Abstract:This essay criticizes recent trends in disability policy as restrictive of individual liberty and informed by too narrow a definition of what constitutes human flourishing. I defend the value of intentional community settings as one legitimate residential option for people with intellectual and developmental disabilities. Recent federal regulations (HCBS Final Rule) define intentional communities or disability-specific housing as presumptively institutional in nature, misunderstanding the positive, noninstitutional features of intentional, integrated communities created by and for people with developmental disabilities. (...) In addition, current disability policy, despite its stated concern for the autonomy of people with intellectual and developmental disabilities, limits individual liberty by strictly defining the types of settings eligible for Medicaid waiver funding, expressly excluding agricultural communities, disability-specific residential settings, and intentional communities. A robust commitment to the autonomy of people receiving Medicaid waiver services would allow them to choose to direct their program dollars, recognizing that some individuals may choose a life in intentional community or with others facing similar challenges to themselves over an illusory “integration” into a wider society that remains too often unwelcoming and difficult to navigate. (shrink)

Supporting families of people with developmental disabilities from culturally diverse backgrounds is receiving increased attention in the era of globalisation. However, there is little information about how disability policy and cultural values work together to support families. This article examined how disability policy and Chinese cultural values influence family care of children and young people with developmental disabilities. By comparing qualitative interview data from Chinese families in Taipei (15) and Sydney (10), we analysed how their expression of cultural (...) values in family care differs by policy context, relative to ethics of care claims for recognition, rights and redistribution. We found that positive expressions of Chinese culture in family care fade if policies do not complement them. Policies can alleviate potential tension with cultural values in three ways: reinforcing family capacity to care; ensuring the rights of both family caregivers and people with disabilities; and extending care choices for families. These approaches resonate with ethics of care principles. We argue that culturally responsive disability policy for families means working with cultural values to achieve ethics of care. This implies that incorporating principles of ethics of care could inform cultural responsiveness in disability policy development. (shrink)

In disability studies, social and medical explanatory models are seen as being conflicting or mutually exclusive, and as mystifying respectively bodily impairment and the agency of social and environmental factors. This article uses critical discourse analysis to discuss the relationship between such models in policy documents produced by The Norwegian Federation of Organizations of Disabled People. Analysis of key topoi in the policy documents shows that they display elements of both social and medical discourse, and that the consequences of (...) medically defined impairments are used as justifications for policy interventions in a framework of social justice. While a strict version of the social model is adopted in general programmatic documents, arguments about specific policy fields conceptualize disability as a property of individuals — traditionally, a medical model framing. Analysis of topoi is shown to be a useful tool when CDA is applied to policy texts. (shrink)

The disability rights movement (DRM) has often been closely associated with the liberal values of individual choice and independence, or the ‘ethics of agency’, where enhancing the capacity to make autonomous decisions in various policy and practice-based contexts is said to facilitate disabled people's well-being. Nevertheless, other liberal values are derived from what will be termed here the ‘ethics of self-acceptance’. The latter is more disguised in liberalism and the DRM, as rather than emphasising the capacity to make autonomous (...) decisions, self-acceptance focuses on the positive acceptance of individual limitations, but again to enhance well-being. The further argument is that while the ethics of agency and self-acceptance often logically cohere and overlap, through promoting the values of self-respect and relational autonomy, dilemmas arise from our asymmetrical, or uneven, dispositions towards time, and present and future lives and experiences. For example, positively accepting individual limitations allows for a present-oriented immersion in ‘the moment’, but which often requires some suspension of future-oriented goals and aspirations. Understanding some of the implications of this asymmetry, and the dilemmas arising from it, provide important insights concerning approaches to physical and intellectual impairments and the subsequent debates within the DRM, social policy and welfare practice. (shrink)

As debate continues around the nature and values of education, it is important to ask the question of what factors motivate a student to engage with the ends of an educational institution. In this paper, a broad, holistic view of learner motivation, derived from Aristotelian ethics, is used to provide a model to drive institutional change. Focussing on the approach of one Higher Education institution to the particular accommodations required for students with disabilities, the paper identifies three factors which motivate (...) students, a failure to engage with the aims and ends of the educational project, a failure to see that a particular learning aim is worth attaining, and a simple lack of will‐power to attain it. To each of these failures a social cause is identified, and a change in both the institutional culture and the individual learner's approach to their education is suggested. (shrink)

