The concept of disability from an ethical viewpoint was examined. Whether disability results from the way society is built and the way ideas and judgments considering disability are established in a communal interaction was discussed (i.e., is disability socially created and constructed?). Although views on disability emphasizing its social nature are basically sound, they are also insufficient because they fail to consider the normative dimension attached to the concept of disability. The core of the concept of disability is ethical, which is why a moral philosophical examination of the concept is needed. Three possible ethical theories of disability (universal, objective, subjectivist, and communitarian) are briefly presented and discussed and a preliminary outline of a basis for a sound ethical model of disability presented.
The traditional and common view of disability is to see it as an individual tragedy and condition that inevitably implies either suffering or limited opportunities for people with impairments. Impairment, which is assumed inevitably to result in disablement, may in itself be a fatal impediment to “human flourishing” or “full human life.” Thus, an individual with impairments is not a “full human being”; he or she is a truncated and defective human being (Kuhse & Singer, 1985, pp. 141, 143; Nussbaum, 1990, pp. 219–225). Western philosophy, among many other academic disciplines, has traditionally treated disability as an individual's unfortunate state of functioning and being. This has resulted in, for example, modern bioethics to the conclusion that impairments can provide relevant reasons for withdrawing life-saving medical treatment, terminating pregnancies, avoiding conception, and acquiring genetic information in order to prevent the birth of a child with impairments (Buchanan, Brock, Daniels, & Wikler, 2000; Davis, 1997; Glover, 1977; Hudson, 2000; Kuhse & Singer, 1985). Also, the belief that having a mental or physical impairment is an unfortunate or tragic position has led some philosophers (e.g., Buchanan et al., 2000; Veatch, 1986) to assert that people with impairments have bad luck, so to speak, in nature's draw, where endowments are given to people on a random basis. Because of this, the surrounding society is obliged to compensate for their misfortune.
On the basis of these presumptions, individuals with impairments are seen as objects of different kinds of rehabilitational, educational, and therapeutic practices, the aim of which is to alleviate or “cure” their impairments. This tendency has worked as a basis for various institutional services intended to serve the assumed good of such people. For example, special education in its varying forms and different kinds of therapies, ranging from psychotherapy to pet therapy, are designed for individuals with impairments. The goal of these interventions is to help people with impairments function more effectively in society; that is, to help them become less impaired or less disabled, as it is assumed in the medical discourse of disability (Riddell, 1996; Skrtic, 1991). According to many disability scholars, this kind of individualistic approach to disability is biased and leads to practices and social arrangements that, in fact, oppress people with impairments. Interventions are aimed solely at the individual, who is regarded as abnormal, while the surrounding community is left intact. This leads to a social and moral marginalization of people with impairments and gives permission to debar them from full participation in society (Oliver, 1990; Silvers, 1994, 1995).
Social Approaches to Disability
The previous criticism has been presented by a large number of disability theorists representing a social approach to defining disability. Some of them (Barnes, 1996; Oliver, 1990, 1996) have claimed that disability is the result of oppressive material arrangements of society. Oliver (1990) called this position a social creationist view of disability. In this perspective it is seen as essential to distinguish the concepts impairment and disability. 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 seen “as 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” (Oliver, 1996, p. 22). The core idea of the social creationist view of disability is that people with impairments are an oppressed social group. This state of affairs is produced by social oppression, not by impairments. 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 (Priestley, 1998; Shakespeare & Watson, 2001).
In North America, theorists have developed the social constructionist perspective, in which disability is seen as a social construct. This approach emphasizes the significance of ideas, attitudes, and language that shape reality. This means that words do not merely or primarily represent reality but construct and produce 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 invented category that primarily reflects the state of mind of those people who use the concept, not of those who allegedly have it. This view does not deny that there are differences, either physical or mental, among people, but it suggests that the nature and significance of these differences depend on how we view and interpret them (Bogdan & Taylor, 1994; Linton, 1998; Taylor, 1996). Thus, according to the social constructionist models “disability is the idealist product of societal development within a specific cultural context” and the units of analysis should be “cultural values and representations” (Priestley, 1998, p. 78).
These theoretical standpoints are not mutually exclusive, although their emphases differ. The nuances of, and differences between, various social perspectives on disability are beyond the scope of this paper. I discuss the concepts of disability and impairment from an ethical viewpoint by considering different interpretations, perspectives, conclusions, and problems arising from the social view of disability. By social view, approach, or model of disability, I refer to a way of thinking that seeks to problematize society rather than the individual. This includes consideration of the material relations of power arising from the development of political economy as well as ideas and judgments established in a communal interaction concerning disability. These value judgments often form a basis for an ideology with the purpose of bringing about, or preventing, a political change (Priestley, 1998). Thus, social creations and constructions are closely intertwined to each other. The way the environment is built is based on assumptions and ideas of how human beings function (i.e., social constructions of a human being form the basis for the material arrangements in society and, thus, produce disablement). On the other hand, the material arrangements of society affect how human beings and their capabilities are regarded. Because people are accustomed to stairs instead of ramps, they tend to think that individuals incapable of using stairs have a disabling condition. The social creations and constructions regarding disability, thus, support each other.
