In his recent article Perry Hendricks presents what he calls the impairment argument to show that abortion is immoral. To do so, he argues that to give a fetus fetal alcohol syndrome is immoral. Because killing the fetus impairs it more than giving it fetal alcohol syndrome, Hendricks concludes that killing the fetus must also be immoral. Here, I claim that killing a fetus does not impair it in the way that giving it fetal alcohol syndrome does. By examining (...) the reason why giving a fetus this condition is wrong, I conclude that the same reasoning, on common pro‐choice accounts, does not apply to killing the fetus. Accordingly, Hendricks's argument does not succeed in showing abortion is immoral. (shrink)

Perry Hendricks has recently presented the impairment argument for the immorality of abortion, to which I responded and he has now replied. The argument is based on the premise that impairing a fetus with fetal alcohol syndrome is immoral, and on the principle that if impairing an organism is immoral, impairing it to a higher degree is also—the impairment principle. If abortion impairs a fetus to a higher degree, then this principle entails abortion is immoral. In my reply, (...) I argued that abortion does not impair an organism in the way fetal alcohol syndrome does, and showed that interest theorists can avoid the argument. Hendricks has responded to my criticisms by demonstrating how abortion does impair an organism. In this reply, I acknowledge Hendricks’ point, but proceed to criticise the application of the impairment principle to abortion, showing that it is invalid if we accept his explanation for why inflicting fetal alcohol syndrome is immoral. I also argue that counter-examples show the impairment principle itself to be dubitable, concluding that the impairment argument remains unpersuasive. (shrink)

This paper considers the importance of the body for self-esteem, communication, and emotional expression and experience, through the reflections of those who live with various neurological impairments of movement and sensation; sensory deafferentation, spinal cord injury and Möbius Syndrome. People with severe sensory loss, who require conscious attention and visual feedback for movement, describe the imperative to use the same strategies to reacquire gesture, to appear normal and have embodied expression. Those paralysed after spinal cord injury struggle to have others (...) see them as people rather than as people in wheelchairs and have been active in the disability movement, distinguishing between their medical impairment and the social induced disability others project onto them. Lastly those with Möbius reveal the importance of the face for emotional expression and communication and indeed for emotional experience itself. All these examples explore the crucial role of the body as agent for social and personal expression and self-esteem. (shrink)

According to Hendricks Impairment Argument (IA), abortion is immoral because it impairs the fetus. Here, I argue it is not sufficient to show merely that abortion impairs, Hendricks must show that it harms the fetus. If the fetus is not numerically identical to the person it will become, then it isn't harmed by an abortion. But if the fetus is numerically identical to the person it will become, it is harmed by the deprivation of a future of value. However, (...) taking this route ultimately undermines the novelty of the impairment argument. (shrink)

I provide an updated version of The Impairment Argument against abortion and respond to numerous objections that can be (and have been) raised to it.

According to Hendricks Impairment Argument (IA), abortion is immoral because it impairs the fetus. Here I argue it is not sufficient to show merely that abortion impairs, Hendricks must show that it harms the fetus. If the fetus is not numerically identical to the person it will become, then it isn’t harmed by an abortion. But if the fetus is numerically identical to the person it will become, it is harmed by the deprivation of a future of value. However, (...) taking this route ultimately undermines the novelty of the impairment argument. (shrink)

Blackshaw and Hendricks have recently developed and defended the impairment argument against abortion, arguing that the immorality of giving a child fetal alcohol syndrome (FAS) provides us with reason to believe that abortion is immoral. In this paper, we forward two criticisms of the impairment argument. First, we highlight that, as it currently stands, the argument is very weak and accomplishes very little. Second, we argue that Blackshaw and Hendricks are fundamentally mistaken about what makes giving a child (...) FAS immoral. Once we acknowledge this, it is clear that our intuitions about giving a child FAS provide no support for the supposed immorality of abortion. (shrink)