This paper discusses three cultural narratives that threaten the health of people with intellectual/developmental disabilities (IDD) and which have become more evident during the COVID-19 pandemic. These meta-narratives are the medical model of health/disability; the population health approach to health inequalities; and policies premised on the assumption of the importance of national economic growth as an incentive for reducing health inequalities. Evidence exists that health research is more likely to become policy if it fits within a medical model (...) and addresses national economic growth. These two criteria are particularly problematic for people who have IDD. The paper also proposes a research model to facilitate the inclusion of IDD related issues in future policy regarding health inequalities. (shrink)

How should we respond to individuals with disabilities? What does it mean to be disabled? Over fifty million Americans, from neonates to the fragile elderly, are disabled. Some people say they have the right to full social participation, while others repudiate such claims as delusive or dangerous. In this compelling book, three experts in ethics, medicine, and the law address pressing disability questions in bioethics and public policy. Anita Silvers, David Wasserman, and Mary B. Mahowald test important theories of (...) justice by bringing them to bear on subjects of concern in a wide variety of disciplines dealing with disability. They do so in the light of recent advances in feminist, minority, and cultural studies, and of the groundbreaking Americans with Disabilities Act. (shrink)

The situations of disability of students in public and private universities in Ecuador and the use of inclusive policies represent a point of analysis and institutional application worthy of research. Through the implementation and evaluation of these policies, it is intended to guarantee equitable access to education, while promoting an inclusive academic environment. The research aimed to determine the relationship between inclusive policies and the permanence of students with disabilities at the University of Guayaquil during the (...) fiscal period 2023, through a quantitative approach, non-experimental design, correlational scope, and cross-sectional section. The adaptation of perception instruments on inclusive policies and student permanence was used, which were validated by experts in addition to establishing adequate reliability indices, for a total sample of 113 students. Among its results, it evidenced a medium perception of inclusive policies with 56.64% by students, about their application in higher education institutions; in relation to the perception of student permanence, a mean perception of 62.83% by students corresponded. Likewise, a positive and significant relationship was denoted between both inclusive policies and the permanence of students with disabilities in the university. In conclusion, as the application of inclusive policies is perceived, the permanence of students with disabilities is guaranteed. (shrink)

This study addresses inclusive strategies and the impact of public policies on the integration of university students with disabilities, with special emphasis on their mental well-being in academic settings. Through a quantitative approach, data from a sample of students with disabilities in public and private universities were analyzed. The results reveal that the proper implementation of inclusive policies significantly improves both academic integration and the emotional well-being of students. Key areas were identified for improving psychological care and academic (...) accommodations, highlighting the importance of a holistic approach to addressing diversity in higher education. (shrink)

L’article explore la question de la politique d’emploi et le fonctionnement du système de soutien à l’activité professionnelle des personnes en situation de handicap mental en Pologne. Les analyses sont basées sur des données provenant d’un projet de recherche plus large: Emploi et handicap. Reconstructions des expériences professionnelles des personnes en situation de handicap mental en Pologne. L’objectif du projet était de connaître la situation professionnelle de ces personnes en termes de politique d’emploi, de pratiques d’accompagnement sur les lieux de (...) travail et d’expérience professionnelle des salariés handicapés, de leurs accompagnateurs et des coordinateurs de projets de soutien professionnel. Le cadre méthodologique du projet s’appuie sur la théorie ancrée, basée sur le constructivisme social, dans la version présentée dans les travaux de K. Charmaz, l’analyse du discours et l’analyse sociologique des pratiques. Le matériau de recherche a été collecté dans 25 lieux de travail de personnes handicapées, dans différentes régions de Pologne, principalement au moyen d’entretiens approfondis, d’observations et de notes de terrain. Les analyses portant sur de la politique d’emploi polonaise indiquent une promotion de l’activité professionnelle des personnes en situation de handicap mental. Cependant, sa mise en œuvre est difficile. Les difficultés résultent de la mauvaise qualité du droit régissant l’activité professionnelle, de l’absence de solutions législatives adéquates, de barrières au niveau des employeurs et de l’absence de soutien financier suffisant. (shrink)

