Which Rationality?

John Harris is among those philosophers for whom the link between rationality and morality is central and self-evident.^{Footnote 1} Moral arguments, and the practices that arise from moral judgments, should first and foremost be rational. What is clearly irrational should be abandoned. Judgment should be based on clear reasons, consistency, and evidence rather than tradition, authority, emotion, or “gut feelings.”

It is hard to question this approach, especially if one is working in the analytic philosophical tradition. One can, of course, discuss the weight rationality should have in moral judgments and especially the contents of rationality in a certain context, but in any case, rationality is generally considered to be the benchmark for good ethical thinking and policy. In this article, we do not even dare to assess whether Harris’s arguments are rational, simply because we are not certain how rationality should be understood. However, from John Harris’s texts one gets the impression that the concept and idea of rationality is clear to all. Also, it seems to be clear what a rational person would do in a given situation. We are puzzled by this, because some of Harris’s arguments concerning disability are not, in our view, compelling or convincing but, rather, confusing, obscure, and even flawed. Whether they are, at the same time, rational we do not know.

It is our aim in this article to supplement some of Harris’s views on disability. At some points, we even intend to correct what we see to be wrong in his arguments. There are many individual points on which we agree with Harris, but on the whole, our thinking on disability clashes with his views. We concentrate on his idea of disability as a harmed condition. What makes it harmful? What is disability all about?

Disability as a Harmed Condition

Questions of definition are important in both academic and practical standards. The theorization and conceptualization of disability has influence on various areas of social life. For example, if disability is simply about an individual’s pathological condition, the medical community is not merely justified but obligated to prevent disability. In practice this means amending and rehabilitating people with impairments and even preventing the existence of such people. And because this kind of project would be morally sound, society ought to support medicine in its efforts. Views as to whether disability should be understood either as an individual’s pathological condition or as a socially produced phenomenon have implications beyond medicine and bioethics: for instance, in relation to the organization of housing and employment arrangements concerning people with impairments. If an individual’s incapacity to undertake certain occupations is explained by his or her deficits, there is no need to alter the social organization of work; rather, it will suffice to conduct the individual to the kind of work he or she is capable of doing, and also to improve his or her faculties in order to make him or her more proficient.

John Harris’s definition of disability is succinct but, at the same time, lies open to various interpretations. Disabilities are the kind of harmed conditions that someone has a strong rational preference not to be in.^{Footnote 2} A harmed condition is relative both to one’s rational preferences and to possible alternatives. In other words, some condition is a disability if it implies the deprivation of worthwhile experiences and of the possibility of exploring them: “The intellectually disabled do miss out on some dimensions of experience which are closed to them in the way that music is closed to the deaf. And this is a disability.”^{Footnote 3} Thus, Harris conceptualizes disability in terms of missed possibilities and opportunities. This approach creates an individualistic framework to the issue from the outset. Disability is something to do with individuals’ abilities to pursue various enriching experiences and possibilities in life. This is one possible starting point and is not necessarily worse than any other. However, Harris’s individualistic definition raises many questions and concerns.

What kinds of possibilities are relevant in the sense that the lack of them amounts to a disability? Harris thinks that hearing is an invaluable faculty, and people are disabled if they cannot enjoy “Mozart, and Beethoven, and dance music, and the sound of the wind in the trees, and the waves on the shore.”^{Footnote 4} This seems intuitively clear to hearing people, but it does not provide a satisfactory argument for the notion that loss of hearing inevitably amounts to a disability—especially because many deaf people do not consider themselves disabled, or unfortunate. Harris does not seem to take into account the fact that certain functions are regarded vital for human well-being because they are “sources of shared experience and social interaction” and also because “our social life and culture are built around some of those functions.”^{Footnote 5} This is why people usually do not feel impaired in lacking a sixth sense or the acoustic range or olfactory sensitivity of a typical dog. Thus, functions and faculties are regarded as good for people on the basis of actual cultural and social accommodation and requirements, regardless of how much these, or some other functions and faculties, could enrich our lives in some other circumstances.^{Footnote 6}

When Harris says that deafness, for example, is a harmed condition that it is rational to try to avoid, he seems to lean on some sort of objective account of human well-being. This is especially the case because, in the light of his position, the experience of many deaf people of their condition as a neutral difference, not as a negative defect, is irrational. Harris does not trust individual people’s own judgments about their quality of life but, rather, looks to what he perceives as rational. The problem, however, is that Harris does not elaborate his view on what is rational as regards subjective well-being and what people should value in order to be rational.