In my discussion social creationist and social constructionist views of disability are compatible and complementary positions. Considering my aim in this paper, it is expedient to see them as a whole and not discuss issues arising from them separately. In this sense my approach resembles that of those philosophers (Amundson, 1992; Silvers, 1998; Wasserman, 2001; Wendell, 1996) who utilized various dimensions and different forms of social approaches to disability in order to illuminate and clarify the issue of conceptualizing disability and impairment.
Although the common distinction between impairment and disability has convincingly been put into question as simplistic (Shakespeare & Watson, 2001), for the purposes of the present discussion, it is useful at this point to separate these two concepts. By impairment I refer to a condition that is medically defined as an organic anomaly (such as a missing limb). Disability, on the other hand, refers either to (a) an individual's state of functioning or being that conflicts with, or jeopardizes, the fulfilment of his or her civic, commercial, and personal flourishing or (b) a state of social and environmental organization that cause the disablement of some individuals. At this point, I do not take a stand with regard to whether disablement is a result of an individual's shortcomings or of society's discriminative practices. I examine disability as a state, or phenomenon, that can be reduced either to biological impairments, social creations, social constructs, or to the joint effect of some or all these three dimensions. I argue that at its core, disability is a social concept that derives its practical forms and meanings from a certain social and cultural context. However, because the significance of impairment in people's lives seems to be one crucial and often ignored dimension in disability studies, I hope to provide an ethical framework for conceptualizing impairment and disability.
Because I do not commit myself theoretically at this point regarding the ontology of disability, I mainly use the term people with impairments rather than people with disabilities or disabled people. I prefer to use a term that identifies people with biomedically defined conditions without making any assumptions about their degree of limitation, well-being, or fair treatment (Wasserman, 2001).
My main focus in this article is to examine the question of whether disability results from social constructions or creations or from biological impairments and to enlighten the ethical dimensions related to the way disability is interpreted. I attempt to show that although the social approaches to disability are generally sound, they are also insufficient accounts because they fail to consider the ethical dimension of disability. I argue that in order to provide a fuller and richer picture of disability, ethical investigation and conceptualization is needed. I preliminarily illuminate the ethical dimension of disability and briefly examine three possible ethical accounts on disability and impairment. My purpose in this brief discussion is to provide a necessary groundwork for the ethical conceptualization of disability. In the conclusion I outline a possible basis for a sound ethical model of disability.
Is Disability a Social Construct and Creation?
It is evident that historical and cultural context determines to a great degree how the criteria for normality, and the ideal or acceptable person, are defined. In antiquity women were regarded as inferior to men, and the deliberative part of their soul was considered to be “without full authority” (Aristotle, Politics, 1260a). Essentially, the social constructionist interpretation of disability seems to be sound: The meanings attached to objects relate to a particular interpretative cultural context. For instance, a tree is an object of nature—a plant. However, different people and groups of people, depending on the cultural context they live in, may see trees primarily or merely as producers of oxygen, as building material, or as dwelling places of spirits. That is, even the objects of nature are meaningless to people until they are given some kind of constitutive meaning, meaning that has its roots in the cultural and social context in which these people live.
This seems to be even more evident in the case of values and norms. On the basis of social constructionism, one can argue that morality does not exist without people establishing it. The normative dimension comes into being after things have been regarded in the community as either good or bad. The only things significant and real are the values and moral norms that people have either adopted or rejected in interaction with others. The significance of norms is primarily determined by the cultural context. By this, I do not mean to say anything about the ontological status of moral values (i.e., whether they are facts existing “out there” that can be discovered or whether they are exclusively social constructs). I simply assert that to people every (moral or amoral) meaning is a construct, regardless of the possible metaphysical existence of parallel meanings independent of the human world.
A social approach implies that disability is first and foremost a social construct or creation, which means that it can be abolished by reconstructing or deconstructing the values and practices that sustain disability. In order to clarify the issue, let us consider a few different kinds of impairments and whether the disability the people with such conditions experience has purely a social origin. For example, a person born without legs seems to have, intuitively and undoubtedly, a disabling condition: He or she cannot walk. This conclusion can, however, be questioned by claiming that an individual born without legs is disabled by the social and material arrangements of society. Suppose that most people were unable to walk and used wheelchairs. If this were the case, we would build ramps rather than staircases to buildings. As Silvers (1994) noted:
By hypothesizing what social arrangements would be in place were persons with disabilities dominant rather than suppressed, it becomes evident that systematic exclusion of the disabled is a consequence not of their natural inferiority but of their minority social status. That is, they are inferior not because they are too defective, but rather because they are too few. (pp. 168– 169)
On the grounds of this line of reasoning, it is logical to question, for example, the moral justification of rehabilitation enterprise by appealing to its one-sided emphasis on normality. Thus, one can claim that the aim of rehabilitation is to assist the individual to be as normal as possible. As a result,
rehabilitation philosophy emphasises physical normality and, with this, the attainment of skills that allow the individual to approximate as closely as possible to able-bodied behaviour (e.g. only using a wheelchair as a last resort, rather than seeing it as a disabled people's mobility aid like a pair of shoes is an able- bodied person's mobility aid). (Oliver, 1990, p. 54)
To equate shoes with a wheelchair as mobility aids seems to result in an unfortunate analogy. One could claim that a person who cannot walk could hardly move around at all without a wheelchair. An able-bodied person, however, can move without shoes, although in some circumstances with difficulty. The idea of a hypothetical society in which most people were unable to walk is relevant regarding unjust social arrangements. On the grounds of this hypothetical example it is, however, problematic to conclude that disability (limitation in mobility in the present context) is solely created by society. The mobility of a person who cannot walk has to be made possible separately in any society by building ramps, elevators, decent sidewalks, and so on. Thus, the mobility of a person who cannot walk requires a more or less developed infrastructure. If this line of reasoning is used it can be argued that inability to walk in itself, at least to some extent, disables the individual.