Falls are frequent in Myotonic Dystrophy type 1, but the pathophysiology of the balance impairment needs further exploration in this disease. The current work aims to provide a richer understanding of DM1 imbalance. Standing balance in 16 patients and 40 controls was tested in two posturographic tests. In the Sensory Organization Test, standstill balance was challenged by combining visual and environmental conditions. In the “react” test, reflexes induced by sudden shifts in the support base were studied. Oscillations of the (...) body centre of mass were measured. In the SOT, COM sway was larger in patients than controls in any condition, including firm support with eyes open. On sway-tuned support, COM oscillations when standing with closed eyes were larger in patients than controls even after taking into account the oscillations with eyes open. In the “react” paradigm, balance reflexes were delayed in patients. Results in both experimental paradigms are consistent with leg muscle weakness. This, however, is not a sufficient explanation. The SOT test highlighted that patients rely on vision more than controls to maintain static balance. Consistently enough, evidence is provided that an impairment of proprioceptive and vestibular systems contributes to falls in DM1. Rehabilitation programs targeted at reweighting sensory systems may be designed to improve safe mobility in DM1. (shrink)

Blackshaw and Hendricks recently developed a strengthened version of the impairment argument (SIA) that imports Marquis’ account of the wrongness of abortion. I then argued that if SIA imports Marquis’ account, then it restates Marquis’ position and thus is not very significant. In turn, Blackshaw and Hendricks explained why they take SIA to be importantly different from Marquis’ account. I have two aims in this response. First, I reconstruct Blackshaw and Hendricks’ arguments for the claim that SIA is importantly (...) different from Marquis’ account. Second, I argue that SIA is not importantly different from Marquis’ account in the respect that Blackshaw and Hendricks take it to be. (shrink)

Quattrocki and Friston (2014) argued that abnormalities in interoception—the process of representing one’s internal physiological states—could lie at the heart of autism, because of the critical role interoception plays in the ontogeny of social-affective processes. This proposal drew criticism from proponents of the alexithymia hypothesis, who argue that social-affective and underlying interoceptive impairments are not a feature of autism per se, but of alexithymia (a condition characterized by difficulties describing and identifying one’s own emotions), which commonly co-occurs with autism. Despite (...) the importance of this debate for our understanding of autism spectrum disorder (ASD), and of the role of interoceptive impairments in psychopathology, more generally, direct empirical evidence is scarce and inconsistent. Experiment 1 examined in a sample of 137 neurotypical (NT) individuals the association among autistic traits, alexithymia, and interoceptive accuracy (IA) on a standard heartbeat-tracking measure of IA. In Experiment 2, IA was assessed in 46 adults with ASD (27 of whom had clinically significant alexithymia) and 48 NT adults. Experiment 1 confirmed strong associations between autistic traits and alexithymia, but yielded no evidence to suggest that either was associated with interoceptive difficulties. Similarly, Experiment 2 provided no evidence for interoceptive impairments in autistic adults, irrespective of any co-occurring alexithymia. Bayesian analyses consistently supported the null hypothesis. The observations pose a significant challenge to notions that interoceptive impairments constitute a core feature of either ASD or alexithymia, at least as far as the direct perception of interoceptive signals is concerned. (shrink)

In order for the so-called strengthened impairment argument to succeed, it must posit some reason R that causing fetal alcohol syndrome is immoral, one that also holds in cases of abortion. In formulating SIA, Blackshaw and Hendricks borrow from Don Marquis to claim that the reason R that causing FAS is immoral lies in the fact that it deprives an organism of a future like ours. I argue here that SIA fails to show that it is immoral to cause (...) FAS and abort fetuses that will not be born because it deprives them of an FLO. This is because fetuses that will not be born have no chance of having an FLO in the first place, so causing FAS for and aborting them cannot deprive them of one. I then consider three responses to my argument. I conclude that each fails. SIA does not accomplish its task of showing why it is immoral to impair fetuses that will not be born. Perhaps it can accomplish the task of showing why it is immoral to impair fetuses that will be born, but not without sacrificing at least some of its alleged significance. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of (...) health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial (as a psychological method of coping) has typically not been addressed in these studies. We propose that this failure has limited our understanding of how ISA and denial differentially affect efforts to rehabilitate persons with TBI. In this selective review paper, we summarize early findings in the field and integrate those findings with more (...) recent observations (i.e., 1999–2019). We believe that this synthesis of information and expert clinical opinion will inform future research on ISA and denial as well as approaches to rehabilitation for persons with TBI. (shrink)

