University of California Causing Disability Causing Non Disability Summary

Description

Summarize both articles briefly. Explain Stramando and Campbell’s main point in their article and then explain Barnes’ main point in their article. Do both articles have the same principle in mind? Based on the articles that you read, what criticisms would Stramando and Campbell have about Barnes’ articles and what criticism would Barnes have about Stramando and Campbell’s article. Who do you agree with and why?

Forthcoming in The Oxford Handbook of Philosophy and Disability
Causing Disability, Causing Non-Disability:
What’s the Moral Difference?
Joseph A. Stramondo, San Diego State University
Stephen M. Campbell, Bentley University
Abstract: It may seem obvious that causing disability in another person is morally
problematic in a way that removing or preventing a disability is not. This suggests
that there is a moral asymmetry between causing disability and causing non-disability.
This chapter investigates whether there are any differences between these two types
of actions that might explain the existence of a general moral asymmetry. After
setting aside the possibility that having a disability is almost always bad or harmful
for a person (a view that we have critiqued at length elsewhere), seven putative
differences are considered. Ultimately, it is concluded that none of these seven
factors can ground a general moral asymmetry between causing disability and causing
non-disability, though each factor can provide some moral reason to avoid causing
disability in certain particular cases.
On the face of it, there seems to be a significant moral difference between causing disability
and causing non-disability.1 For many of us, the idea of making a person disabled often
raises moral alarms that the idea of preventing or removing disability does not. This may
suggest that there is virtually always a strong moral reason to avoid causing disability that
does not apply to causing non-disability. In this chapter, we want to examine this apparent
“moral asymmetry” between causing disability and causing non-disability, most
fundamentally asking: are there any differences between these two types of actions that
could ground a general moral asymmetry of this kind?
One possibility that many find compelling, both in professional philosophy and in
the social milieu writ large, is expressed by the Standard View about disability and well1
We are very grateful to Adam Cureton, Daniel Singer, and David Wasserman for their
insightful feedback on this chapter.
1
being: the view that having a disability is always—or at least almost always—bad for a
person in a way that non-disability is not.2 The truth of the Standard View is often
uncritically assumed and, with it, the plausibility of a moral asymmetry. After all, if the
Standard view were true, then of course there would be an important moral asymmetry
between causing disability and causing non-disability: the former diminishes human wellbeing, the latter does not. However, this widely accepted justification for a moral
asymmetry is bankrupt because the Standard View is false. Or so we think. In a recent
essay, we have offered a systematic critique of the Standard View and thereby joined a
steadily growing chorus of philosophers who reject that view.3
Rather than accepting the moral asymmetry by appealing to the Standard View,
some scholars have reversed this reasoning and tried to defend the Standard View by
appealing to our intuitions about a moral asymmetry. The thinking goes something like
this: The Standard View must be true since, if it were false, it would be permissible to cause
disability in much the way that most people think it is permissible to remove or prevent
disability; presumably that is not the case.4 This argument appeals to most people’s intuitive
sense that, unlike causing non-disability, there is something morally problematic about
causing a disability.
Elizabeth Barnes squarely confronts this defense of the Standard View in her 2014
paper “Valuing Disability, Causing Disability” and subsequent book The Minority Body
(2016). Part of Barnes’ strategy is to establish that even if the Standard View (or “BadDifference View” in her terminology) is false, there are other potential explanations of the
wrongness of causing disability in certain cases. In particular, she identifies two
independent factors that could explain this. First, causing disability in another person
without their consent would constitute a form of unjustified interference in their life, even
if it weren’t bad for them. Second, even if being disabled is not in general a bad or harmful
thing, becoming disabled usually involves the transition costs of having to adopt and adapt
2
The label “Standard View” is drawn from Amundson 2005, 103.
Campbell and Stramondo 2017. Other philosophers who have challenged the Standard View
or some variant of it include Amundson 2005; Wasserman and Asch 2013; Schramme 2013;
Barnes 2016, ch. 3; Barker and Wilson 2018.
4
Cf. Harris 2001, Singer 2004, McMahan 2005, Kahane 2009.
3
2
to a new lifestyle. However, when those factors are not present, Barnes seems willing to
“bite the bullet” and say that causing disability is no more morally problematic than causing
non-disability. In this way, she rejects the idea that there is a general moral asymmetry
between causing disability and causing non-disability.5
While we sympathize with much of Barnes’ discussion and will ultimately agree
with her that we should reject the idea of a general moral asymmetry, there are other
potentially promising explanations of a moral asymmetry between causing disability and
non-disability that she doesn’t address and that appear to be independent of the Standard
View. These factors merit investigation, if only because the idea that there’s something
morally problematic about causing disability is a deep-rooted conviction for many people,
including many of those who staunchly reject the Standard View and deny that disabilities
need be bad for a person. What, if anything, might explain this belief? And more
importantly for our purposes, are there any differences between causing disability and nondisability that actually do justify the apparent moral asymmetry? Our goal in this chapter
is to answer this question.
1. The Scope of Our Inquiry
Before we launch into an analysis of these factors, it is worth putting a finer point on the
scope of our inquiry. Foremost, we want to be clear about what we mean by the term
“disability,” given that there is a wide variety of competing models or definitions of the
concept. Since our task is daunting enough without attempting to figure out the nature of
disability, we’ll help ourselves to the ordinary understanding of which conditions qualify
as disabilities or impairments and not worry about whether there’s a coherent and plausible
metaphysical account underlying this grouping. Paradigmatic examples of conditions
widely considered to be disabilities or impairments include blindness, deafness, Down
syndrome, spina bifida, muscular dystrophy, achondroplasia, quadriplegia, and cerebral
palsy. So, when we discuss causing disability and non-disability, we are merely referring to
5
Barnes 2014 and 2016, ch. 5.
3
causing people to have, or not have, the kinds of embodiment commonly taken to be
disabilities. We are not making any metaphysical claims about the nature of disability.
Next, our topic involves the concept of causation. For the purposes of this
discussion, we’ll understand “causing a feature X” in a fairly broad way: making an active,
non-negligible contribution to either the creation or the continuance of X. Causing
disability includes everything from selecting and implanting an embryo with
achondroplasia to participating in a full-contact sport that is likely to result in a traumatic
brain injury or other disabling injuries. Causing non-disability would include undergoing
the procedure of phacoemulsification to replace an eye’s lens that has a cataract on it,
getting a polio inoculation, or implanting a cochlear implant in a child.
Since we are here concerned with a possible moral asymmetry between causing
disability and causing non-disability, we are going to exclude cases only involving the
prudential value of causing disability or non-disability. In other words, we will not focus on
cases in which competent choosers are making a self-interested personal decision about
whether to cause disability or non-disability in themselves. Instead, this chapter will
investigate cases in which either (1) a competent chooser is acting as proxy to decide
whether to cause disability or non-disability in another person who is not currently
competent to choose for themselves, or (2) a medical professional or other third party
must decide whether to assist in causing disability or non-disability when this has been
requested by a competent chooser or their proxy.6
2. Putative Factors in the Explanation of a Moral Asymmetry
What considerations might explain the apparent moral asymmetry between causing
disability and non-disability? As already noted, the Standard View probably helps to explain
why many people find the moral asymmetry intuitively appealing. But since we reject the
Standard View and have defended this rejection at length elsewhere (Campbell and
6
We also wish to set aside the complications in the so-called “the non-identity problem” (Parfit
1984, ch. 16). To that end, we will focus on cases where disability or non-disability is caused
in the same individual, rather than cases in reproductive medicine that involve causing
disability or non-disability by opting to create one future person rather than another.
4
Stramondo 2017), we will not consider it as a justification for the moral asymmetry.
Likewise, we will not focus on the factors of unjustified interference and transition costs
because these considerations have been adequately addressed in Barnes’ work. Moreover,
since these factors don’t apply in every case of causing disability or non-disability, they
could not justify a general moral asymmetry between causing disability and non-disability.7
Instead, we will examine the following seven putative differences between causing
disability and causing non-disability that might be thought to ground a general moral
asymmetry.
• Likelihood of Lower Well-Being: Being disabled is more likely to render a
person worse off than being non-disabled.
• Risk of Very Low or Negative Well-Being: A basic minimum of capacities is
necessary to live a prudentially good life. Disability, unlike non-disability, entails
having at least one diminished capacity, and thus involves a higher risk that, at some
future time, one will fall below that basic minimum and have a life with very low
or negative well-being.
• Irreversibility: Disability is irreversible, whereas non-disability is reversible.