The Subjectivity of Well-Being

Harris’s implicitly objective starting point to the definition of disability and human well-being is, in any case, problematic in many ways. One obvious reason for this is the subjective nature of the concept of well-being; well-being concerns unavoidably “what is good or bad for the subject in question.”^{Footnote 7} There are undoubtedly objective factors that weigh on one’s chances for a happy life—impairment may be one of them. The environment and one’s relationships with others, however, may count a great deal more than impairment when assessing one’s well-being.^{Footnote 8} Also, it seems curious in general to detach goodness or badness from individuals’ preferences. There is no value, for example, in knowledge, rational activity, love, or the awareness of beauty if they are entirely devoid of pleasure. In other words, the badness of a pain consists in its being disliked; it is not disliked because it is bad. What is of value, or is good for someone, requires an individual’s desire for it.^{Footnote 9}

Yet, there appear to be cases in which an individual’s judgment on his or her own well-being is clearly erroneous, and we have good reasons for thinking so. Consider the following example. Females in certain poor regions of India suffer from diseases of malnutrition in greater numbers than males do. This is the result of traditional distributional inequalities, reinforced by culturally learned values. When questioned, these women might not only say that they feel good and are doing well, but they may also say that their position is in accordance with their deeply held conceptions of what is good and right for women.^{Footnote 10} In this case, most of us would probably be inclined to say that these women have got it all wrong. They should not resign to their fate, feel good about their lives, and accept them as they are; rather, they should be angry at the culture and society that oppresses them. Thus, in this case one may think that it would be justified and rational to deny the validity of these women’s subjective voices. And because most people would prefer not to have impairments, it may seem reasonable to think likewise in the case of people with impairments. So, if deaf people say that their loss of hearing does not bother them or compromise their well-being, one could justifiably respond: “Well, you’re wrong!”

However, in both cases people can indeed have the subjective experience of doing well. People’s desires are connected to their view and knowledge of the social world. If in some social context it has been regarded for a long time that women are inferior to men, women probably adopt this view without question and adjust their desires and hopes accordingly. Also, the loss of hearing does not amount to a disability and a quality-of-life-threatening factor in a Deaf community in which hearing simply does not have any function—especially if these people have been deaf from birth and have not experienced a loss of hearing and the concomitant experiences. Deaf advocates consider Deafness to be a minority cultural experience based on shared language, not an impairment. However, the cases of oppressed women in India and deaf people are not analogous.

First, unlike malnutrition, deafness does not constitute a health hazard (this applies to many impairments). Second, the malnutrition of women in India is based on oppression, whereas the loss of hearing of deaf people is not. However, many of the tribulations that deaf people confront are based on socially produced barriers. So, the abolition of oppression in these two cases has different results. In the first example it would imply putting an end to the malnutrition of women and guaranteeing them equal social and moral status with men. In the second example, putting an end to discrimination against deaf people would remove the social barriers that threaten the social participation of these people. It would not, however, remove their deafness. To conclude, if women in India accept their position and adjust their life expectations to the situation as it is, the oppression continues, and future women are exposed to the same life-threatening practices. If deafness is accepted as being legitimately in line with one’s subjective well-being, no oppression of current or future people is encouraged.

To this line of thinking one could respond that if deafness is considered to be a neutral condition, then causing deafness to children would be morally neutral (one does not have to be a logician to see that the right side of the conditional does not follow). This, however, is clearly counterintuitive. Thus, deafness is not a neutral property, and one should not cause it deliberately to anyone (unless, perhaps, one lives in a society in which the majority of people are deaf). So we are ready to admit that deafness does include an undesirable dimension—the severity of the undesirability of deafness depends, of course, a lot on the social environment. But admitting that deafness includes an undesirable dimension does not imply that it is a harmed condition. All people face undesirable limitations in their lives as embodied beings that do not amount to harm or disadvantage.

For example, being British, Finnish, middle class, white, straight, male, or deaf in themselves include disadvantageous things. All these identity-forming factors set limits to our lives and possibilities. From a Finnish perspective, being British may seem a disadvantage, and from a female perspective, being male may seem a disadvantage—and, from these starting points, probably with good reasons. However, one should differentiate between something being a disadvantage and something being disadvantageous on balance.^{Footnote 11} Deafness is a disadvantage in the sense that it precludes the possibility for many activities and careers but, at the same time, leaves many other opportunities available. So, on balance deafness may not amount to a disadvantage, although the impairment in itself may be considered as a disadvantage, something most of us probably would prefer not to have.