This argument is based on the assumption that mobility as such is a fundamental human function and that restricted opportunities for practicing it inevitably results in disablement. Yet, there is an obvious flaw in this reasoning, which is a consequence of ignoring the social origins of considering mobility as a fundamental human function. It is the communal values and practices that decide whether a certain form of functioning is considered essential in the context of humanity. If a person without legs does not consider his or her condition as disabling, it seems highly problematic to discount the person's own experience by appealing to some objective standard that condemns him or her to an inferior form of humanity. In addition, many individuals without legs can indeed move by, for example, crawling and do not find it dehumanizing, but for themselves a natural way of moving. They only need wheelchairs for longer distances in the same way that people with legs prefer using bicycles or cars for longer distances. The difference regarding mobility is that of quantity: Getting from one place to another may require a longer time and more effort from chain-smokers, overweight people, and people with physical impairments than for other people. Thus, individual characteristics do not primarily determine when a person is physically disabled but, rather, the communal normative standards of “proper” mobility.
The example of crawling presented in the previous paragraph is problematic in the sense that to some people, wheelchair users crawling suggests animal-like behavior. In the light of the history of disablement, this can trigger offense in many readers. Why is it, then, that crawling suggests animal- like behavior and is, thus, potentially an offensive example? The answer, I think, has to do with the interrelated nature of social creations and constructions. First, society does not consider the human variety in mobility; instead, the environment is arranged in a manner that suits only the majority of population. This process of social organization leads to the disablement of some people. Second, the way the environment has been built affects how people view the variety in mobility. Atypical mobility is easily interpreted as species atypical functioning, animal-like and undesirable for human beings. The social creations, therefore, have an effect on social constructs. On the other hand, social constructs inevitably influence the way society is built. Our environment is usually built on the basis of the assumptions of what is a typical, “normal,” and desirable way of moving for humans. Social constructions can in themselves label some people as inferior, but they also work as a basis for social creations that disable some people. In conclusion, the reason why we view crawling as animal-like behavior or walking as the way of moving for human beings are the social constructs that result from the ableist discourse.
These considerations apply to mental retardation as well. According to Bogdan and Taylor (1994), mental retardation is a social construct and a metaphor that
exists in the minds of those who apply the label, and not in those to whom the label is applied. The answer to the question, “Who is mentally retarded?”, depends on the classification procedures used to define people as such. (p. 48)
That is, certain people have been categorized as mentally retarded by so-called normal people, not by people with “mental retardation.” Also, all definitions depend and are based on the classification practices, which stem from the prevailing cultural beliefs and norms. The majority of those people who are seen to “suffer from” mental retardation are disabled in that particular culture, but would not, perhaps, be disabled in some other culture. Their disability is primarily related to cultural factors and is, therefore, a contingent disability: It is determined and produced by accidental and arbitrary factors.
In sum, the definition of disability always takes place in social interaction, where normal people define dichotomically, in relation to themselves, persons differing from them as disabled. When physically or mentally “deviant” people are defined, normality is also defined. In other words, when the majority of people are able to describe the difference between themselves and the anomalous minority, not only are deviance and abnormality being constructed, but normality and normal people as well—or first and foremost, perhaps (Linton, 1998, pp. 22–25). In disability research this could be explained by the fact that most of the research has been, and still mainly is, carried out by those who have the power (nondisabled individuals) upon those who do not (disabled individuals) (Oliver, 1992). Yet, it would be naïve to assume that people with impairments are exempt from the tendency to stereotype and objectify; after all, people with and those without impairments have both been schooled in the same ableist discourse. Thus, even many people with impairments themselves have started to believe what the traditional explanations of disability tell them; problems that they experience in everyday living are a direct result of their own personal inadequacies or functional limitations (Linton, 1998; Oliver, 1992; Stone & Priestley, 1996).