• Questionable Preference in the Individual: The desire to be non-disabled is
typical, whereas the desire to be disabled is atypical. This atypicality raises the
question of whether a person lacks decision-making competence, has corrupted
desires or false beliefs, or is not exercising good prudential judgment.
7
As it happens, the factor of unjustified interference doesn’t even represent a difference between
causing disability or non-disability. Causing non-disability in a person without their consent or
against their will is as much of an unjustified interference as causing disability in this way. So,
while Barnes is right to point out that unjustified interference helps to account for what’s
wrong with causing disability in certain cases, it is a non-starter as an explanation or
justification for a moral asymmetry. (To be clear, the aim of Barnes’ discussion is slightly
different than our own. She sought to explain the apparent badness of causing disability
whereas our focus is on the apparent moral asymmetry between causing disability and nondisability.)
5
• Questionable Motivation in Third Party: The desire or willingness to cause a
disability springs from indifference to a person’s well-being or even malicious
intent, whereas this cannot be said of a desire or willingness to cause non-disability.
• Vulnerability to Stigma and Discrimination: Disability has a much higher
chance of opening one up to discrimination or stigma than non-disability.
• Social Cost: Disability generates more social burdens and costs than nondisability.
To be clear, we are not endorsing any of these supposed facts. Our aim in the remainder
of this chapter is to analyze whether these claims are true and, if so, whether they thereby
justify a general moral asymmetry that is independent of the Standard View.
3. Evaluating the Putative Factors
It is quite possible that some or all of the preceding factors help to explain why many
people have asymmetrical intuitions about causing non-disability vs. causing disability. But
this empirical question about people’s psychology will not be our focus here. Instead, our
interest is in assessing whether these considerations are, in fact, compelling reasons for
permitting the causing of non-disability and being leery of causing disability. In this section,
we will assess each consideration with an eye to whether it identifies a genuine general
difference between causing disability and causing non-disability and, if so, whether that
difference represents a moral difference that can justify the asymmetry under
consideration.
Likelihood of Lower Well-Being
According to the Standard View, being disabled always or almost always negatively impacts
one’s well-being. Even if this generalization is false, it might be argued that a different
generalization about disability’s impact on well-being gives us reason to accept a moral
asymmetry between causing disability and causing non-disability: namely, that disability is
likely to be worse for a person than non-disability. In other words, having a disability is
6
likely to make a person worse off than she would be without that disability.8 We will
consider two distinct routes by which this claim of likelihood might be defended.
The first route appeals to population-wide trends. It might be claimed that, on
average, disabled people are worse off than non-disabled people and, as a result, causing
disability is likely to render someone worse off than causing non-disability.9 We grant that
this claim about likelihood is probably true, but it is noteworthy that the average well-being
of disabled people as a group is brought down by three factors. First, many disabilities are
acquired and involve transition costs. As Elizabeth Barnes observes, “even if being
disabled is not a harm, becoming disabled is still a difficult and painful process” and this
is because when a person becomes disabled, “his lifestyle and perhaps even his selfconception will be radically, drastically interrupted. He will have to reshape his life around
his new disability” (Barnes 2014, 96). To make an analogy, many people dislike moving,
even if they know they will be equally happy in their new home once they settle in. This is
due to the transition costs of moving. Relatedly, some “progressive” conditions involve
something like transition costs since the nature and effects of the disability shift over time.
Multiple sclerosis, for example, often involves the sudden appearance of new or relapsing
symptoms that dissipate after a short period of time, only to return again after a remission.
Of course, moving from disabled to non-disabled also involves transition costs, but
presumably transition costs will tend to be greater when moving in the other direction—
in large part due to society’s favorable orientation towards the non-disabled. Second, there
are some kinds of disabilities that, arguably, greatly diminish a person’s well-being in a wide
range of contexts.10 Such disabilities are not offset by the existence of extremely beneficial
disabilities that greatly enhance well-being in most contexts. Finally, as disability studies
scholars and disability activists readily point out, inaccessible and otherwise hostile social
8
In Campbell and Stramondo 2017, we refer to this as a “probabilistic variant of the Standard
View.”
9
The empirical literature on this matter is helpfully examined in Amundson 2010 and Barker
and Wilson 2018.
10
While we hesitate to make claims about the value of particular disabilities, we expect that
clinical depression is one example of a harmful disability that lowers the average well-being of
disabled people.
7
institutions and practices diminish the well-being of many disabled people in very
significant ways. Given these three factors, it should not be surprising if, on average,
disabled people are worse off than non-disabled people.
Yet, even if it is true that the average disabled person is worse off than the average
non-disabled person, facts about population-wide patterns should not guide our behavior
when making particular decisions about causing disability or non-disability. Unlike the
statistician who drowned while trying to wade across a river with an average depth of four
feet, we should appreciate that what is true on average may not hold in specific instances.
What is true of the average disabled person does not necessarily hold for any particular
disabled person. Decisions about causing disability or non-disability in specific instances
should be judged on a much narrower, if not a case-by-case, basis. Factors like transition
costs, particular disabilities that are typically very bad for a person, and hostile social
environments should only influence our decisions in those cases where they are present.
There are many instances in which causing disability is not likely to diminish a particular
person’s well-being partly because these factors are not present or are outweighed by other
considerations. For a very striking example, take the character Thomas from the television
show Downton Abbey who, finding himself amidst the horrors of trench warfare, raises his
hand into the line of fire to amputate it in order to be sent home. Contrary to what may
be true on average for disabled people as a group, for this particular person becoming
disabled likely increased his well-being. A less extreme, real-world example of a disabled
person who, arguably, can trace much of her well-being to her disability is Temple
Grandin. In her 2008 memoir Thinking In Pictures, Grandin describes how her enormous
success as an animal scientist who designs livestock-handling facilities is not in spite of her
autism but because of it.
The above examples illustrate why we need a fine-grained, context-dependent
evaluation of the impact that causing disability or non-disability is likely to have on the
well-being of a particular person in their particular context. We cannot justify a general
moral asymmetry between causing disability and non-disability based on the notion that,
on average, disabled people are more likely to be worse off. Judgments about particular
cases should be based, as far as possible, on an assessment of the specific context.
8
Let us now consider a second route for defending the claim that having a disability
is likely to make a person worse off than she would be without the disability. According
to this line of thought, having a disability typically means there is something significant
that you cannot do. For instance, a blind person cannot enjoy watching a fireworks show
and a dwarf cannot play as a center in the NBA. Hence, having a disability cuts one off
from certain valuable things in life. It limits one’s opportunities to secure a wider range of
the goods of life, whereas non-disability allows for more opportunities.11 This restricted
opportunity to access the goods of life is likely to be bad for a person. So, the reasoning
runs as follows:
1. Having a disability limits one’s opportunity to access the goods of life (in a way
that lacking that disability does not).
2. Something that limits one’s opportunity to access the goods of life is likely to
make them worse off than they otherwise would be.
3. Therefore, having a disability is likely to make a person worse off than they
otherwise would be.
We think both premises in this line of reasoning are problematic.
The first premise states that disability restricts one’s opportunity to access the
goods of life. This claim is open to challenge on a few fronts. To begin, the features of a
life that are most plausibly and widely regarded as “goods of life” (that is, things that tend
to contribute to well-being) have a very general character. One often hears mention of
such things as happiness, achievement, rewarding relationships, virtue, meaning,
knowledge, aesthetic appreciation, and freedom. It is true, of course, that disabilities often
render specific ways of realizing these goods inaccessible to a person, but these goods are
multiply realizable. A blind person who cannot appreciate beauty through vision can do so
through other senses. A person with quadriplegia cannot run marathons but might instead
make achievements as a philosopher, poet, writer, or physicist. While specific avenues for
securing the goods of life may be closed off as a result of disability, there are typically many
11
Discussions of a child’s “open future” are relevant here. See Feinberg 1980; Buchanan et al.
2000, 170-172; and Davis 1997, 2001.
9
other avenues available. Even in those cases where a given disability (or a social
environment that is unwelcoming to that type of disability) cuts a person off entirely from
a specific type of good, one can arguably still have an incredibly rich life if one has
sufficient access to other types of goods.12
Furthermore, it is important to avoid an overly simplistic picture of the relationship
between disability and opportunity. It just isn’t the case that a decrease in the level of a
particular function correspondingly decreases one’s opportunities. Take, for example,
someone who has extremely sensitive hearing such that they perceive much more of the
auditory world around them than typical hearers. This could be a serious disadvantage to
those aspiring to any number of careers that require intense concentration, such as
computer programming, neurosurgery, or philosophy. There is some testimonial evidence
from deaf individuals that an inability to hear is advantageous for some of these tasks and
has opened up more opportunity for them in that context (Burke 2014). In addition,
disabilities can open up opportunities in other ways. Disability narratives commonly attest
to the beneficial ways in which having a disability can broaden one’s perspective on life,
generate a new sense of identity, and open up new social relationships. For all of these
reasons, it is dubious that, as a general matter, having a disability restricts a person’s
opportunity to access to the goods of life. Causing disability will sometimes increase
opportunity, just as causing non-disability will sometimes decrease it.