Recent years have seen increased interest among 4E cognition scholars in physical disability, leading to the development of the EE-model of disability. This paper contributes to the literature on disability and 4E cognition in three key ways. First, it examines the relationship between the EE-model and social constructivist views that address the bodily reality of disablement, highlighting commonalities and distinctions. Second, it critiques the EE-model’s focus on individual strategies for expanding disabled persons’ affordance landscapes, arguing that (...) class='Hi'>disability policy should integrate insights from both the EE-model and social constructivist approaches. Finally, it assesses the EE-model against the 'dogma of harmony'. We argue that while the EE-model’s focus on active human-environment collaboration is valuable, it can inadvertently perpetuate this dogma. We contend that integrating certain social constructivist insights can help the EE-model avoid the dogma of harmony. (shrink)

For the last eighteen months, I have worked with a group of disability and health policy researchers. I began this interview-based project trying to learn how these researchers’ disability identities shaped their work. How did their disability standpoint contribute to the liberatory nature of their research? I found that the disability standpoint of these researchers was in fact hard-won and grew not just out of their own disability experiences but out of their connections with the (...) larger disability community. These connections, for the most part, helped researchers come to “claim crip,” and that later influenced their research. (shrink)

One of the most significant economic challenges faced by people with disabilities in Turkey and globally is employment. Unfortunately, even in developed countries, the desired level of employment of the disabled individuals has not yet been measured up. The fundamental rights and freedoms of employment and labor have gained a basis of legitimacy through certain principles within the legal system throughout human history. As a matter of fact, in the main references of Islamic law, the principles of justice, rights, equality (...) of opportunity, merit, anti-discrimination, and social responsibility for all people in general and disabled people in particular have been a reference in the development of employment policies. In this regard, the main objective of Islamic economic policies has been determined as ensuring the happiness of the individual in this world and the hereafter since the early period. The study first includes active and passive employment models developed in modern legal systems. It can be stated in this framework that from the early period, both in the practices of the Prophet Muhammad and the Companions and in the later Islamic societies, institutionalization was provided according to the characteristics of the period in which disabled individuals were actively and passively employed, and it can be stated that the developments regarding the employment of disabled individuals in Islamic societies started much earlier than expected. However, we must admit that legal regulations in the modern sense were introduced later compared to the West. The study focuses on the phenomenon of disability, the problems and needs of the disabled, and the studies on employment in Islamic societies from the past to the present. It is determined that many disabled people in Islamic society are actively employed in state positions ranging from imam to judge, from commander to governor according to their abilities, and the disabled people who cannot be employed are compensated for their disadvantages through passive employment methods such as health, care, housing, salary binding, and tax reduction. Determining the principles of employment of disabled according to Islamic law is the main subject of the study, and it has been established that maslahah, custom, siyasa shar’iyya, merit, and sedd-i zerâi constitute the jurisprudential basis of the employment of the disabled in Islamic law. In this framework, it has been stated that the principle of maslahah plays a key role in the development of social responsibility policies, in resolving issues that are not included in verses and hadiths and furû fiqh acquis, in gaining the economic independence of disabled and ensuring the minimum standard of living. Maslahah is also beneficial for the individual, family, society and the state, too. It has been pointed out that the employment of disabled people has become one of the most significant matters of both national and international legal regulations today, and it has been determined that the employment of disabled people has transformed into customary practices in accordance with the criteria of being a source of Islamic law. In Islamic administrative law, active and passive employment policies, legal regulations, and institutional structures related to disabled are carried out by the authority delegated to public administrators under the siyasa shar'iyya. It has been emphasized that administrative and public service appointments in Islamic law are ordered to be made on the basis of merit, that nepotism and favoritism are prohibited, and that disability is not an obstacle to employment. In conclusion, the insufficiency of studies on employment of people with disabilities in Islamic law has been pointed out and it has been suggested that further studies should be carried out on these subjects and exploitation of disability according to Islamic law should be studied. (shrink)

This Article explores the connections between disability and health justice in service of further tethering the two theories and practices. The author contends that disability should shift from marker of health inequity alone to critical demographic in the analytical and practical application of health justice. This theoretical move creates a more robust understanding of the harms of health injustice, its complexities, and, remedially, reveals underexplored legal and policy pathways to promote health justice.