Most opposition to abortion stands or falls on whether a fetus is the sort of being whose life it is seriously wrong to end. In her influential paper ‘A defense of abortion,’ Judith Jarvis Thomson effectively sidesteps this issue, assuming the fetus is a person with the right to life yet arguing this alone does not give it the right to use the mother’s body. In a recent article, Perry Hendricks takes inspiration from Thomson and assumes the fetus is not (...) a person, arguing that abortion is wrong because causing fetal impairment is wrong and abortion is worse than causing fetal impairment. Here I argue Hendricks’ impairment argument fails. For Hendricks, risking fetal impairment is wrong because it risks harm to a future person, but if we assume the fetus is not a person, abortion doesn’t harm anyone, it merely prevents them from existing. (shrink)

This review essay addresses the question, "What, properly speaking, is a pragmatic impairment?" Drawing on work from two recent books, it presents three possible answers, and evaluates them.

Perry Hendricks’ original impairment argument for the immorality of abortion is based on the impairment principle (TIP): if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. Since abortion impairs a fetus to a higher degree than fetal alcohol syndrome (FAS) and giving a fetus FAS is immoral, it follows that abortion is immoral. Critics have argued that the ceteris paribus is not met for FAS and abortion, (...) and so we proposed the Modified Impairment Principle (MIP) to avoid these difficulties. Dustin Crummett has responded, arguing that MIP is open to various counterexamples which show it to be false. He also shows that MIP can generate moral dilemmas. Here, we propose a modification to MIP that resolves the issues Crummett raises. Additionally, Alex Gillham has criticized our appropriation of Don Marquis’ ‘future like ours’ reasoning about the wrongness of impairment. We show that his objections have minimal implications for our argument. (shrink)

One challenge in providing an adequate definition of physical disability is unifying the heterogeneous bodily conditions that count as disabilities. We examine recent proposals by Elizabeth Barnes (2016), and Dana Howard and Sean Aas (2018), and show how this debate has reached an impasse. Barnes’ account struggles to deliver principled unification of the category of disability, whilst Howard and Aas’ account risks inappropriately sidelining the body. We argue that this impasse can be broken using a novel concept: marginalised functioning. Marginalised (...) functioning concerns the relationship between a person’s bodily capacities and their social world: specifically, their ability to function in line with the default norms about how people can typically physically function that influence the structuring of social space. We argue that attending to marginalised functioning allows us to develop, not one, but three different models of disability, all of which—whilst having different strengths and weaknesses—unify the category of disability without sidelining the body. (shrink)

AbstrctSean Aas, Dana Howard, and Leslie Francis raise compelling and interesting objections to the definition of disability I defend in The Minority Body. In this paper, I reply to these objections and elaborate on my criticisms of the disability/impairment distinction.

To define the determinants of impaired facial emotion recognition (FER) in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS), we examined 76 patients with unilateral MTLE-HS, 36 prior to antero-mesial temporal lobectomy (AMTL) and 40 after AMTL, and 28 healthy control subjects with a FER test consisting of 60 items (20 each for anger, fear, and happiness). Mean percentages of the accurate responses were calculated for different subgroups: right vs. left MTLE-HS, early (age at onset <6 years) (...) vs. late-onset, and before vs. after AMTL. After controlling for years of education, duration of epilepsy and number of antiepileptic drugs (AEDs) taken, on multivariate analysis, fear recognition was profoundly impaired in early-onset right MTLE-HS patients compared to other MTLE patients and control subjects. Happiness recognition was significantly better in post-AMTL MTLE-HS patients compared to pre-AMTL patients while anger and fear recognition did not differ. We conclude that patients with right MTLE-HS with age at seizure onset <6 years are maximally predisposed to impaired fear recognition. In them, right AMTL does not further worsen FER abilities. Longitudinal studies comparing FER in the same patients before and after AMTL will be required to refine and confirm our cross-sectional observations. (shrink)