The second premise in the above reasoning asserts that one is likely to be made
worse off by something that limits their access to the goods of life. There are three ways
in which greater opportunity to access the goods of life might be thought to benefit a
person: (1) it is likely to result in the person actually securing more goods and, as a result,
having higher well-being; (2) it is likely to lead to a greater diversity of goods, which might
be thought to be good for us; (3) the very opportunity to secure those goods of life might
itself be good for us.
We are skeptical of all three claims. Regarding (1), more opportunity to access the
goods of life does not necessarily result in a likelihood of higher well-being. Most of us
have access to many more opportunities than we have the time, energy, or inclination to
12
Campbell & Stramondo 2017, 157-158. See also Campbell, Nyholm, and Walter 2019.
10
pursue. Consider various ways that one might bring aesthetic appreciation into one’s life:
listening to music, composing music, playing music, singing, painting, viewing others’
paintings, sculpting, engaging with others’ sculptures, photographing things, appreciating
the photographs of others, designing buildings, appreciating architecture, appreciating
natural beauty, dancing, attending others’ dance performances, and so on. Most of us are
only able to engage in a few of these activities, so it often makes little practical difference
when some of them are made inaccessible to us (Asch and Wasserman 2010, 208). When
there is a surplus of opportunities to achieve well-being, a diminishment of one’s
opportunity need not result in a likelihood of lower well-being.
This has a bearing on (2). Since more opportunity to access the goods of life does
not always increase the odds that one will achieve more goods (of any type), more
opportunity need not raise the odds that one will achieve a greater diversity of the goods
of life. As noted above, a disability may not cut a person off from any of the widely
recognized goods of life, even if it places some limits on the ways in which a person can
access them. So there is no reason to associate disability in general with less diversity of
goods. One might try to insist that diversity in particular forms of a good has value in itself,
but we find this implausible. If a person derives much pleasure and meaning from, say,
playing piano, she would not seem to be any worse off than a person who derives the same
overall amount of pleasure and meaning from playing piano and chess. Thus, reflecting on
the multiple realizability of the goods of life and the fact that most of us have more
opportunity to access these goods than we are able to actualize suggests that we should
not associate fewer opportunities to access the goods of life with less diversity in the goods
one possesses.
Finally, we reject (3), the suggestion that opportunity itself is good for us. For this
to be true, even unactualized opportunities would need to be of value. But this seems
implausible. Consider a professor who prefers to bring her lunch to the office every day
rather than buy lunch at one of the many eateries near her campus. If half of those
restaurants shutter their doors next semester, is she made worse off merely because she
11
no longer has the opportunity to eat lunch at these venues? We think not. It is the
actualization of opportunity that is of benefit to a person, not the bare opportunity itself.13
In summary, we have argued that limitations on one’s opportunity to pursue the
goods of life is not always a bad thing and that disability’s impact on such opportunity is
not so simple. So, the assertion that disability is more likely to be worse for a person than
non-disability cannot be defended by insisting that disabilities reduce opportunities to seek
prudential goods.
Risk of Very Low or Negative Well-Being
A related but distinct way of trying to justify the alleged moral asymmetry between causing
disability and causing non-disability appeals to the fact that having a disability raises a
person’s risk of having a prudentially impoverished life. One might defend this claim by
appeal to the somewhat plausible suggestion that it would be difficult or impossible to
secure the goods of life without a certain basic minimum of capacities. For instance,
imagine a baby with congenital rubella that is born blind, deaf, and with a severe brain
injury.14 Lacking these sensory and cognitive capacities, it seems very unlikely that such an
individual would lead a flourishing life given the barriers that would separate her from
other people, society, and human culture. One could reasonably predict that this condition
of multiple disabilities would lead to low or even negative well-being. The worry is that
having a disability, which typically involves the loss or diminishment of some capacity,
carries a higher risk that at some future time one will fall below that basic minimum. So,
even if a disabled person is actually living a full and happy life at a given time, they are still
13
Three qualifications about this point. First, a person’s perception of having limited opportunity
might be bothersome to her—but presumably the source of disvalue would be those negative
mental states and not opportunity per se. Second, the fact that opportunity is not intrinsically
good for a person does not mean that a person cannot be wronged when they are purposefully
barred from opportunities by others (cf. Wasserman 1998, 198). Third, we grant that
autonomy may have intrinsic prudential value and that some options may be needed in order
to enable meaningful autonomous choices. However, it by no means follows that any
restriction of options is bad for us.
14
This example is drawn from Savulescu and Kahane 2009.
12
at a higher risk than a non-disabled person of being in a state of disability that would ensure
low or negative well-being.
To illustrate this way of thinking about disability and well-being, imagine that an
anvil is suspended above one’s head by a number of cords. A certain number of cords is
needed to keep it from falling, but there are currently more than enough cords in place. If
someone severs a single cord, the anvil will not drop, but it won’t be held in place as
securely and the risk of it falling is increased. If instead one refastens a severed cord or
introduces a new cord, the anvil will have greater stability. Intuitively, there is some moral
reason to avoid severing a cord, whereas there is no such reason to avoid adding a cord. If
anything, adding a cord might be morally good. In this analogy, the cords are one’s
capacities, and the dropping of the anvil represents a person’s descent into a prudentially
impoverished life due to a lack of capacities. Severing a cord represents causing a disability,
and refastening or adding a cord represents causing non-disability. Drawing upon this
analogy, it might be thought that it is morally better to cause non-disability (refasten or
add a cord) than to cause disability (sever a cord). Causing non-disability decreases the risk
of the person having a prudentially bad life due to lacking a basic minimum of capacities
(the anvil dropping), whereas causing disability increases that risk. Even if a person’s wellbeing can remain high with a disability, they have less “insurance” against a prudentially
impoverished life than one who is not disabled and has a full complement of capacities.
However, this analogy is flawed in various ways. One shortcoming is that it
presumes that causing disability always entails the loss of capacities. The distinction that is
sometimes drawn between mode of function and level of function is informative here. The
level of function refers to the efficacy or efficiency with which a function achieves a goal;
the mode of function refers to how the goal is accomplished (Silvers 1998a, 101). So, one’s
level of function may be the speed at which one can mobilize down a sidewalk, whereas
the mode concerns whether one does this using organic legs, a wheelchair, a unicycle, etc.
As others have argued at length elsewhere, becoming disabled doesn’t always occasion a
loss of function but may only involve a change in one’s mode of function (Silvers 1998a, 2002).
A change in one’s mode of function does not at all equate to a loss of capacity because the
level of function may remain intact or even increase. For example, Hugh Herr was a rockclimbing child prodigy who had both of his legs amputated after an accident at the age of
13
17. Herr reports that, with less body mass and with prosthetics that he designed and built
specifically for climbing, “I began ascending rock faces that I actually could not have
ascended before the accident with biological legs.”15 In fact, sometimes gaining a disability
means gaining an additional capacity. It is far too simplistic to treat causing disability as
merely removing a capacity. The relationship between disability and capacity is more
complicated.
There are at least two other important flaws in the anvil analogy. First, it does not
obviously acknowledge the role that the social environment and a person’s temperament
play in determining disability’s impact on well-being. On the face of it, the anvil analogy
seems to embody a simple medical model in which the loss of capacities entails certain
impacts on well-being irrespective of the social environment and features of the
individual’s psychology. One powerful challenge to this understanding can be found in
cases where people with locked-in syndrome, who have lost most of their physical
capacities, still manage to flourish in certain ways—largely thanks to their temperament
and mindset and a supportive social environment.16 Another shortcoming of the anvil
analogy is that it treats all capacities alike, as so many cords supporting an anvil. But some
capacities bear a trivial relationship to well-being and others may play a pivotal role—
though, again, this is likely to depend on contextual factors.