Policy motives for work for people with a disability (PWD) are divergent along two discourses: work as a right vs norm. Work as a right, based on the UN Convention on the Rights of Persons with Disabilities (UNCRPD), portrays work as a potential gateway for inclusion. Work as a norm fits a neoliberal agenda. It considers labor market participation of all, including PWD, as a civil responsibility crucial for economic welfare. Critics argue that the work as a norm discourse (...) presents a risk for inclusion of PWD. Work is seen as a necessary condition for and not one of many ways to inclusion in society. To make the right to work for PWD work, critical scholars call to unravel whether and how the discourses of work as a right and norm for PWD become intertwined in policy. In response and through the lens of recontextualization, we study how discourses of work as a right and norm for PWD are received, reproduced and reworked in political debate in Flanders (Belgium) over time. We examine policy texts and parliamentary questions of four government terms (2004–2024). The findings illustrate how the work as a right discourse is gradually recontextualized into the work as a norm discourse to legitimize neoliberal policies of strict activation. In accordance, we see a gradual move towards neoliberal-ableism. Although the UNCRPD aims to eradicate ableism, its recontextualization and appropriation reinforces neoliberal-ableism. (shrink)

The specialist field of intellectual disability nursing has been subjected to a number of changes since the move towards deinstitutionalisation from the 1970s. Government policies sought to change the nature of the disability workforce from what was labelled as a medicalised approach, towards a more socially oriented model of support. Decades on however, many nurses who specialise in the care of people with intellectual disability are still employed. In Australia, the advent of the National Disability (...) Insurance Scheme offers an apt moment to reflect upon these decades of specialised nursing care as the context of this nursing care will continue to evolve. A review of the published literature was conducted to explore what has shaped the field in the past and how this might inform the future of this speciality area under new policy and service contexts. People with intellectual disability have specific health and support needs that require a specialised workforce. Specialist nurses continue to be needed for people with intellectual disability. (shrink)

This paper considers the range of possible policy options that are available if we wish to attempt to treat people with cognitive disabilities as equal members of society. It is suggested that the goal of policy should be allow each disabled person to establish a worthwhile place in the world and sets out four policy options: cash compensation, personal enhancement, status enhancement and targeted resource enhancement. The paper argues for the social policy of targeted resource enhancement for individuals with cognitive (...) disabilities, in the form of providing cash with some limits on its use. Taking the example from the UK of ‘self-directed support’ it is argued that such policies can be cost-effective and advance the autonomy of people with cognitive disabilities, especially when compared with current policies of centrally provided services. (shrink)

“Discrimination on the grounds of disability is seldom malicious, but stems more from a lack of understanding.” A disabled businessman explores the need for businesses to cultivate and implement greater disability awareness. After graduating in engineering, he gained his MBA from London Business School in 1992. He now works as a consultant, capitalising on his background in business management and his personal experience of disability to assist clients in developing anti‐discriminatory policies and practice.

Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care medicine (...) and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian (Switzerland, Spain, Belgium, France, England and Italy), concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency. (shrink)

We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use (...) ventilators in their daily lives (e.g., home ventilation) present to acute care hospitals, their personal ventilators should not be reallocated to other patients. Fifth, designate triage officers to assess patients individually on the basis of objective medical evidence, not stereotypes or assumptions. Sixth, include disability rights advocates in policy development and dissemination. (shrink)

This paper asks whether statutory social insurance programs, which provide contributory tax-based income support to people with disabilities, are compatible with the disability rights movement's ideas. Central to the movement that led to the Americans with Disabilities Act is the insight that physical or mental conditions do not disable; barriers created by the environment or by social attitudes keep persons with physical or mental differences from participating in society as equals.The conflict between the civil rights approach and insurance seems (...) apparent. A person takes out insurance to deal with tragedy, such as premature death, or damage, such as accidental harm to an automobile or home. Social insurance, for example, the United States Social Security old-age and disability programs, consists of government-run insurance to cover risks of advanced age and disability for which the private market has not provided affordable coverage. But the civil rights approach to disability posits that disability is not a risk, not tragedy, and not a damage or defect. Instead it is a maladaptation of society to human variation. This paper argues that a justification remains for social insurance under the civil rights approach to disability, and further suggests that expansion of social insurance for disability is both compatible with disability rights principles and supported by wise public policy. (shrink)