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two. This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated by (...) painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings. (shrink)

The ‘impairment argument’ against abortion developed by Perry Hendricks aims to derive the wrongness of abortion from the wrongness of causing foetal alcohol syndrome. Hendricks endorses an ‘impairment principle’, which states that, if it is wrong to inflict an impairment of a certain degree on an organism, then, ceteris paribus, it is also wrong to inflict a more severe impairment on that organism. Causing FAS is wrong in virtue of the impairment it inflicts. But abortion (...) inflicts an even more severe impairment, and so, ceteris paribus, is also wrong. Notably, Hendricks thinks that this argument does not require the claim that the foetus is a person. Here, I respond to Hendricks by arguing that the ceteris paribus clause of the impairment principle is not met in ordinary cases of pregnancy. Carrying an unwanted pregnancy to term is much more burdensome than is refraining from excessive drinking for nine months. This provides a pro tanto justification for obtaining an abortion that does not apply to causing FAS. If the foetus is not a person, it seems fairly clear to me that this justification is strong enough to render abortion permissible. Hendricks is therefore incorrect in claiming that the impairment argument can go without claims concerning foetal personhood. If the foetus is a person, then whether burdensomeness justifies abortion depends on certain questions relating to Thomson’s famous violinist argument. I will not attempt to answer those. But anyone who is otherwise sympathetic to Thomson’s argument should not be moved by the impairment argument. (shrink)

Fahr’s disease is a rare idiopathic degenerative disease characterized by calcifications in the brain, and has also been associated with balance impairment. However, a detailed analysis of balance in these patients has not been performed. A 69-year-old woman with Fahr’s disease presented with a long-lasting subjective imbalance. Balance was analyzed using both clinical and instrumented tests. The patient’s balance was normal during clinical tests and walking. However, during standing, a striking impairment in vestibular control of balance emerged. The (...) balance behavior displayed mixed parkinsonian and cerebellar features, with a discrepancy between the high severity of the static and the low severity of the dynamic balance impairment. The balance impairment characteristics outlined in this study could help neurologists and physiatrists detect, stage, and treat this rare condition. (shrink)

Autism has recently become the focus of continuous philosophical inquiry, because it affects inter-subjective capacities in a highly selective manner. One of the first behavioural manifestations of autism is impaired play, particularly the lack of pretend play. This article will show that the prevailing 'Theory-Theory of Mind'-approach cannot explain impaired play. I will suggest a richer, phenomenological account of inter-subjectivity. It will be argued that this improves the understanding of impaired play in autism.

Although psychologist impairment has received attention from researchers, there is a paucity of empirical data aimed at determining the point at which such impairment necessitates action. The purpose of this study was to provide such empirical data. Members of Division 42 ( n = 285) responded to vignettes describing a psychologist whose symptoms of either depression or substance abuse varied across five levels of severity. Results identified specific levels of impairment at which psychologists were deemed too impaired (...) to practice psychotherapy, as well as significant differences between ratings of increasingly severe impairment. Practical and ethical implications of these results are discussed. (shrink)

Hendricks’ The Impairment Argument (TIA) claims that it is immoral to impair a fetus by causing it to have fetal alcohol syndrome (FAS). Since aborting a fetus impairs it to a greater degree than causing it to have FAS, then abortion is also immoral. In this article, I argue that TIA ought to be rejected. This is because TIA can only succeed if it explains why causing an organism to have FAS impairs it to a morally objectionable degree, entails (...) that abortion impairs an organism to a morally objectionable and greater degree than causing FAS, and satisfies The Impairment Principle’s ceteris paribus clause. In order to do all three things, TIA must presuppose some theory of well-being. Even then, no theory of well-being accomplishes all three tasks that TIA must in order to succeed. However, even if this is false and TIA can meet all three objectives by presupposing some theory of well-being, it would not do very much to advance the debate about the morality of abortion. As I argue, TIA would essentially restate well-established arguments against abortion based on whatever theory of well-being it must presuppose in order to be successful. (shrink)