Although every meaning and definition in communal life is socially constructed, all the dimensions related to them cannot be reduced to social practices. First, pain that pertains to some impairments is pain notwithstanding the environment; to some people, having impairments implies the kind of pain, limitation, and suffering that cannot be removed by environmental factors (French, 1993; Morris, 1991; Wendell, 1996). Bodily experiences like pain, however, are also intimately connected to one's cultural environment. Wendell (1996), for example, noted partly on the basis of her personal experience, that “pain is an interpreted experience …sometimes and in part a product of the interpretation of sensations” (p. 171). Personal interpretations do not take place in a vacuum; they are connected to cultural, societal, and religious values, which means that the definition and experience of pain depends, at least to some extent, on cultural factors. Second, authors have suggested that it is practically impossible to eliminate all the limitations or hardships associated with many impairments by any environmental arrangements (Asch, 2000; Ferguson, 1987; French, 1993; Shakespeare & Watson, 2001). These points include a strong normative dimension because they assume certain things to be in themselves undesirable or, inevitably, to cause undesirable limitations to individuals. The next thing, then, is to consider whether certain impairments are undesirable despite the environment (i.e., do they automatically result in disablement?). For instance, as Ferguson (1987) suggested, is there indeed “something profoundly unfortunate about severe cognitive limitations” (p. 54)?
Toward an Ethical Model of Disability
Disability is essentially a social phenomenon and concept. It is constructed 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 society ought to be constructed in order to treat its members equally. The term disability implies that individuals considered as disabled lack essential human abilities or possibilities to qualify as persons (in a morally significant sense) or to live a good life. Whether “disability” can accurately be explained by social and environmental factors, or by biological factors, determines when “disability” is actually a concept describing society or the characteristics of some of its individuals. In either case, however, having a “disability” implies an undesirable state of functioning or being of an individual— either to him or herself or to other people and society.
Physical or mental abilities are essential constituents of humanity, not merely because these abilities differentiate us from most non-human animals, but because they make possible the communal and relational aspect of human life. The concept disability reflects the idea that persons considered as disabled lack certain abilities, or possibilities, that could contribute to their well-being as humans and as contributing members of a community. Abilities and possibilities are considered good and useful whereas disability is seen as an impediment regarding human well-being.
Sociological or psychological research, for example, can illuminate on what basis certain phenomena, ways of being or functioning, are defined as disabilities, but the essential core of the concept of disability is ethical. The tenets of the traditional individual approach to disability imply that disability is a matter of an individual's insufficient abilities. This inevitably places persons with impairments 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, proponents of these approaches emphasize that these two phenomena are distinct. Supporters of the social views do not regard impairments as such as necessarily undesirable conditions. Disability, however, seems to be considered an undesirable state of functioning, or 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 as regards social arrangements.
The crucial point, then, is to examine the relevance and soundness of the norms that cause us to define certain phenomena, conditions, and ways of functioning as disabilities. The crucial starting point from a traditional, moral, philosophical viewpoint is the question: What individual conditions or ways of functioning can, on sound normative grounds, be considered to result in disablement in the sense that they would jeopardize our well-being, pursuits of a good life, or capability of acting as responsible moral agents? That is, can we define plausible criteria for a morally desirable way of functioning and being a human being? 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 Nussbaum (1990):
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)
Because 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. From this perspective the crucial question would be, is disability an indication and the result of social and political systems? If it is, in what manner, and to what extent, is society obliged to redress the systems and arrangements that have disabled some of its members?
If these questions concerning well-being and justice are found relevant, there are at least three alternative ways to answer them: (a) universal, objective theory of humanity, which can distinguish disabled people from the nondisabled people on the grounds of their biological characteristics; (b) a subjectivist theory of disability that would make an individual's personal experience the central, and the only relevant, criterion (i.e., if an individual feels or thinks that he or she is disabled, then he or she is disabled); and (c) a communitarian theory of disability in which disability would be defined according to the prevailing cultural traditions and communal practices. I will now take a brief, critical look at these three possible ways of defining disability.
Universal, Objective Theory of Disability
At first glance, the view that impairments are good or desirable conditions from the individual's perspective seems to be a highly counterintuitive position. For example, causing impairment to anyone, especially to one's child, is generally and reasonably considered as prima facie immoral (Vehmas, 2002). This is because impairments are not, in fact, seen as neutral factors regarding human well-being. What are the reasons for this conclusion?
Nussbaum's (1988, 1990, 1992) aim was to provide a basis for giving answers to this question by arguing that there is an intrinsic value in the possession or exercise of certain cognitive, sensory, and motor functions because they are essential components of humanity and the human good. In her theory the tasks and obligations of society cannot be understood apart from a rather substantial account of the human good and what it is to function humanly. The aim of political planning is the distribution to the society's individual people of the conditions in which a good human life can be chosen and lived. This distributive task aims at making people able to function in certain human ways that are in accordance with a good human life. In order to provide an account of the human good and what it is to function humanly, an ethical investigation is needed.