It is widely assumed that disability is typically a bad thing for those who are disabled. Our purpose in this essay is to critique this view and defend a more nuanced picture of the relationship between disability and well-being. We first examine four interpretations of the above view and argue that it is false on each interpretation. We then ask whether disability is thereby a neutral trait. Our view is that most disabilities are neutral in one sense, (...) though we cannot make simple generalizations about disability's relationship to well-being in other important senses. After defending this view, we discuss its practical implications for selective abortion for disability, nondisabled people's interactions with disabled people, and the use of QALYs in health policy. (shrink)

Disability, like questions of race, gender, and class, is one of the most provocative topics among theorists and philosophers today. This volume, situated at the intersection of feminist theory and disability studies, addresses questions about the nature of embodiment, the meaning of disability, the impact of public policy on those who have been labeled disabled, and how we define the norms of mental and physical ability. The essays here bridge the gap between theory and activism by illuminating (...) structures of power and showing how historical and cultural perceptions of the human body have been informed by and contributed to the oppression of women and disabled people. (shrink)

In the first decade post-1989 no gender policies with clear objectives and specific instruments existed in Romania. The gender mainstreaming was first stated in the two National Action Plans for Equal Opportunities between Women and Men (1996 and 2000). Still, the attention of the various Romanian Governments, concerning women's issues, was focused especially on labour relationships and on related domains, such as social security and health insurance. Other fields, such as education, political participation, family and civil rights, were under- (...) developed, as regards the consideration of women's needs and interests.The legislation and institutions that implement and monitor the observance of equality take no special interest in women's discrimination, as women are treated together with other discriminated categories (the disabled, Rroma, homosexuals). (shrink)

In this article, I reflect back on the period since the publication of the first edition of Foucault and the Government of Disability in order to argue that the intervening years have seen the increasing advance of neoliberal politics that impact on the lives of disabled people. Beginning from an overview of Foucault’s 1978-9 lectures on neoliberalism, I seek to demonstrate that a range of policy developments that affect disabled people can be read against the background of Foucault’s analyses (...) of neoliberal rationalities and practices of government. The impact of these developments has been economically harsh for many; hence, the article considers the potential for effective critique of these issues starting from a Foucauldian analytics. I argue that Foucault’s works, whilst useful in unsettling taken-for-granted assumptions about subjectivity and autonomy given by neoliberal governmental rationalities, do not, in and of themselves, suggest a form of critique that is capable of mounting an effective challenge to the neoliberal consensus. My argument ends with a challenge to Foucault-inspired social scientists to ally the valuable insights available from Foucauldian analyses to a critical perspective that can, in addition, diagnose and respond to problems of economic marginalisation, the concentration of wealth, and the marketisation of the social. (shrink)

Is disability disadvantageous? Although many assume it is paradigmatically so, many disabled individuals disagree. Whom should we trust? On the one hand, pervasive mistrust of already underrepresented groups constitutes a serious epistemic injustice. Yet, on the other, individuals routinely adapt to mistreatment and deprivation and claim to be satisfied. If we take such “adaptive preferences” (APs) at face value, then injustice and oppression may not be recognized or rectified. Thus, we must achieve a balance between taking individuals’ preferences and (...) self-assessment as definitive, and ignoring them entirely. Furthermore, current accounts of APs suffer from an ambiguity: are APs an unreliable guide to individuals’ interests, or to just policy? This chapter argues that we should distinguish between those that are unreliable in the former sense (“well-being APs”), and the latter (“justice APs”). Although all APs are nonautonomous, only well-being APs are irrational. Thus, preferences may be diagnosed as unreliable from the perspective of justice without impugning individuals’ rational capacities. (shrink)

The “expressivist objection” argues that prenatal screening leading to termination of embryos or fetuses with disabilities sends a harmful message to people with disabilities, such as the message that their lives are not worth living. I first argue that whether it sends such a message depends on how a reasonable person would see the motives behind the screening. I then argue that a reasonable person would see a harmful message, not when individuals terminate embryos, and not for severe disabilities, but (...) when the state allows the screening and termination of embryos with less severe conditions, such as Down syndrome. This sends the message that it is permissible not to pay a higher cost to support people with disabilities, when there is an abled alternative. This attitude is harmful to the welfare, rights and self-worth of people with disabilities because it reinforces the refusal to provide them with equal opportunity. The state therefore has a strong pro tanto reason to ban prenatal screening for less severe disabilities. (shrink)