All that said, we grant that sometimes causing a disability of a certain kind in a
certain type of individual in a certain social context will increase the risk of that person
ending up in a condition of multiple disabilities that would lead to low or negative wellbeing. Even so, it is questionable whether this fact can justify the moral asymmetry under
consideration. After all, we make many choices for ourselves and our dependents that are
not themselves harmful but do raise the risk of future harm or even death, and we often
15

16
See, for instance, Bauby 1998 and Tavalaro and Tayson 1998. We are certainly not suggesting
that most people with locked-in syndrome do or could flourish. The point is only to emphasize
that environment and individual temperament are extremely important. A highly restrictive
disability can be compatible with flourishing under the right conditions, and a minimally
restrictive disability can be devastating with the wrong environment or attitudes.
14
choose these things over less risky options. For example, taking an infant on an
international trip to introduce her to extended family will sometimes expose the child to a
myriad of risks, including serious health risks. Yet, many people would not find these risks,
by themselves, compelling. An action that carries some risk of a very bad result can be the
action that is likely to yield the greatest benefit, and people are frequently willing to take
on such risks in the pursuit of higher expected benefit. Granted, there is probably some
threshold of risk of ending up in a state of very low or negative well-being that it would
be morally problematic to cross. At some point, the likelihood of such diminished wellbeing is too great to justify any benefits that could be gained. However, we ought to be
consistent with how we react to such risks and, in cases where causing disability doesn’t
incur a degree of risk that crosses this threshold, we ought to treat it as we would
comparable risks that are routinely taken in other domains of life. Thus, the idea that
disability increases one’s risk of being in a state of very low or negative well-being is an
unpromising candidate for justifying a general moral asymmetry.
Irreversibility
Another putative factor that might explain a moral asymmetry is that causing disability is
irreversible, whereas causing non-disability is reversible. Colloquially, when something—
like a ship—is said to be “disabled,” this means that it has been damaged and is inoperable.
We tend to think that something that is undamaged (whether repaired or never damaged
in the first place) could always be damaged in the future, but moving from a damaged to
an undamaged state is not always so easy. In the case of fragile human bodies, repair is
sometimes impossible. Thus, it is tempting to think that disability is irreversible in a way
that non-disability is not.
However, it is overly simplistic to associate disability with irreversibility. Drawing
again on the mode/level distinction, acquiring a given disability can mean that one
irreversibly loses the capacity to achieve some function via a particular mode. But the
outcome of the function is usually what matters most, and one’s capacity to achieve a
valued outcome may be preserved or even enhanced, even if one is unable to achieve it by
a particular mode. So, it may be that concerns about the irreversibility of causing disability
15
are actually about the irreversibility of removing one particular mode of function for
achieving a valued goal. It is not clear that this kind of loss is always or even usually morally
significant.
Furthermore, it’s a mistake to associate non-disability with reversibility. Practically
speaking, one typically can’t find medical professionals who will “disable” them. Often it’s
just the opposite. Lasix surgery is commonplace now, but one will have enormous
challenges finding someone who will surgically weaken their eyesight or blind them in
some fashion.17 In addition to deeply entrenched individual attitudes and professional
codes of medical professionals that would make it difficult to find someone willing to
cause disability, there are longstanding legal traditions and institutions that discourage or
outright forbid causing disability but don’t do the same for causing non-disability. Insofar
as decisions to cause non-disability can also be, for all practical purposes, irreversible, this
apparent difference in reversibility does not apply.
Even if we could distinguish causing disability and causing non-disability in terms
of ir/reversibility, it is doubtful that this would ground a moral asymmetry between the
two. We are not generally opposed to people making irreversible choices. In fact, it is
common practice to celebrate certain choices that we believe, or at least hope, are
permanent such as having a child, getting married, or graduating with a college degree.
Perhaps there’s a greater moral imperative to deliberate seriously about life-altering choices
that are difficult or impossible to reverse, but it’s not clear that there’s any moral reason to
actually avoid making an irreversible decision. Irreversibility, on its own, seems to have
very little moral significance.
Irreversibility can become a morally salient feature of a choice when it is combined
with an additional normative feature: the probable goodness or badness of the choice itself.
Insofar as performing some action is deemed to be good or bad to begin with, it might be
seen as even better or worse if it is irreversible. To illustrate this point, imagine a young
person with socially conservative parents who warn him against getting a tattoo because
17

16
of its permanence, while at the same time encouraging him to make a lifelong commitment
of marriage to the girl next door. This seemingly inconsistent response to the feature of
irreversibility is easily explained by the parents’ drastically different judgments about the
value of tattoos and marriages. For these conservative parents, and for everyone else,
permanence is a bad thing when the choice will or might be a bad one, but a good feature
of the choice when the choice itself is good. Thus, the irreversibility of causing disability
is only a bad feature of a choice in those cases where disability is likely to make a person
worse off. In sum, we think that the irreversibility justification for the moral asymmetry
falls apart.
Questionable Preference in the Individual
One might argue that the justification for a moral asymmetry derives from the fact that
the motivations of individuals who desire to be disabled are questionable or problematic
in some way. This argument hinges on the perception that the desire to be or become
disabled is highly atypical, whereas the desire to be or become non-disabled is
commonplace. Just as it is atypical for a person to want to die, it is atypical for people to
want to be or become disabled. This atypicality raises a question of whether a person lacks
decision-making competence, or has corrupted desires (perhaps as a result of illness), or
has false beliefs, or is simply not exercising good prudential judgment. These would be
reasons for proxies or third parties to exercise restraint in causing disability.
While the mere atypicality of certain desires is no reason, by itself, to dismiss them,
we grant that the atypicality of a desire might sometimes signal a lack of competence. If
so, this incompetence would need to be established on grounds that are independent of
the bare fact that the person desires to be disabled. In such cases, people may not be
competent to choose to cause disability in themselves, but they would not be competent
to choose non-disability either.
That said, it is unclear that this applies generally to the desire to be disabled. While
the desire to become disabled may be quite rare, many disabled people do desire to remain
disabled. That desire is not so atypical. While the desire to be disabled may still seem
somewhat foreign to non-disabled people, if we were to regard this desire as a reason to
17
presume the holder of that desire is an incompetent chooser, we would need to radically
rework the entire informed consent process. After all, a desire to remain disabled, for one
reason or another, motivates many refusals of treatment that informed consent requires
that we respect.
Nevertheless, some do call into question the rationality of disabled people who
desire to be disabled. Specifically, they maintain that if a disabled person prefers to be
disabled, it is because they have adapted their preferences to a narrowly constrained set of
choices and would not have this preference if non-disability had been an option. Like the
fox who tells itself that the grapes it cannot reach are sour, the disabled person who prefers
disability over non-disability is thought to be merely settling for the lesser option because
it is the only one available.
It seems clear that the temptation to see the desire to be disabled as adaptive or as
signaling incompetence is rooted in the conviction that having a disability is bad for a
person. This seems true whether the idea of an adaptive preference is understood in
normative terms (e.g. a preference to be in a bad or suboptimal condition) or is given a
purely procedural interpretation (e.g. a preference that one would not possess under
conditions of full information and rationality). Thus, the assumption that a desire to be
disabled is adaptive or indicates incompetence depends on something like the problematic
Standard View.18
Once we abandon the faulty view that disability is almost always bad for a person,
there is no reason to automatically assume that an individual’s desire to have a disability is
questionable. This consideration cannot justify a general moral asymmetry between
causing disability and causing non-disability.
Questionable Motivation in Third Party
A related but distinct argument focuses on the motivations of any third party who either
acts as proxy when deciding whether to cause disability or non-disability in another or
18
Granted, there is a sizable literature on adaptive preferences, and therefore much more to
be said on the topic. For helpful discussions of adaptive preferences and disability, see
Amundson 2005, Goering 2008, Barnes 2016, ch. 4, and Begon 2019.
18
assists another who has expressed a desire to cause disability or non-disability in
themselves. This attempted justification of a moral asymmetry rests on the fact that the
desire or willingness to take away or lessen another person’s capacities in ways that would
be regarded as disabling is more commonly associated with malicious intent than
beneficence.
Whether and how the agent’s psychology bears on the ethical status of an action is
a complex and controversial issue in ethical theory. For present purposes, we will simply
grant that if malicious motives can give one reason not to perform an action, this would
clearly apply to cases where someone aims to cause disability (or non-disability) with
malicious intent. That said, once we dismiss the view that disability is generally bad for a
person, there is less reason to assume that a proxy decision-maker’s motivations for
causing disability are suspect. If it is not inevitably irrational for someone to desire disability
for themselves, why would it be so to desire it for someone else? A proxy who chooses
disability for another need not be acting maliciously, but very well may be implementing
the wishes of a formerly competent chooser or making a choice for a non-competent
individual that shares significant contextual features with choices made by competent
individuals who reasonably choose disability for themselves.
