• Ethics

Despite antidiscrimination laws, disability discrimination remains ongoing. A recent field experiment in the USA indicates that employers are significantly more reluctant to interview qualified applicants with disabilities, whether physical or mental. This reluctance is especially noticeable among smaller employers and for more experienced job applicants.1 Such barriers impede people with disabilities from work, economic self-sufficiency, employer-provided health insurance, and more generally full participation in the societies in which they live. These impediments, in short, are a serious problem of justice and yet another indication that we live in an imperfect world in which non-ideal and partial compliance theorising about justice is imperative.2–4

It is thus highly welcome to see this journal devote a mini-symposium to philosophy and disability. The contributions illustrate many ways that philosophical techniques can inform our understanding of disability and disability discrimination and with this of bioethics more generally. This achievement is not always deliberate for the articles vary in success and at times primarily illustrate the limits of philosophical methods. Nonetheless there are important lessons to be drawn: that context matters to the understanding of disability and disability discrimination, and that applied ethics relies on the interplay of conceptual analysis, understanding of how arguments function, and the challenges of often-unjust social circumstances. The relevance of social context should not surprise readers familiar with claims about the social nature of disability: that the disadvantages attendant on differences in bodily functioning vary with the structures of the built and social worlds. It should also not surprise readers in bioethics familiar with non-ideal justice: that what justice requires in contexts of injustice may be very different from what it would require in an ideal world.

Greg Bognar's ‘Is Disability Mere Difference?’ deploys conceptual analysis to debunk the claim that disability is only difference. Take spinal cord injury: while evidence indicates that people with spinal cord injuries view their conditions differently from people without these injuries, it does not support the more radical claim that they do not view it as disadvantageous at all. Even if they did, Bognar says, they might be mistaken about their own well-being or have an overly simple view of well-being such as equating it with pleasure and the absence of pain. A further argument is that people adapt to such injuries by pursuing different aims or learning new skills to compensate. Bogner believes this last may be ‘undermined by the everyday, common-sense experience of disability that most people have’ (whatever that might be). Moreover, this argument assumes that disability is a harm, only one that can be offset by compensation. As for the social model of disability, Bognar says, the idea that changing social circumstances can alter the disadvantages associated with disability does not obviate other reasons for considering disability a harm.

Yet the ‘mere difference’ claim as Bogner interprets it literally is a straw man: the claim's rhetorical force is not that disability is literally difference, but that the differences associated with disabilities have been misunderstood in extent and in kind. This is a matter of context, as the recent study of employment discrimination illustrates: employers were significantly more reluctant even to interview highly qualified applicants with identified spinal cord injuries than applicants who did not so identify.1 Spinal cord injury is mere difference when work-capable people with spinal cord injuries, or diabetes, or small children, or even the need to fidget, have the workplace structures that enable them to do their jobs well. And the ‘mere difference’ claim points out that it is irrelevant to job capability. So when Bognar concludes that “[t]here is no reason to give up just yet the view that disability is a harm”, what he is saying trades on context-independence. While in some contexts there may be every reason to challenge circumstances that perpetuate it, in others there may not be.

Moral metaphysicians have much debated whether people with serious cognitive disabilities have ‘full moral status’, spilling philosophical ink on questions such as what features of an entity ground its moral status or whether moral status is a relational characteristic. Ben Curtis and Simo Velmas use an approach to argumentation to bypass these debates. To be convincing, arguments must be valid: their logical structure must guarantee that the premises cannot be true when the conclusion is false. But to be convincing—that is, sound—arguments must also have true premises. But we may have differing levels of confidence about the premises or conclusion of a valid argument. Here's an illustration: moral status depends only on having certain intrinsic psychological properties (eg, self-consciousness); some humans have psychological properties that are similar to those of non-human animals rather than other humans; therefore some humans have the moral status of the non-human animals they resemble rather than the moral status of other humans. Curtis and Velmas say we have greater confidence in the falsity of the conclusion of this argument than we do in the truth of its premises. They then conclude that we should reject the premises—which represent a standard account of moral status—rather than accepting the conclusion of the argument.