Nussbaum's (1990) Aristotelian “thick vague conception of the human being” and “thick vague conception of the good” draw the general outlines of the good life by first determining what are the things that make us human beings. For this purpose she gives us an open-ended list containing 10 essential features of human beings, including “being able to move about from place to place” and “being able to use the five senses” (Nussbaum, 1990, p. 225). She also wrote that practical reason and affiliation are the human functions that organize and arrange all of the others, giving them in the process a characteristically human shape:
All animals nourish themselves, use their senses, move about, and so on—and all of this as beings in one number. What is distinctive, and distinctively valuable to us, about the human way of doing this is that all these functions are, first of all, planned and organized by practical reason, and, second, done with and to others. (p. 226)
According to Nussbaum (1990), life without these previously stated elements “is less than human, a fortiori surely not a good human life” (p. 227). McMahan (1996) shared the normative premises regarding impairments with Nussbaum and supported them with the following considerations:
People who are born blind, for example, are thereby deprived of certain dimensions of well-being: they cannot perceive the sublimity of an Alpine landscape, create or appreciate works of visual art, and so on. …people born autistic are incapable of forming deep personal relations. Although in some cases deprivations of these sorts are on balance compensated for, there are many other cases in which they are not. (pp. 3–4)
Why do we think that people born blind or autistic need some sort of compensation for their deprivations? Because appreciating works of visual art and forming deep personal relations are of vital importance to us, to so-called “normal” people. Certain functions are regarded as species- typical and 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” (Wasserman, 1996, p. 133). This is why people do not feel themselves impaired, for example, in lacking a sixth sense or the acoustic range or olfactory sensitivity of a typical dog. Functions and faculties are regarded as species-typical and good for people on the basis of cultural and social accommodation, regardless of how much these, or some other functions and faculties, could in themselves enrich our lives.
In other words, people who have never been able to perceive the sublimity of an Alpine landscape would not feel deprived of anything at all unless they were told that they suffered from a deficiency (this, of course, does not apply to people who become blind after being sighted). Also, an individual incapable of forming deep personal relations does not necessarily suffer from this deprivation. His or her deprivation can actually be the deprivation of other people. It makes perfect sense that the parents of a child with autism feel deprived due to the lack of interaction with their child. The child, however, may not have this problem. The subjective experience of deprivation and disability may be primarily that of the parents, not of the child. It is noted, however, that many people with autism do suffer due to a sense of alienation from other people and experience frustration, depression, and a sense of apprehension (Jones, Zahl, & Huws, 2001). To what extent these experiences can be reduced to communal values, practices, and expectations as opposed to autism in itself, is often hard to tell.
In the case of individuals with severe cognitive impairments, MacMahan (1996) provided the following reasons for their unfortunate state of being:
First, their disabilities may obviously be instrumentally disadvantageous. They are wholly dependent on others for their continued existence and for whatever other goods their lives contain and are therefore precariously vulnerable to neglect and abuse. Second, their permanently infantile condition may seem objectively degraded. . . . Their misfortune is the indefinite extension into adolescence and adulthood of a state of being that is appropriate only to infancy. Third, and most importantly, individuals born with only very rudimentary cognitive and emotional capacities necessarily have a highly restricted capacity for well- being. . . . [They] are incapable, for example, of deep personal and social relations, creativity and achievement, the attainment of higher forms of knowledge, aesthetic pleasures, and so on. Their signal misfortune is thus that they are excluded from many or most of the various dimensions of a good life. (pp. 7–8)
As for the first reason MacMahan (1996) gave for the unfortunateness of cognitive impairments, one must ask: Are we not all dependent on others and, therefore, vulnerable to neglect and abuse? The well-being or ill-being of all individuals depends primarily on their relation to other people (Vehmas, 1999). If people close to me decided to exploit my vulnerability, I would probably feel distress no matter what kind of intellectual competence I had. Humanity and human well-being are, thus, mainly granted to us by other people; the humanity of all individuals, and their well-being depends on other people's recognition.
The crucial point behind all MacMahan's (1996) remarks, in fact, seems to be the idea that the condition of individuals with severe cognitive impairments is “objectively degraded” and that they have a restricted capacity for well-being. One basic problem in both MacMahan's (1996) and Nussbaum's (1990) position is how they view the concept of well-being, and in Nussbaum's case the concept of flourishing as well. Well-being is essentially a subjective concept by its very nature; well-being concerns unavoidably “what is good or bad for the subject in question” (Sumner, 1995, p. 767). There are, of course, objective factors that weigh on one's chances for a happy or good life. Intellectual competence, for example, may be one of them. The environment and relationship with others, however, may count a great deal more than intellectual competence when assessing one's well-being (Vehmas, 1999, p. 115).