Likewise, there is little reason to be suspicious of the motivations of a third party
who is not a proxy decision maker but has been asked by an individual for assistance to
cause disability in themselves. The decision about whether or not to assist someone in
causing disability or non-disability can rest squarely on whether that individual is a
competent chooser who is not under duress of some sort. Implementing the wishes of an
incompetent chooser (in the direction of either causing disability or causing non-disability)
ought to be what is regarded with suspicion. Whenever a third party assists a chooser who
is competent and free from coercion, it seems far more natural to suspect that this third
party is committed to the autonomy of the chooser and a rejection of paternalism.
Vulnerability to Stigma and Discrimination
One might reject the view that disability generally decreases a person’s well-being while
still holding that the stigma and discrimination experienced by disabled people is an
19
objectionable injustice. Perhaps a moral asymmetry is justified by the fact that causing
disability has a much higher chance of opening a person up to harmful discrimination than
causing non-disability would.19
The first point to make is that the relationship between disability and
discrimination is a contingent one. The amount of stigma and discrimination surrounding
disability can vary dramatically depending on such factors as the social context, the type of
disability, the social status of the disabled individual, etc. Take the case of Magdiel Sanchez,
who was shot and killed by police because he did not obey their commands to stop moving
toward them while carrying a weapon. Sanchez was deaf and did not hear the commands
being given and, according to witnesses in his low-income neighborhood, often carried
some kind of stick to fend off the many stray dogs in the area (Miller 2017).20 Arguably, it
was Sanchez’s race and socio-economic class in combination with his disability that
exposed him to this sort of police violence. Yet, in other kinds of circumstances, having a
certain type of disability will not increase, and could even lessen, the discrimination that a
person faces. For example, in spaces where the social norms and expectations are set by
disabled people, it is non-disabled people who may find themselves somewhat ostracized.
It is commonly reported by average height siblings that they are socially isolated when
accompanying a family member with dwarfism to a Little People of America meeting
conference. Since an increased vulnerability to discrimination and stigma is not a static or
essential feature of disability, this feature cannot ground a general moral asymmetry
between causing disability and causing non-disability.
That said, disability-based oppression is a real phenomenon that often impacts the
lives of disabled people and diminishes their well-being. In principle, we can imagine
counterfactual scenarios in which ableist oppression was global in scale, impervious to
change, and so harmful that it would justify a moral prohibition on causing disability that
19
This point is related to the “likelihood of lower well-being” factor discussed earlier.
However, it is a distinct factor provided that the moral relevance of being subjected to injustice
and wrongs is not exhausted by its impact on a person’s well-being.
20
Thank you to Teresa Blankmeyer Burke for highlighting this example of how ableism
intersects with racism and classism in her talk “Grasping Power: Deaf Ethics and Signed
Language Interpreting” given on October 17, 2017 at San Diego State University.
20
could be generalized to all or most cases. However, we suspect that, at least in a
constitutional democracy like the present United States, the situation is not so dire and we
ought to give moral priority to ending oppressive attitudes, practices, and institutional
structures instead of reducing the number of people who have identities that are subject
to this oppression. Our way of life gives us a good measure of control over the kinds and
degree of social oppression that exist in our society, unlike citizens who are purely subject
to the will of a dictator or a monarch. Thus, it would be deeply troubling to give so much
ground to the social oppression that currently exists by using it as a justification for why
more people with the oppressed identity ought not exist. Indeed, there seems to be
something perverse about using this line of reasoning to serve as a justification for the
moral asymmetry in a society in which there is the potential to change the widespread
ableist oppression that is causing the harm to disabled people.
Social Cost
Finally, it might be thought that a moral asymmetry between causing disability and causing
non-disability is grounded in the fact that disability has a higher social cost. It shouldn’t be
controversial to claim that disabled people require accommodations of various kinds in
order to fully participate in social life. So, perhaps it follows that insofar as having a
disability requires accommodations that will draw upon social resources that would not be
needed for a non-disabled person, causing disability tends to generate greater social cost
than causing non-disability.21 While this line of thinking may seem to have a place in public
policy debates rather than the ethics of individual action, presumably individuals have
some resonsibility to consider the collective impact of their private decisions on the
common good. Just as one might reasonably take rising global temperatures into account
when deciding whether to buy a full-sized SUV or a compact hybrid, one might consider
21
We are granting this assumption for the sake of argument. However, it is far from firmly
established that causing disability is more costly than causing non-disability. Much of the
health care industry can be understood as an apparatus for preventing disability or causing
non-disability, and it is widely accepted that the societal costs of health care in the United
States are escalating toward an unsustainable level.
21
social costs when deciding whether to cause disability or non-disability. In this way, social
costs could be an ethical consideration even at the level of an individual proxy or clinician.
However, we don’t believe that this consideration is ultimately compelling.
Arguments have been made that the standard of equality of opportunity held by a liberal
democracy like ours requires society to provide accommodations to disabled people as a
matter of justice (Silvers 1998b).22 The attempt to remedy inequality of opportunity for a
marginalized group will typically generate a significant social cost for those in the
advantaged social position. For example, ending chattel slavery in the American South
incurred a tremendous cost for plantation owners and other white people benefitting from
this brutally exploitative system. This is not at all to say that accommodating disabled
people is the moral equivalent of emancipating slaves. Yet, someone always benefits from
an unjust system and remedying the injustice typically harms those beneficiaries to some
degree, even if such harms are ultimately outweighed by other beneficial consequences.23
Thus, the bare fact that causing a disability that will later be accommodated might create
social costs does not seem sufficient to justify a general moral asymmetry.
Further, it is important not to hold causing disability to a higher moral standard
than we apply to other individual choices that result in serious social costs. People make
major life-choices all of the time that are likely to generate significant social costs. Yet,
society still leaves many of these choices up to the individual in the name of liberty. For
example, there is evidence that the choice of whether to have one or multiple children has
a much greater impact on the generation of greenhouse gasses than the kind of car one
drives or whether they use solar energy in their homes (Wynes and Nicholas 2017). These
and many other individual choices that generate social costs are typically regarded as falling
within a protected sphere of personal liberty. It would be unreasonable to hold the choice
of causing disability to a different moral standard than other choices that incur comparable
social costs but enjoy strong protection. It may be that the choice to have children is
22
Conversely, arguments have been made that there are limits to what non-disabled members
of society owe disabled people because there are morally significant social costs generated by
accommodations that must be recognized. See, for instance, Buchanan 1996.
23
These other beneficial consequences might include increasing virtue and decreasing vice,
greater social cohesion and cooperation, an increase in happiness, etc.
22
common, while the choice to cause disability is less common. However, an essential feature
of respecting personal liberty is that it protects uncommon choices to the same degree that
it supports prevalent ones.24
4. Conclusion
Our goal in this chapter has been to assess whether there is a general moral asymmetry
between causing disability and causing non-disability. To that end, we examined seven
factors that might explain and justify such an asymmetry. Our findings are somewhat
mixed. None of the factors can ground a general moral asymmetry between causing
disability and causing non-disability, but each of them points in the direction of morally
relevant considerations that generate at least some moral difference between causing
disability and causing non-disability in some particular cases. These include:
• the likelihood that causing disability in a particular instance will render the person
worse off than they would be otherwise
• a substantial risk that if a particular person becomes or remains disabled, they will
end up in a state that ensures very low or negative well-being
• irreversibility of the choice to cause disability in those cases where the disability is
likely to be bad for the person
• lack of decision-making competence in a person who wishes to become or remain
disabled
• questionable motives for causing disability in another person (provided that
motives are relevant to the ethical status of an action)
• a substantial risk that a person will experience harmful stigma and discrimination
• substantial social costs associated with the choice to cause disability
24
Some of these points are addressed in Wasserman 2017 and Williams 2017, which raise
further critical points about social cost arguments against causing or allowing disability.
23
We think that each of these factors has some moral significance, though it is worth
emphasizing that not all of these factors are present in all cases of causing disability.
Further, many of them apply to some instances of causing non-disability. It is important
not to hold disability to a double standard and give special weight to these factors in cases
of causing disability when they are given little or no weight in other domains of life.