Their argument is a type of burden of persuasion argument. In law, a case's outcome may depend on which party bears the burden of persuasion and the stringency of that burden. In US criminal law, the prosecutor bears the burden of persuasion beyond a reasonable doubt. In some US jurisdictions, a party seeking to withdraw life-sustaining treatment from an incapacitated person bears the burden of ‘clear and convincing evidence’ that withdrawal is what the person would have wanted or what is in her best interests. Here, according to Curtis and Velmas, the person arguing that humans with severe cognitive disabilities have the moral status of non-human animals must bear the burden of persuasion on the ‘standard account’ that moral status rests only in intrinsic psychological properties, and this burden must be sufficiently high to offset our confidence in the falsity of the conclusion that humans with these severe disabilities have the same moral status as many non-human animals (and thus it would be permissible to euthanatise them, eat them, experiment on them, or whatever else it is permissible to do with beings of such lesser status).

Context matters doubly in this burden of persuasion argument. First, context matters in figuring out whether we have more confidence in the falsity of the conclusion than the truth of the premises: perhaps the conclusion risks wrongful treatment of these humans. Second, context matters to how we regard this burden of persuasion argument: perhaps we have experience of being led astray by too-ready acceptance of enticing premises that lead us to conclusions that surprise us. We construct burdens of persuasion as we do in law, for example, out of considerations of individual rights and social justice; these are, in contemporary societies, questions of partial compliance theory.

Brain-computer interfaces (BCIs) are developing technologies that permit people to act in the world without relying on their own physical connections to it. David Wasserman and Sean Aas ask the conceptual question of whether BCIs are just bodily extensions or a different way of impacting the external world. Whichever way BCIs are construed, Wasserman and Ass argue, they have the ability to liberate or oppress—not as a matter of the misuse of technology but as how we construe the body and stigmatise. BCI technologies differ from ‘standard prostheses’: they are largely extracorporeal, need not mimic a species-typical function, and may enable users to do things that typically embodies humans cannot. We may come to see them as parts of the body or as external tools. But in either case stigmatisation might persist. If BCIs are seen as parts of the body—extensions—in widespread use, stigmatisation might attach to those who cannot use such phenomenal new inventions. If they are in more limited use, they might be judged bodily distortions, of use to those whose bodies do not function well. On the other hand, if they are seen as mere tools, like headgear put on to play a game, they may not undermine the idea that some bodies are more normal than others. Wasserman and Aas end their paper by suggesting that the adoption of these devices might undermine stigma by reducing the importance of normal bodily function. But they issue a final caution about progress towards this goal: that medicalisation of BCIs may divert attention from social aspects of disability.

Adam Cureton explores the advantages of having a parent with a disability, aimed specifically to counter stereotyping about what constitutes good parenting and how people with disabilities can achieve this. He begins by attacking common biases: that persons with one disability are likely to be disabled in other ways, that our own experiences with parenting make us good judges of how others will parent, or that the typical ways of doing things are the best. Cureton's discussion of how people with disabilities parent draws on the richness of interconnections between parents, their children, other family members, and socially available resources. These resources include accessible products, home designs, specialised training and access to transportation and healthcare. The article serves as an important reminder of the social nature of parenting and the relevance of social justice to the constitution of families.

The articles by Wasserman and Aas and Cureton exemplify normative theory in practical context. For Wasserman and Ass, the questions about adopting the novel technology of BCI are not questions about whether these devices are ‘human’, ‘natural’, or frightening in their power. They are instead about how these devices might be transformative for people with or without disabilities alike—and how these transformations might play out in actual contexts of implementation. For Cureton, the issue is how different types of parenting can be valuable in supportive social contexts.

The conference at Syracuse University where several of these articles were originally presented is an excellent illustration of how work in philosophy and disability studies can be mutually informative. As these articles illustrate, a particularly fruitful area of intersection lies between non-ideal theory and the social aspects of disability.