For Nussbaum, however, the Aristotelian concept of flourishing is an objective one, contrary to well-being. Flourishing refers to the kind of happiness and subjective well-being that is brought about by living according to the objective ideals that form the idea of a good life; one has to practice an intellectually contemplative and politically active life; develop one's virtuous dispositions, such as practical reason (phronesis) and fortitude; and carry out in practice the virtues that one ought to hold in order to qualify as a virtuous person and, thereby, be able to live a good life. That is, subjective well-being does not necessarily imply a good life. What matters from Nussbaum's theoretical viewpoint is the objective concept of flourishing and whether one lives according to it. Subjective well-being counts morally only as long as it is the result of flourishing. This position, however, gives rise to at least as many problems as it purports to solve. First, Aristotle's objective account of morality and the good life is merely one theory among many others, and, at least so far, there is no consensus as to why we should adopt Aristotle's theory (let alone Nussbaum's application of it) as the ultimate criterion for a good human life. Second, it seems very curious to detach goodness or badness altogether from individual's preferences. There is no value, for example, in knowledge, rational activity, love, or the awareness of beauty if they are entirely devoid of pleasure. So, 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 (Parfit, 1986, pp. 499–502).
Third, is it possible to separate meaningfully flourishing and subjective well-being from each other the way Nussbaum (1990) does? Subjective well- being, as well as the ideas of objective criteria for flourishing, are inevitably culture-bound; the customs, traditions, and values of a community affect how actions and ways of living are considered morally. Also, the contents of objective values and virtues (such as knowledge, rational activity, and beauty) are formed in a cultural context and, to a large extent, produced by it as well. It seems also highly difficult and arbitrary to evaluate exactly when an individual is not practicing his or her practical reason independently enough as opposed to being unconsciously and uncritically following the moral mores he or she has been taught. Further, how can we determine what kind of subjective well-being is not in accordance with flourishing?
Thus, well-being and flourishing too are relative concepts. This being the case, where do we draw the limit between acceptable and unacceptable moral ideals? It seems that Nussbaum's (1990) objective “thick vague conception of the good” is not a very helpful tool if one is to consider all the dimensions in individual and social lives. This, in fact, applies to all moral theories: Any categorical norm or theory is too rigid to account for the distinct particularities of human life. That is, human life is too complex for almost any universal moral theory to capture, which is why these theories can only generate prima facie guidelines for action. This is why purely objective conceptual accounts on disability would inevitably be insufficient.
A Subjectivist Theory of Disability
If the concept of well-being is considered to be of crucial importance in the normative definition and conceptualization of disability, an individual's subjective experience would seem to be the most weighty factor. That is, in order to avoid paternalistic ideas and concomitant practices, the individual him or herself should have the one and only relevant voice in determining whether he or she is disabled, whether he or she has a disabling impairment. In some sense, this seems a promising alternative. It would prevent the flaws of the medical model of disability based on the absence of subjectivity of people with impairments, an approach that has been, for example in disability research, argued to result in promoting, rather than solving, the problem of discrimination and oppression (Barnes, 1996; Oliver, 1992; Stone & Priestley, 1996). Some disability scholars can be seen to stand for a subjective account on disability. Their position 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 or she feels so, and it also means that the subjective experience of disablement is an elementary constituent of his or her self- understanding. The process is largely determined by how the individual positions him or herself in relation to other people, their identities and characteristics (French, 1993; Morris, 1991; Priestley, 1998).
A normative subjectivist position, however, causes serious problems, of which one is the submission to social injustice. 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 may 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 (Nussbaum, 1988, p. 175). Similar kinds of examples could be presented of people with impairments who have adopted the arrangements of their environment as the basis of their subjectivity, arrangements (regarding, for example, education and work) that place them in an inferior position to other people.
Thus, in some cultures the upbringing of certain people has been hedged around with discrimination and inequality, with the result that the people that are actually discriminated against do not acknowledge this negative experience, have adapted to the prevailing circumstances, and have the subjective experience of doing well. Obviously, we do need some sort of objective valuational procedure that will have the power to criticize the evaluations made by people who have accustomed themselves to discrimination. In the case of discrimination, Nussbaum's (1988) following comment seems justified and relevant:
Just as people can be taught not to want or miss the things their culture has taught them they should not or could not have, so too they can be taught not to value certain functionings as constituents of their good living, where their culture has an interest in, or cannot avoid, denying them access to these functionings. (p. 176)
A subjectivist position also has problems with regard to distributing goods, assuming that the subjective experience of disablement could work as a basis for the right to obtain extra financial support from society. If disability would be a relevant factor in considering distributive justice, the issue automatically involves other people, their resources, and interests. This being the case, subjective experiences cannot possibly be sufficient reasons for allocating resources. If they were, we would end up in a hopelessly relativistic situation, where all subjective voices should count equally; none of these voices could be said to be better or worse than any other. Subjectivism excludes in this kind of situation the possibility of rational persuasion and negotiation. To conclude, a subjectivist normative theory of disability would inevitably be an insufficient and unsound account.
A Communitarian Theory of Disability
Communitarianism is a political doctrine that emphasizes the good of the community and the health of the group. According to communitarians, the emphasis on individual rights in Western culture must be supplemented and corrected by a focus on responsibilities, and the good of the community and integrity of its traditions should be promoted by a variety of means, including the deliberate use of public policy. In this position, people are seen essentially as social and historical creatures, whose capacities, values, aspirations, and identities result from them being born and raised in particular communities. What constitutes a true community is a matter of dispute among the communitarians. MacIntyre (1985) denied that a modern nation– state could be a community in a real sense. The only genuine communities today are nonpolitical, such as religious and ethnocultural groups, which sustain traditions and practices that embody and promote a common good for their members.