So, we have identified several factors that speak against causing disability in
particular cases. This means that the falsity of the Standard View does not by any means
entail that there’s no moral difference between causing disability and causing nondisability. Often there is. At the same time, we join Barnes in rejecting the idea of a general
moral asymmetry between causing disability and non-disability. Our analysis implies that
we should avoid such crude generalizations about the ethics of causing disability and nondisability. Any intuitions we may have about an asymmetry, even if they apply in many
particular cases, do not generalize enough to justify a broad moral principle that favors
causing non-disability over causing disability. Such a principle would oversimplify the
complex reality and would inevitably ignore morally relevant differences between
particular cases. Whenever we encounter a choice about whether to cause disability or nondisability in another person, we should aim to base our decision, as far as possible, upon
the nuanced details of that particular case and its context in order to judge whether or not
it is a permissible or impermissible thing to do.
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27
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The Minority Body
A Theory of Disability
Elizabeth Barnes
1
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To Clay Barnes—Thanks for these wacky genes,
and for teaching me how to live with them
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Table of Contents
Preface
Introduction
1. Constructing Disability
ix
1
9
2. Bad-Difference and Mere-Difference
54
3. The Value-Neutral Model
78
4. Taking Their Word for It
119
5. Causing Disability
143
6. Disability Pride
168
Bibliography
Index
187
199
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Preface
This book is personal. Maybe it’s strange to admit that about a philosophy
book, when we so easily buy into the myth that philosophy is supposed to
be a purely rational endeavor unclouded by messy things like emotions.
But there’s no point in hiding it. I’m disabled, and this is a book about
disability. Of course it’s personal.
I used to think I couldn’t philosophize about disability precisely
because the topic is so personal. But on reflection, that’s absurd. Disability is a topic that’s personal for everyone. The last time I checked, most
non-disabled people are pretty personally invested in being nondisabled. The fact that this sort of personal investment is so easy to
ignore is one of the more pernicious aspects of philosophy’s obsession
with objective neutrality. It’s easy to confuse the view from normal with
the view from nowhere. And then it’s uniquely the minority voices which
we single out as biased or lacking objectivity. When it comes to disability,
I’m not objective. And neither are you. And that’s true whether you’re
disabled or (temporarily) non-disabled.
My introduction to disability as an area of academic study was as an
undergraduate, through the English department. It was there that
I encountered the cross-disciplinary conversation in the humanities
and parts of the social sciences that gets labeled disability studies. The
ideas I discovered there were, with no exaggeration, life-changing. My
disability (which is called Ehlers-Danlos syndrome, if you’re curious) is
complicated, and requires ongoing complex medical care. I see a lot of
doctors, I’ve had a lot of surgeries, I take a lot of medicine. And like
many people with complicated and rare conditions, I spent a lot of time
bouncing around from misdiagnosis to misdiagnosis. In short, my
experience of disability was extremely medicalized.
The ideas I encountered in disability studies were—or at least felt—
radical. It had never occurred to me that there might be a social dimension to the difficulties I was experiencing. That my disability might be
something more than my own sad, little tragedy was a revelation. It
wasn’t exactly that I became convinced by the books I read arguing for
disability pride and inclusion. It was more that reading these things made
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PREFACE
clear, for the first time, something I had always felt, but had never been
able to express—even to myself. That experience was transformative.
But as much as the work I found through the English department
moved me, I was already in love with analytic philosophy. So I enrolled
in an applied ethics class, eager to discover what insight philosophy
would offer into disability. I encountered two philosophical arguments,
as an undergraduate, that dealt specifically with disability—Peter Singer’s
argument for the permissibility of infanticide and Derek Parfit’s ‘handicapped child’ case. To say that I was disappointed would be a massive
understatement. ‘Heartbroken’ might be closer to the truth.
My disappointment with much of the philosophical engagement with
disability I encountered only strengthened in grad school. Of course
there were amazing exceptions—Eva Kittay, Anita Silvers—but most of
the philosophical work on disability that I managed to find seemed to
focus primarily on who can do what to which kinds of fetuses in which
very abstract circumstances. So I kept my head down, kept reading
non-philosophy disability studies on the side, and mostly focused on
metaphysics.
I decided that I could actually do philosophy about disability when
I read Sally Haslanger’s work on adoption. She openly acknowledges that
the topic is personal for her—that the moral significance of her own
family is at stake in the debate. And then she proceeds to give completely
clear and compelling arguments. Reading Sally’s work taught me several
crucial things. The first is that it’s possible to do excellent philosophy on
topics in which you’re personally invested. The second, and perhaps
more important, is that philosophy needs the voices of those who are
personally invested. The literature on adoption wouldn’t be complete
without the perspective of adoptive mothers. Likewise, there’s a reason
why much of the philosophical engagement with disability didn’t resonate with me. It’s dominated by non-disabled people. And philosophical
discussion of disability is always going to be incomplete if disabled
people are largely on the sidelines. A key slogan of the disability rights
movement is ‘Nothing about us without us.’ That includes philosophy. If
I didn’t like what I was reading—and I didn’t—I needed to get involved.
So here we are.
Portions of chapters 2 and 5 were previously published in Elizabeth
Barnes, ‘Valuing disability, causing disability’, Ethics 125 (1) (2014),
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xi
pp. 88–113; sections of chapter 4 were previously published in Elizabeth
Barnes, ‘Disability and adaptive preference’, Philosophical Perspectives
23 (1) (2009), pp. 1–22.
I have benefited, over the course of writing this book, from the help
and insight of more people than I am going to remember to acknowledge. Thanks for helpful comments and feedback to Kate Abramson,
Joel Anderson, Teresa Blankmeyer-Burke, Tim Button, Steve Campbell,
Ben Caplan, Ruth Chang, Shannon Dea, Tom Dougherty, Janice Dowell,
Daniel Elstein, Delia Graff Fara, Miranda Fricker, Brie Gertler, Elizabeth
Harman, Sally Haslanger, Jonathan Jacobs, Katharine Jenkins, Jeff King,
Eva Kittay, Meena Krishnamurthy, Gerald Lang, Rae Langton, Heather
Logue, Ofra Magidor, Kris McDaniel, Jeff McMahan, Trenton Merricks,
Sarah Moss, Daniel Nolan, Laurie Paul, John Protevi, Mike Rea, Jonathan
Schaffer, Miriam Schoenfield, Alex Skiles, Paulina Sliwa, David Sobel, Joe
Stramondo, Eric Swanson, Amie Thomasson, Kevin Timpe, Christina
Van Dyke, Pekka Vayrynen, David Wasserman, and audiences at Cambridge University, Durham University, Leeds University, MIT, Ohio State
University, Oxford University, Rutgers University, Syracuse University,
the University of Virginia, and the Arizona Ontology Conference. I’m
also very grateful to the amazing students I had the opportunity to
interact with at Leeds University and the University of Virginia, most
especially Dani Adams, Sarah Adams, Richard Caves, Jim Darcy, Matt
Duncan, Fran Fairbarn, Jade Fletcher, Derek Lam, Robb Muckle, Nick
Rimmel, Alex Roberts, Adam Tiller, and Carl Warom. I’m sure I learned
more from getting to teach each of them than they could possibly have
learned from getting taught by me. Thanks also to the Mind Association
for funding a semester of research leave in order for me to work on
this book.
I’m especially grateful to Jenny Saul. I would have been completely at
sea, in writing this book, without the help and insight of feminist
philosophy. And it was Jenny who (gently, patiently) encouraged me to
give feminist philosophy more than a passing glance. She also challenged
me, pushed me, and helped me—in the best ways—on so many sections
of this book. I can’t even begin to thank her for everything she’s done,
both for this book and for me as a person.
And then there are my dear friends, my best allies, my partners in
crime—Jason Turner and Robbie Williams. The best philosophers are
the ones who can have amazing, insightful things to say about pretty
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PREFACE
much anything, whether it’s their area or not. The best friends are the
ones who always make you feel accepted, encouraged, and valued. Jason
and Robbie are the best philosophers and the best friends. There’s no way
in hell I’d have had the guts to write this book without them.
And finally, thanks to my other half, my love, and my favorite thing
in the world—Ross Cameron. Ross has read and commented on multiple
drafts of everything in this book, and there isn’t an idea in here that
hasn’t benefited from discussion with him. He has been unfailingly
supportive, unfailingly generous, unfailingly obnoxiously smart. And
he has always loved me just the way I am.
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Introduction
There is a massive disconnect between the way disability is understood in
the disability rights and disability pride movements and the way disability is understood within analytic philosophy. The former see being
disabled as primarily a social phenomenon—a way of being a minority,
a way of facing social oppression, but not a way of being inherently or
intrinsically worse off. But while this view of disability has been widely
incorporated into academic disability studies, it remains at the margins
of analytic philosophy. The idea that disability is not inherently bad or
suboptimal is one that many philosophers treat with open skepticism,
and sometimes even with scorn.