The Definition of Disability

Debates about the definition of disability have continued for decades: within the World Health Organization, within social science research, and particularly within the disability movement.^{Footnote 12} The difficulty in achieving consensus can be explained partly by the complexity of the phenomenon. Disability is a multifactorial, scalar concept. Wittgenstein’s discussion of family resemblances seems relevant to the wide range of manifestations of impairment and embodiment that are aggregated under the single heading of disability.^{Footnote 13} This intrinsic complexity explains the varying estimates of the number of disabled people that have been produced in different surveys. To take two examples from the United Kingdom: in 1971, Amelia Harris and her team produced an estimate of 1,288,000 impaired people in the UK aged between 16 and 65. In 1988, the Office of Population, Census and Surveys conducted a second survey, finding a total of more than six million disabled people across the life course. The only way to resolve the disparity is to conclude that disability is dependent on the parameters and expectations we have about embodiment. As Eda Topliss wrote in reference to the Harris survey, “Disablement cannot be regarded as an objectively determined departure from able-bodied perfection, but is related to social norms.”^{Footnote 14}

The contextual nature of disability has been further analyzed by disabled activists and scholars, in a work of sociological imagination by which what formerly were seen as private problems have been turned into public issues. Crucial to this process has been the distinction between impairment and disability. Impairments are never experienced abstractly, only within particular environments, value systems, and social relations. It is this social context that can turn impairment into disadvantage. In the right context, an undoubted impairment can be experienced as a neutral difference. Classic examples include the New England community on Martha’s Vineyard, where there was a high incidence of deafness, and sign language was culturally accepted as a form of communication: consequently Deaf people were not excluded or devalued. Another example may be dyslexia: this mental variation causes problems in a society in which comprehension and production of particular kinds of language and text is a prerequisite for independence and productivity. In preliterate societies, the mental difference existed but caused no problems for the vast majority of those who experienced it. Even within a particular society or particular sociohistorical context, impairments are variably experienced: to lose a joint of one’s little finger would cause few of us major problems (in the case of the comedian Dave Allen, it was a distinctive attribute that triggered memorable humorous anecdotes). But for a concert violinist or pianist, it might be a life-changing and career-destroying disability.

The conceptual shift brought about by the disability movement is important because it triggers a further distinction: between impairment or disability as a form of harm—which we would not contest—and between disability as a harmed life. The problem with John Harris’s approach is that he does not sufficiently distinguish between these claims, or else he implies that one state invariably leads to another. Disabled activists and scholars have pointed to the importance of social and economic factors in producing quality-of-life outcomes for disabled people: the same impairment, in a different social environment, can have radically different consequences for individual flourishing. It is not the degree or type of impairment that is important as much as the extent and appropriateness of social provision.

Establishing the scalar, complex, and socially contextual nature of impairment and disability leads to another important insight. As American sociologist and disability activist Irving Zola argued, disability should be conceived not as the experience of a minority but as part of what it means to be human.^{Footnote 15} He argued against the concept of “special needs,” calling for the universalization of disability. In other words, disability is not a label that separates one group of people from another group of people. It describes a continuum of embodiment on which we are all located. We are all vulnerable to injury and disease; as we age, we decline; eventually we all expire. For example, the Human Genome Project shows that genetic disease is not the attribute of a minority. Everyone has approximately one hundred genetic mutations in their genome. Each of us carries four or five alleles for recessive genetic disease. All of us have predispositions to late-onset disease, which may develop into illness given the right circumstances. Impairment is part of the human condition. In the words of Robert Louis Stephenson,

This approach to embodiment, which locates vulnerability and dependency at the heart of the human condition, raises questions for many liberal rational conceptions of justice and equality, as feminists such as Eva Feder Kittay have argued. In Kittay’s approach, society is not an association of equals, because of inequitable dependencies. This way of thinking brings out questions of care, concern, and connection that may be obscured in mainstream moral and political philosophy. Rawls’s model, for example, excludes those who are dependent and those who attend to them: Kittay claims, “Once we stop ignoring dependency, then we are obliged to think of how dependency needs are met in a manner that is equitable to all.”^{Footnote 17} In the same way, Harris’s approach has no room for the inextricable feature of everyday life: parenting, aging, dependency, and impairment. No conceivable developments in medicine or society could eliminate these aspects of human social relations, and therefore a useful approach to disability and bioethics must respond to this challenge. We are with Alasdair Macintyre when he calls for

From a social scientific perspective, Harris’s definition of disability as individual harmed conditions is unhelpful because it cannot be operationalized. As a definition, it does not discriminate between those who may need to be targeted for legal protection or welfare support and the rest of the crooked timber of humanity. If researchers were to take an objective approach, the description “harmed condition people have a rational preference not to be in” could be extended to include most of species-typical functioning. If researchers were to take a subjective approach, they would rapidly discover that most disabled people feel they have a good quality of life and do not experience the harms that Harris predicts. In legal terminology, it does not define a protected class.

From a philosophical perspective, Harris’s approach appears not just decontextualized but also ungrounded. If impairment and dependency are part of what it means to be human, then the rational preference not to be disabled implies an unattainable hope for perfection. In which case, we are left with Sophocles’ chorus:

Not to be born at all

Is best, far best that can befall.^{Footnote 19}

To conclude, we are saying not that impairment is unproblematic, but that impairment is not the same as disability—not neutral, but not necessarily harmed.