According to MacIntyre, an individual's moral identity is intertwined with his or her social roles and is determined by them. Our social identities are formed in relation to the various roles we hold (e.g., I am someone's daughter or son, a member of this or that profession). This implies that the good life is not the same for all individuals everywhere; one's cultural and historical context along with one's particular social identities determine the contents of the good life. As MacIntyre (1985) noted:
Hence what is good for me has to be what is good for one who inhabits these roles. As such, I inherit from the past of my family, my city, my tribe, and my nation a variety of debts, inheritances, rightful expectations, and obligations. These constitute the given of my life, my moral starting point. This is in part what gives my life its own moral particularity. (p. 220)
Community is in MacIntyre's (1985) theory a set of practices. As in chess or football, societal and political life requires that people learn and obey the established rules. Each person cannot play by his or her own rules—otherwise the community would end up in chaos. In order to live the good life, one must be a good member of the community: act according to one's social roles and their concomitant moral norms. This is not possible if one does not follow the rules and traditions of one's community. Even transforming community and its practices has to take place in a manner in which the community's traditions, customs, and values are respected.
Communitarianism is based on the assumption that community requires likeness; it is rooted in what is common (Moon, 1998). When applied to the definition of disability and the position of people with impairments in the community, communitarianism may have at least the following kind of implications. The conditions set upon the members of the community apply equally to all of them. Individuals with impairments should acknowledge that they are members of the community, occupants of certain roles, and that they have to adapt to the culture they were born into and in which they live. If their aptitudes imply limited opportunities, as well as an inferior social status, because of the communal practices, they simply have to accept that fact and try to be as good members of the community as possible.
This kind of position would inevitably lead into the kind of oppression and the tyranny of “normal” people many disability scholars have been talking about. Although it is not something MacIntyre himself would probably condone (MacIntyre, 1999), his original reconstruction of morality seems prey to oppressive and relativistic worries. Contemporary culture contains a multiplicity of traditions. When we are born into one of them, we can only regard a decision to remain within it or to leave it for another. Within the communitarian framework, it seems very difficult to evaluate the relative validity of one tradition with respect to its rivals; we end up in a situation with an arbitrary choice between traditions (Mulhall & Swift, 1992, p. 91). To conclude, without some objective criteria for arranging human communities, a communitarian model would result in an arbitrary situation where any tradition could be justified, even if it resulted in the oppression of people with impairments. Communitarians have expressed some important points about issues such as identity, but, as such, it is an insufficient basis for the conceptualization of disability.
A Combined Ethical Theory of Disability: A Preliminary Proposal
Traditional ethical theories consist of assumptions and norms about what makes us distinctively human. For example, in philosophy the concept of a “moral being” signifies a being that merits moral rights and is capable of acting morally. Philosophers have argued that only rational beings can be moral, which implies that non-human 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 rather 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” (Sapontzis, 1987, chapter 3).
One can reasonably argue that people with impairments are, in the light of ethical theories and theories of social justice, marginal human beings. Philosophical practice presents people with impairments in the light of pessimistic extremities, not in the light of their daily routine. By doing so, philosophy depicts living this way as a fringe existence (MacIntyre, 1999, chapter 1; Silvers, 1998, pp. 2–3; Vehmas, 2004). This leaves us three alternatives. The first is to accept the tenets of Western moral philosophy and admit that people with impairments indeed 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 impairment and disability, these theories that are, after all, supposed to say something essential about all kinds of human lives.
Thus, impairment and disability are highly relevant to philosophical practice because they raise fundamental issues about the significance of variations in physical and mental functioning for human well-being, for personal and social identity, and for social justice. On the other hand, recent Anglo American philosophy should be of interest to disability scholars because of its close analysis of concepts critical to the conceptualization of disability, such as health, normality, disease, well-being, discrimination, justice, and equality (Wasserman, 2001, p. 219).
I have suggested in this article that in order to conceptualize and define disability and impairment satisfactorily, ethical investigation is needed. Although the social approaches to disability seem to be sound accounts on the whole, they miss something crucial by ignoring the scrutiny of the normative dimension of disability. I have outlined three possible ethical theories of disability: a universal, objective theory; a subjectivist theory; and a communitarian theory. My brief discussion of these possible theories was aimed at showing that they would inevitably be insufficient. This is understandable due to the ignorance of philosophical discourse regarding the various dimensions of disability. What we need, then, is dialogue of philosophy and disability studies in order to conceptualize disability satisfactorily from an ethical viewpoint.
To correct the mistakes of the possible ethical theories of disability that I have outlined in this paper, one should develop the kind of combined normative theory of disability that would consider factors from all three theories; objective, subjectivist, and communal aspects that have moral relevance. The development of such a theory would have to be based on a thorough examination of the possible implications of the major ethical theories on the definition of disability. That is, one should take into account, at least, virtue-based, duty-based, and outcome-based ethics. Also, an ethical examination of disability requires understanding of different impairments and how they affect people's well- being in different cultures.