The goal of this book is to articulate and defend a version of the view
of disability that is common in the disability rights movement. I will
argue that to be physically disabled is not to have a defective body, but
simply to have a minority body.
0.1 The Relationship Between Disability
and Bioethics
Philosophical work on disability is often assumed to be ‘applied ethics’ or
‘bioethics’. And this is unsurprising, given that many philosophers adopt
a medicalized view of disability, according to which disability is nothing
more than a kind of biological disorder. (I’ll discuss the inadequacy of
this conception of disability in chapter 1.) I don’t deny that there are
many interesting disability-centric issues which can usefully be described
as bioethics. But this book isn’t (or isn’t primarily) about them. The
issues I’m going to focus on are to my mind more foundational. They are
the kinds of things that need to be addressed before we can grapple with
the complicated questions of, for example, healthcare resource allocation
or who can select what type of fetus under what circumstance.
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INTRODUCTION
What is disability? What is its connection to well-being? What would
it mean—and what would it entail—to say that disability isn’t something
that’s inherently bad or suboptimal? These issues are, in my opinion,
crucial topics for any philosophical analysis of disability, and they
aren’t—again, in my opinion—topics that are well described as bioethics.
Or at least I don’t think they deserve the label ‘bioethics’ if we don’t also
describe Sally Haslanger’s work on gender, for example, as bioethics.
For lack of a better term, I think of these as issues in social philosophy,
and so I think of this book as a work of social philosophy. My own
discussion of these issues is heavily influenced by feminist philosophy.
Whether this book also therefore deserves to be called feminist philosophy is a taxonomical question that probably isn’t very interesting.
0.2 Varieties of Disability, and Why I’m
Not Talking About Some of Them
This book is about physical disability. There are, of course, other forms of
disability—including psychological and cognitive disability. But unfortunately I’m not going to talk about them.
The primary reason for this is simplicity. The task of saying what (if
anything) disability is, or what its connection to well-being is, gets
complicated enough given the heterogeneity of things we classify as
physical disability. Including cognitive and psychological disability in
the mix increases that complexity (and heterogeneity) exponentially. So
my tentative suggestion is that the way to approach theories of disability
is ‘ground-up’ rather than ‘top-down’. We first need to see whether
workable accounts can be had of physical disability, psychological disability, and cognitive disability, respectively—or whether, indeed, this
tripartite grouping is just mistaken. And then we need to ask whether
and to what extent these categories might be usefully unified. Perhaps,
for example, some things we think of as psychological disabilities have
more in common with physical disabilities than they do with other
psychological disabilities. Or perhaps the tripartite distinction is right
and we need separate, unrelated theories of physical, psychological, and
cognitive disability, respectively. Or perhaps there’s a single notion of
disability that covers physical, psychological, and cognitive forms of
disability. Or perhaps instead these categories are unified by analogy.
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INTRODUCTION

(To borrow an example from Kris McDaniel, exercise, broccoli, Stephen
Curry, and my marriage are all healthy—but arguably there’s no single
property that they all share in virtue of which they are healthy.1 ‘Healthy’
is a concept that’s unified by analogy. ‘Disability’ might be as well.)
I don’t have a settled view on any of these incredibly complex questions.
But I do think it’s worth talking about physical disabilities as a group,
while remaining agnostic about whether and to what extent what I want
to say about physical disability should be extended. I’m thus going to
proceed by focusing exclusively on physical disability and seeing what
progress I can make.
The other main reason for focusing on physical disability has to do
with the epistemology of testimony. Throughout the book, I’ll be appealing to—and relying on—the first-person testimony of disabled people,
and I’ll specifically argue (in chapter 4) that this testimony is reliable
(or, more carefully, that we don’t have special reason to think it’s
unreliable). But psychological and cognitive disabilities raise complicated
issues for the reliability of testimony that simply aren’t present in the case
of physical disability. So—again, mostly for simplicity—I’m going to
restrict my attention to physical disability as the easiest and most
straightforward test case. That’s not to say that the testimony-based
arguments I give here don’t work for other forms of disability. It’s just
to say that more work would need to be done to show whether they do,
and the book is already long enough as it is.
So in what follows, I focus on physical disability without taking a view
on what the connection is between physical disability and other forms
of disability. I think simplifying in this way is warranted, regardless of
the fact that we have a single word—‘disability’—that can refer to all the
different varieties of disability. That is, I don’t think we should infer that
there is a unified category—or a unified connection to well-being—
covering psychological, physical, and cognitive forms of disability simply
because our word ‘disability’ can refer to physical, cognitive, or psychological disability. Modifiers like ‘physically’, ‘mentally’, ‘psychologically’,
etc. can do a lot of work. Suppose we say of Anna that she is mentally
restrained, and of Ben that he is physically restrained. We are saying that
Anna is calm, collected, and focused, whereas we are saying that Ben is
1
McDaniel (2010).
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INTRODUCTION
tied up. These cases might be unified by analogy, but it doesn’t seem like
there’s obviously any particular feature or property that they have in
common. Nevertheless, we can say of each of Anna and Ben simply that
they are restrained, without explicitly specifying whether they are physically or mentally restrained. Context does a lot of work.
That’s not to deny that there is such a unified category. It’s just to say
that our use of the word ‘disability’ doesn’t by itself show or suggest that
there is. Again, I think the best way to approach the question of whether
and to what extent different types of disability form a common kind or
have a common connection to well-being is by first engaging in detailed
analysis of the different varieties of disability and then exploring the
potential commonalities (and differences). We should also be open to the
possibility that such commonalities might cut across the way we standardly divide disabilities. That is, we shouldn’t assume that either all
psychological or cognitive disabilities share a common feature with
physical disability or none of them do. Nor should we assume that a
particular psychological or cognitive disability will have more in common with other such disabilities than it will with physical disabilities.
Certainly the neurodiversity and autism acceptance movements (as well
as similar campaigns for Down syndrome) seem to have a lot in common
with the disability pride campaigns that have more traditionally been
associated with physical disability. It might be that autism simply has a
lot more in common—at least with respect to well-being—with physical
disability than it does with, say, schizophrenia.
Again, I don’t want to take a stand on these issues, nor do I want to
take a stand on whether the physical/cognitive/psychological classification of disabilities is a helpful one. I’m going to argue that we should
re-evaluate much of the way we think about the connection between
disability and well-being at least for what we think of as physical
disability. I’m neutral on whether these arguments extend to other
cases (that is, whether or not they apply at most to physical disability).
My sincere hope, in exploring these issues for physical disability, is that
similar projects for other forms of disability arise in tandem. That—
rather than an attempt at a global theory of anything and everything
that gets labeled ‘disability’—is, I think, the best way forward for
philosophical analysis of disability.
As Eva Kittay often says, disability needs to be a ‘big tent’, including a
lot of diverse perspectives and experiences. In focusing on physical
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INTRODUCTION

disability, it’s not my intention to exclude or marginalize other forms of
disability. I simply want to start small (or smaller), with the hope that
others can engage in similar projects in other areas, and then connections
can be explored.
In what follows I will, for the sake of simplicity, use the term ‘disability’
to refer to physical disability.
0.3 Terminology
Like many cases in which we’re discussing social kinds and marginalized
groups, word choice when it comes to talking about disability is a vexed
issue. I know of no terminology in the area that isn’t offensive or
upsetting to someone. So rather than trying to find terminology that is
universally acceptable, I’ve simply tried to settle on terminology that
is principled.
I use the term ‘ableism’ to mean social prejudice and stigma directed
against the disabled in virtue of the fact that they are disabled, just as
people use the term ‘racism’ to mean social prejudice and stigma directed
against those of a particular race in virtue of the fact that they are
members of that race. But this prejudice encompasses more than just
personal attitudes—it can include the way our society is structured and
organized. So, for example, a world free of ableism is not simply a world
where no individuals harbor prejudiced thoughts about the disabled,
it’s also a world that doesn’t contain massive accessibility barriers for
the disabled. (I’m sometimes tempted by the view that ableism—like
racism—is best understood as entirely structural, rather than a matter of
individual belief and attitude, but I won’t take a stand on that here.)
I use the word ‘disability’ to refer to particular bodily features or
conditions. I give an account of what I take these bodily features to be
in chapter 1. Because I think that ‘disability’ refers to the physical states
of bodies—to particular bodily features—my usage of ‘disability’ is closer
to what is often meant by ‘impairment’ in the literature on disability.
I explain in chapter 1 why I think a distinction between disability and
impairment isn’t necessary, and since ‘disability’ is the more familiar
term, that’s the one I’m using.
