RT Journal Article SR Electronic T1 A realist account of the ontology of impairment JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP 93 OP 95 DO 10.1136/jme.2006.019042 VO 34 IS 2 A1 S Vehmas A1 P Mäkelä YR 2008 UL http://jme.bmj.com/content/34/2/93.abstract AB This paper provides a philosophical analysis of the ontology of impairment, in part social and in part not. The analysis is based on the division between two categories of facts concerning the world we live in: “brute” and institutional facts. Brute facts are those that require no human institution for their existence. To state a brute fact requires naturally the institution of language, but the fact stated is not the same as the statement of it. For example, regardless of any human institution or opinion, the presence of an extra chromosome 21 is a brute fact, and despite of people’s constructions or deconstructions, this fact remains. As for the lives of people with extra chromosome 21, the social reality and human institutions enter the picture. The social and moral status of these people is never a matter of brute fact.