, I suggest that a fruitful way to conceptualize
disability from an ethical viewpoint would be to examine the question:
Are there individual conditions that in themselves prevent individuals
from living a good life, or which in themselves constitute a
significant threat to human well-being? This question reflects the
following idea. If the unfortunateness of some condition actually
results from communal values and social arrangements, that particular
condition is a contingent disability—it has been
determined and created by accidental and arbitrary factors. If this is
the case, disability can be removed by social arrangements as well.
Society has produced injustice and is therefore obliged to abolish the
structures, practices, and values that cause and sustain people's
disablement and prevent the consideration of different dimensions of
the human variety. The possibility of constructing an “ethical
model of disability” based on such premises is an issue that
merits further examination.