I use ‘disabled people’ to refer to people who have the sorts of bodily
features or conditions picked out by the term ‘disability’. I use ‘disabled
people’ rather than ‘people with disabilities’ because ‘disabled people’
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INTRODUCTION
mirrors our usage of other terms which pick out minority social
groups—for example, we say ‘gay people’ not ‘people with gayness’. It’s
sometimes suggested that we should say ‘people with disabilities’ because
‘disabled people’ suggests that disability somehow defines the person.
But I simply don’t think that’s true. Saying that someone is a disabled
person doesn’t mean that disability defines who they are any more than
saying that someone is a gay person means that sexuality defines who
they are.
I am using ‘disabled’ rather than a replacement term like ‘differentlyabled’. Words are hard to replace. I think it’s easier to shift meanings. It’s
probably a presupposition of the common usage of ‘disabled’ and ‘disability’ that being disabled is bad, and that disabilities are bad. But—as
‘reclaiming’ projects have taught us—presuppositions can be objected to,
and they can be changed.
It used to be a presupposition of the common usage of ‘queer’ that it
was bad to be queer. It isn’t any more. Likewise, the origin of its use as a
term for describing sexuality is bound up in a lot of anti-gay prejudice.
But its contemporary usage isn’t. I think we can do the same thing for
‘disabled’ (and, similarly, for terms like ‘crip’). Changing the received
presuppositions and implicatures—and getting away from the unfortunate roots of these words—is, I think, an easier task than getting people
to stop using words like ‘disabled’ and ‘disability’. So I’ll proceed with the
common-usage terms.
0.4 The Plan
I’m going to defend the idea that being disabled is not something that by
itself or intrinsically makes you worse off. Being disabled is, I’ll argue, a
way of being a minority with respect to one’s body, just as being gay is
a way of being a minority with respect to sexuality. It is something that
makes you different from the majority, but that difference isn’t by itself
a bad thing. To be disabled is to have a minority body, but not to have a
broken or defective body.
So that’s the destination. Here’s the roadmap.
Chapter 1: Constructing Disability—The things we group as ‘disabilities’ are strikingly heterogeneous. The first task of any philosophical
theory of disability is thus to argue that there is something unifying these
disparate cases to which philosophical analysis can be usefully applied.
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
Many accounts of disability attempt to explain what unifies individual
disabilities via reference to specific features of disabled bodies, but I argue
that such accounts fail. There is no objective feature(s) of disabled bodies
such that all and only bodies with that feature(s) count as disabled.
Instead, I argue that disability is socially constructed. On my view, we
should care about disability—and care about philosophical analysis of
disability—primarily because disability is a way that people have grouped
themselves when organizing a civil rights struggle. This basic idea yields
a social constructionist account that is importantly different from the
more familiar social model of disability, as well as from other familiar
social constructionist projects in philosophy, such as Sally Haslanger’s
account of race and gender.
Chapter 2: Bad-Difference and Mere-Difference—In this chapter, I
elaborate on the distinction between what I call the ‘mere-difference’
conceptions of disability and the more familiar ‘bad-difference’ conceptions of disability (which maintain that disability is something inherently
bad for you). The distinction is a complex one, because the key issue is
the relationship between disability and well-being. There are various
theories of well-being, and no single way of characterizing the baddifference/mere-difference distinction cuts across them all. Instead
of offering a single distinction, I offer multiple ways of characterizing
bad-difference and mere-difference views of disability. These characterizations are independent of one another—they each offer sufficient but
non-necessary conditions for maintaining bad- and mere-difference
views. I argue that these various characterizations combine to form a
composite picture of the family of views I am labeling ‘mere-difference’
and ‘bad-difference’. I then further argue that no version of the ‘baddifference’ view should be considered obvious or common sense.
Chapter 3: The Value-Neutral Model—Here I articulate and defend a
particular way of holding a mere-difference view of disability, which
I call the ‘Value-Neutral Model’ of disability. The goal of this account is
to give a model of disability according to which disability is meredifference, and yet may still be viewed as (in a restricted sense) a harm.
Based on this model, I argue that one needn’t say that all the harms
associated with being disabled are socially mediated or caused by social
injustice (that is, one needn’t deny that disability might involve harms
even in an ideal, ableism-free society) in order to maintain a meredifference view of disability. Likewise, I argue that it’s consistent to
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INTRODUCTION
think both that disability is not in general something bad and that
disability is bad for some people or in some circumstances.
Chapter 4: Taking Their Word for It—The arguments in chapters 2
and 3 rely heavily on the first-person testimony of disabled people who
claim to value being disabled. This chapter focuses on the epistemological issues surrounding such testimony. It’s sometimes suggested
that this sort of testimony is unreliable because it is based on adaptive
preference. Drawing on the influential work of Miranda Fricker, I argue
that this dismissal of disabled people’s testimony is unwarranted, and
that discounting the testimony of disabled people in this way is a type of
testimonial injustice.
Chapter 5: Causing Disability—This chapter examines two major,
interrelated objections to any mere-difference view: that it makes it
permissible to cause disability, and that it makes it impermissible to
remove disability. I attempt to unpack both these objections. I argue
that in neither case does the mere-difference view generate a universal
response. That is, it doesn’t tell you whether, regardless of the circumstances, it is always permissible to cause disability or impermissible to
remove it. I further argue that neither the case of causing nor the case of
removing provide effective objections to the mere-difference view.
Chapter 6: Disability Pride—In conclusion, I defend the epistemological importance of disability pride. Disabled people—in addition to
being subject to testimonial injustice—are subject to the other form of
epistemic injustice Miranda Fricker identifies: hermeneutical injustice.
Parts of their own experience are obscured or made difficult to articulate
because of dominant stereotypes and assumptions about disability. Disability pride is, I argue, essential to combating this.
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1
Constructing Disability
Sometimes we who are activists and thinkers forget about our
bodies, ignore our bodies, or reframe our bodies to fit our theories
and political strategies. For several decades now, activists in a
variety of social change movements, ranging from black civil rights
to women’s liberation, from disability rights to queer liberation,
have said repeatedly that the problems faced by any marginalized
group of people lie, not in their bodies, but in the oppression they
face. But in defining the external, collective, material nature of
social injustice as separate from the body, we have sometimes
ended up sidelining the profound relationships that connect our
bodies with who we are and how we experience oppression.
Eli Clare (2001)
1.1 The Problem
The things we group together under the label ‘disability’ are strikingly
heterogeneous. Spinal chord injuries are very different from deafness.
Deafness is very different from MS. MS is very different from achondroplasia. And so on. The goal of this book is to explore the connection
between disability and well-being. I’m going to pursue the idea that
disability, like other minority features, is (by itself ) neutral with respect
to well-being. But the first hurdle that greets any such project is simply
this: Does it make any sense to ask philosophical questions about
disability per se, rather than about individual disabilities? Is there anything unifying the disparate cases of individual disabilities, such that it’s
worth talking about disability as a kind?
Certainly, philosophers often do talk about disability as a kind. We ask
under what conditions, if any, it’s permissible to knowingly bring a
disabled child into existence. We ask what duties societies have toward
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CONSTRUCTING DISABILITY
disabled people. We ask whether disabled people pose a problem for
certain theories of justice. And so on. But the question is whether this
practice is in good standing. To say that it is, we need to be able to say
that there’s something unifying the heterogeneous group of things we
label ‘disabilities’, such that it makes sense to engage in philosophical
questions about disability in general, rather than about individual
disabilities.
In what follows, I focus specifically on the question of what—if
anything—unifies particular instances of physical disability (see the
discussion in section 2 of the introduction). I take no stand on whether
what I say here will generalize to other forms of disability, such as
cognitive disability or psychological disability.
1.2 Criteria for Success
I want to figure out what disability is. This is a project in social
metaphysics—I’m not investigating what our word ‘disability’ means,
nor trying to give a theory of our folk concept of disability. I’m asking
what it is for something to be a disability. But I first need to briefly set out
what I take to be the major criteria of success for any such account of
disability. None of these criteria are uncontroversial. But (as I’ll explain)
I take them to be desiderata of an account of disability that does the work
I want an account of disability to do.
(i) Delivers correct verdicts for paradigm cases
A successful account of disability needs to say that paradigm cases of
disability are in fact disabilities (and that paradigm cases of nondisability are not). I would hazard a guess that most of us didn’t begin
an interest in disability by interest in the abstract concept. We begin with
an interest by ostension. We want to know what these kinds of things—
deafness, blindness, paralysis, achondroplasia, MS, etc.—are, such that
they have something in common wit…
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