One basic mistake in the arguments of many philosophers is to see disability, and its significance regarding people's well-being, from a strictly individualistic perspective. For example, Singer, who is probably the best known philosopher writing about disability, argued that disability is the result of individual's impairments, results in an impoverished human existence, and can thus be a morally significant factor in the sense that individuals (especially fetuses and infants) with impairments are less entitled to life than others (Kuhse & Singer, 1985; Singer, 1993, 1995). Accounts based on individualistic and atomistic ideas of disability and human well-being are incorrect because people are relational beings whose survival, let alone flourishing, is in debt to other people. No account of the human condition that ignores the impaired nature of all human lives, our vulnerabilities and afflictions, and the extent of our dependence on particular others can be credible (MacIntyre, 1999, p. 1; Vehmas, 1999, pp. 114–115).
Moral philosophy has constructed a division between people on the basis of disability where individuals with impairments are seen as “them,” as other than “us.” In this dichotomy, “we” are “normal” and “they” are “abnormal”; “we” pay the costs and “they” get the benefits (MacIntyre, 1999, p. 2; Veatch, 1986, pp. 166–168). This dichotomy is patently false; all people are impaired in some sense and face limitations in their lives. It is, however, also true that the level of impairments and limitations varies from the trivial to the profound (Shakespeare & Watson, 2001).
So, what is needed is the kind of an ethical account in which attention is paid to the social and communal nature of disability, well-being, and human lives in the first place. From that perspective, a virtue ethical approach seems a promising foundation because it sees human lives and morality in the context of a community, not individualistically. According to the modern virtue ethics perspective, values and virtues are shaped, and have a meaning, in a cultural context. They are not necessarily constituents of the universal human telos as classical ethics of virtue (Aristotle) saw it. Quite the opposite, to seek a universally valid basis for ethics and to formulate universal moral principles is an endeavor doomed to failure because morality is a historically determined human institution that can be properly understood only if it is seen as such: “all morality is always to some degree tied to the socially local and particular …the aspirations of the morality of modernity to a universality freed from all particularity is an illusion” (Macintyre, 1985, pp. 126–127).
Thus, from a virtue ethics perspective (especially MacIntyre's (1985), morality is particular and historically determined. This, in fact, is a universal feature of human life. This approach to ethics that emphasizes the cultural nature of morality fits in nicely with the social approaches to disability in which disability is seen as socially constructed, culturally shaped and produced. In the same way as it seems odd to detach morality from a particular context, it is absurd to assume that we could plausibly construct a universal definition of disability, beyond cultural and social contexts. Without understanding the particular material and ideological circumstances of a community, we cannot possibly know what disability is all about.
According to MacIntyre (1985), people's telos is communally defined. When I discussed communitarianism earlier in this paper, I pointed out that to base a moral theory, or theory of disability, in what is considered normal for people, is to end up in an account that discriminates against the marginalized members of the community. MacIntyre (1988, p. 367) stressed that a neutral perspective (regarding morality and rationality) is a conceptual impossibility; the notion of understanding presupposes understanding from a certain viewpoint. This implies that we cannot evaluate the moral norms of other cultures from a neutral viewpoint but, rather, from our own tradition. In the same way, defining humanity, human well-being, or the good life cannot take place beyond our experiences and subjectivity. The way people without impairments view people with impairments and their chances for well- being and good life inevitably is based on their experience and point of view as nondisabled persons. Thus, when defining disability, without hearing the subjective voices of those seen as disabled, we can only construct an external, the kind of “objective” model that does not explain much of individuals' experiences—it would merely be a projection, “our” view of “them.”
To conclude, although I have not offered here an exhaustive scrutiny of the ethical conceptualization of disability, I have tried to show that we cannot construe a plausible universal, normative account of disability. Definition, let alone normative conceptualization, always takes place in a social context with varying traditions, values, and requirements. It seems that it is not, after all, essential to ask what individual conditions compromise people's well-being or pursuit of a good life. Rather, a more crucial issue is how other people, the surrounding environment altogether, should regard people with impairments. What kind of theoretical foundation, and consequent practical arrangements, should we produce in order to create the kind of reality where people with a variety of characteristics (including impairments) are not a nuisance, but equal, valuable contributors to the communal life? Perhaps the well-being of the marginalized groups of society ought to be seen as an essential indicator of the flourishing of the whole society. As MacIntyre (1999) pointed out: “For it is insofar as it is need that provides reasons for action for the members of some particular community that that community flourishes” (p. 109).
NOTE: I thank Peter Herissone-Kelly, Matti Häyry, Tuija Takala, and Gregor Wolbring for their critical comments on this paper.
Author: Simo Vehmas, PhD, Postdoctoral Researcher, Department of Moral and Social Philosophy, University of Helsinki, PO Box 9, 00014 Helsinki, Finland. Simo.vehmas@Helsinki.fi