Patients with apraxia perform poorly when demonstrating how an object is used, particularly when pantomiming the action. However, these patients are able to accurately identify, and to pick up and move objects, demonstrating intact ventral and dorsal stream visuomotor processing. Appropriate object manipulation for skilled use is thought to rely on integration of known and visible object properties associated with ‘ventro-dorsal’ stream neural processes. In apraxia, it has been suggested that stored object knowledge from the ventral stream may be less (...) readily available to incorporate into the action plan, leading to an over-reliance on the objects’ visual affordances in object-directed motor behaviour. The current study examined grasping performance in left hemisphere stroke patients with (N = 3) and without (N = 9) apraxia, and in age-matched healthy control participants (N = 14), where participants repeatedly grasped novel cylindrical objects of varying weight distribution. Across two conditions, object weight distribution was indicated by either a memory-associated cue (object colour) or visual-spatial cue (visible dot over the weighted end). Participants were required to incorporate object-weight associations to effectively grasp and balance each object. Control groups appropriately adjusted their grasp according to each object’s weight distribution across each condition, whereas throughout the task two of the three apraxic patients performed poorly on both the memory-associated and visual-spatial cue conditions. A third apraxic patient seemed to compensate for these difficulties but still performed differently to control groups. Patients with apraxia performed normally on the neutral control condition when grasping the evenly weighted version. The pattern of behaviour in apraxic patients suggests impaired integration of visible and known object properties attributed to the ventro-dorsal stream: in learning to grasp the weighted object accurately, apraxic patients applied neither pure knowledge-based information (the memory-associated condition) nor higher-level information given in the visual-spatial cue condition. Disruption to ventro-dorsal stream predicts that apraxic patients will have difficulty learning to manipulate new objects on the basis of information other than low-level visual cues such as shape and size. (shrink)

Visually impaired people have unique perceptions of and usage requirements for various urban spaces. Therefore, understanding these perceptions can help create reasonable layouts and construct urban infrastructure. This study recruited 26 visually impaired volunteers to evaluate 24 sound environments regarding clarity, comfort, safety, vitality, and depression. This data was collected in seven different types of urban spaces. An independent sample non-parametric test was used to determine the significance of the differences between environmental evaluation results for each evaluation dimension and to (...) summarize the compositions of sound and space elements in the positive and negative influence spaces. The results suggested that visually impaired people (1) feel comfort, safety, and clarity in parks, residential communities, and shopping streets; (2) have negative perceptions of vegetable markets, bus stops, hospitals, and urban departments; (3) feel anxious when traffic sounds, horn sounds, manhole cover sounds, and construction sounds occur; and (4) prefer spaces away from traffic, with fewer and slower vehicles, with a suitable space scale, and moderate crowd density. These results provide a reference for the future design of activity venues (i.e., residential communities, vegetable markets, bus stops, parks, shopping streets, hospitals, and urban functional departments) and the planning of accessibility systems for visually impaired urban residents. (shrink)

A common justification for abortion rights is that the death of the fetus does not violate any of the fetus’s time-relative interests. The time-relative interest account (TRIA) of harm and wrongdoing tells us that a necessary condition for harming someone is that his or her time-relative interests are frustrated. Regarding the justification for abortion, this account falls prey to impairment arguments. Impairment arguments entertain cases of prenatal injury, such as the mother using illicit drugs that disable the child. (...) The intuition is that the child who is born with such disabilities is harmed by the mother’s drug use. But it is unclear what time-relative interest is violated in cases of prenatal harm. Typical responses to impairment arguments point out that the abortion case is different because the child does not exist to experience such harms; but in prenatal injury + survival cases, the child does live to experience those harms. Thus, the TRIA justification for abortion is not impugned by impairment counter-examples. This article argues that this response to impairment arguments is viciously circular. The response must say that so long as you kill the child, no harm is done. But this assumes that killing itself is morally inconsequential and is not itself a case of harm. The response to impairment arguments, then, assumes the permissibility of abortion. (shrink)