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a (...) number of items that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability. (shrink)

Cette étude fournit une analyse comparative des politiques liées à la position des personnes handicapées sur le marché du travail en Finlande et en Italie, deux pays où l’écart d’emploi entre les personnes handicapées et non handicapées est relativement faible. Cette étude examine les politiques visant à améliorer la position des personnes handicapées sur le marché du travail et se base sur la littérature existante et des entretiens avec des experts. L’analyse comparative montre que ces deux pays emploient des approches (...) politiques différentes. En Finlande, les compensations sont relativement élevées et les politiques mettent l’accent sur la prévention. Cependant, les mesures d’activation pour les bénéficiaires de compensations d’invalidité font défaut. En Italie, les politiques se concentrent sur l’activation. La loi italienne sur les quotas oblige les entreprises à embaucher des personnes handicapées. En outre, les coopératives sociales offrent des emplois aux personnes handicapées. Les résultats suggèrent que les efforts visant à garantir des mesures de compensation et d’activation adéquates, combinés à des processus créés pour construire une société inclusive, peuvent contribuer à améliorer la situation du marché du travail pour les personnes handicapées. (shrink)

Disagreement about the properattitude toward disability proliferates. Yetlittle attention has been paid to an importantmeta-question, namely, whether ``disability'' isan essentially contested concept. If so, recentdebates between bioethicists and the disabilitymovement leadership cannot be resolved. Inthis essay I identify some of the presumptionsthat make their encounters so contentious. Much more must happen, I argue, for anydiscussions about disability policy andpolitics to be productive. Progress depends onconstructing a neutral conception ofdisability, one that neither devaluesdisability nor implies that persons withdisabilities (...) are inadequate. So, first, I clearaway the conceptual underbrush that makes usthink our idea of disability must bevalue-laden. Second, I sketch someconstituents of, and constraints upon, aneutral notion of disability. (shrink)

Genetic testing poses fundamental questions for insurance. Testing can predict a low probability of future illness and disability, which can help promote the insurability of individuals with a family history of genetic risk, but it can also invite insurers to reject applicants, increase premiums, exclude people with certain illnesses and disabilities, and otherwise adjust the underwriting processes for individuals with certain genotypes. In the workplace, these issues may cause employers who offer or pay for insurance to alter their hiring (...) behavior, either by selecting those with desirable genetic makeup or rejecting, dismissing, or reassigning those who carry an unwanted risk, ultimately threatening employability and the safety net that insurance is intended to provide. (shrink)

This Essay explains why model policies proposed or adopted in response to the COVID-19 pandemic that allocate scarce medical resources by using medical evidence to pursue two core goals—saving more lives and saving more years of life—are compatible and consonant with disability law. Disability law, properly understood, permits considering medical evidence about patients’ probability of surviving treatment and the quantity of scarce treatments they will likely use. It also permits prioritizing health workers, and considering patients’ post-treatment life (...) expectancy. These factors, when based on medical evidence and not inaccurate stereotypes, are legal to consider even if they disadvantage some patients with specific disabilities. It then discusses the ethical advantages of triage policies that use medical evidence to save more lives and years of life, which I call “evidence-based triage,” focusing on the benefits of these policies for patients with disabilities. In doing so, I explain why recent critiques err by treating people with disabilities as a monolith, overlooking the political disadvantages of less-visible victims, and treating the social origins of scarcity as a justification for saving fewer lives. Evidence-based triage parallels other policy responses to the COVID-19 pandemic, like physical distancing and postponement of medical procedures, which may burden patients with specific disabilities or medical conditions but are nevertheless justified because they save more patients. (shrink)

It often appears that the most appropriate form of addressing disadvantage related to disability is through policies that can be called “status enhancements”: changes to the social, cultural and material environment so that the difficulties experienced by those with impairments are reduced, even eradicated. However, status enhancements can also have their limitations. This paper compares the relative merits of policies of status enhancement and “personal enhancement”: changes to the disabled person. It then takes up the question of (...) how to assess the priority of the claims of disabled people in the face of scarcity of resources for which there can be many competing social claims, arguing for the theory of “declustering disadvantage”. (shrink)