Tom Shakespeare’s important new book includes, among other topics, a persuasive critique of the social model of disability. A key component in his case against that model consists in an argument against the impairment/disability distinction as this is understood within the social model. The present paper focuses on the case Shakespeare makes against that distinction. Three arguments mounted by Shakespeare are summarised and responded to. It is argued that the responses adequately rebut Shakespeare’s case on this specific issue. Moreover, (...) as the engagement with Shakespeare’s argument illustrates, his claim to employ a critical realist perspective appears to be in considerable tension with the case he offers against the impairment/disability distinction. (shrink)

Although psychologist impairment has received attention from researchers, there is a paucity of empirical data aimed at determining the point at which such impairment necessitates action. The purpose of this study was to provide such empirical data. Members of Division 42 (n = 285) responded to vignettes describing a psychologist whose symptoms of either depression or substance abuse varied across five levels of severity. Results identified specific levels of impairment at which psychologists were deemed too impaired to (...) practice psychotherapy, as well as significant differences between ratings of increasingly severe impairment. Practical and ethical implications of these results are discussed. (shrink)

There is controversy as to whether children with developmental language disorder (DLD) and those with high-functioning autism plus language impairment (HFA-LI) share similar language profiles. This study investigated the similarities and differences in the production of Chinese negative sentences by children with DLD and children with HFA-LI to provide evidence relevant to this controversy. The results reflect a general resemblance between the two groups in their lower-than-TDA (typically developing age-matched) performance. Both groups encountered difficulties in using negative markers, which (...) suggests that they might be impaired in feature agreement. Slight differences were detected between the two groups. Specifically, children with DLD experienced difficulties with the agreement on the feature [+telic] and that on the feature [+dynamic], while children with HFA-LI had difficulties with the agreement on the feature [+dynamic] and that on the feature [−dynamic]. This study supports the idea of a common symptomatology for the two disorders. More importantly, it suggests that these two disorders, DLD and HFA-LI, are not altogether the same in terms of language impairment. This paper concludes that general labels should not be simply attached to any children with language disorders. Instead, atypical language is very worthy of further analysis in the categorization of language disorders. (shrink)

According to Hendricks Impairment Argument (IA), abortion is immoral because it impairs the fetus. Here, I argue it is not sufficient to show merely that abortion impairs, Hendricks must show that it harms the fetus. If the fetus is not numerically identical to the person it will become, then it isn't harmed by an abortion. But if the fetus is numerically identical to the person it will become, it is harmed by the deprivation of a future of value. However, (...) taking this route ultimately undermines the novelty of the impairment argument. (shrink)

Most democratic countries either limit or deny altogether voting rights for people with cognitive impairments or mental health conditions. Against this weight of legal and practical exclusion, disability advocacy and developments in international human rights law increasingly push in the direction of full voting rights for people with cognitive impairments. Particularly influential has been the adoption by the UN of the Convention on the Rights of Persons with Disabilities in 2007. Article 29 declares that states must ‘ensure that persons with (...) disabilities can effectively and fully participate in political and public life on an equal basis with others, directly or through freely chosen representatives, including the right and opportunity for persons with disabilities to vote and be elected’. This article also argues for the right of all people to vote, including people with cognitive impairments, by adopting a uniquely strategic approach. Firstly, some of the strategic limitations of existing arguments in favour of extending the franchise are highlighted. Most such arguments are flawed because they run the risk of inviting disparaging philosophical commentary which compares disabled people to animals, or because they are based on implausible empirical claims, or because they inadvertently tie the case for voting rights for the disabled to other cases unlikely to ever enjoy widespread acceptance. This article, instead, justifies extending voting rights to all people with cognitive impairments based on a simple cost-benefit analysis that avoids all of these problems. (shrink)

The justice of criminal punishment depends in part on the possibility of holding people accountable for their choices. There is a wide variation between nations on the age at which juveniles can be prosecuted in adult criminal courts. This variation reflects disagreement about the underlying logic of responsibility. This paper examines the philosophical difference between adults and children as agents. The paper argues that the moral status of children is importantly distinct from adults, specifically with respect to how responsibility should (...) be mitigated. The paper explains this in terms of the developmental aspect of childhood. By considering empirical evidence from psychology and neuroscience we can understand the mistakes that juveniles make as a form of developmental impairment. The paper shows why these findings lead to the conclusion that the practice of trying children as adults is immoral and should be eliminated. (shrink)

What should patients know about the degree to which their physicians may be impaired—unable, in the words of the American Medical Association, “to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence”? What patients do in fact find out about such matters as alcohol or other drug abuse by, say, the surgeon or the anesthesiologist in charge of their care is another matter altogether; most patients learn about such (...) impairment the hard way. But what should they know beforehand, if at all possible? (shrink)

We have argued here that to attribute criminal responsibility to psychopathic individuals is to ignore substantial and growing evidence that psychopathic individuals are significantly impaired in moral understanding. They do not appear to know why moral transgressions are wrong in the full sense required by the law. As morally blameless offenders, punishment as a basis for detention cannot be justified. Moreover, as there are currently no successful treatment programs for psychopathy, nor can detention be justified on grounds of treatment. Instead, (...) we argue detention on the grounds of self- defence, due to the severe and continuing threat posed by the psychopathic criminal. (shrink)

In 1968, the Harvard criteria equated irreversible coma and apnea with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors. Since then, clinical studies have defined a spectrum of states of impaired consciousness in human beings: coma, akinetic mutism, minimally conscious state, vegetative state and brain death. In this article, we argue against the validity of the Harvard criteria for equating brain death with human death. Brain death does not disrupt somatic (...) integrative unity and coordinated biological functioning of a living organism. Neurological criteria of human death fail to determine the precise moment of an organism’s death when death is established by circulatory criterion in other states of impaired consciousness for organ procurement with non-heart-beating donation protocols. The criterion of circulatory arrest 75 s to 5 min is too short for irreversible cessation of whole brain functions and respiration controlled by the brain stem. Brain -based criteria for determining death with a beating heart exclude relevant anthropologic, psychosocial, cultural, and religious aspects of death and dying in society. Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis on autopsy; therefore, they do not completely exclude reversible loss of integrated neurological functions in donors. The questionable reliability and varying compliance with these guidelines among institutions amplify the risk of determining reversible states of impaired consciousness as irreversible brain death. The scientific uncertainty of defining and determining states of impaired consciousness including brain death have been neither disclosed to the general public nor broadly debated by the medical community or by legal and religious scholars. Heart-beating or non-heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of physician-assisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs. (shrink)

I argue here that the impairment principle requires clarification. It needs to explain what makes one impairment greater than another, otherwise we will be unable to make the comparisons it requires, the ones that enable us to determine whether b really is a greater impairment than a, and as a result, whether causing b is immoral because causing a is. I then develop two of what I think are the most natural accounts of what might make one (...) impairment greater than another. The quantitative understanding of greater impairment is problematic because it leaves the impairment principle vulnerable to counterexamples; just because impairment b impairs a larger number of abilities or the same number of abilities but for a longer period or to a higher degree does not mean that b is a greater impairment than a. The qualitative understanding of greater impairment is problematic because it does not explain examples of greater impairment used in the literature, means that an abortion is always a qualitatively more severe impairment than causing fetal alcohol syndrome regardless of how the organism is affected, and/or entails that lethal impairment is always greater than nonlethal impairment. (shrink)

A defining characteristic of Alzheimer’s disease is difficulty in retrieving semantic memories, or memories encoding facts and knowledge. While it has been suggested that this impairment is caused by a degradation of the semantic store, the precise ways in which the semantic store is degraded are not well understood. Using a longitudinal corpus of semantic fluency data, we derive semantic network representations of patients with Alzheimer’s disease and of healthy controls. We contrast our network-based approach with analyzing fluency data (...) with the standard method of counting the total number of items and perseverations in fluency data. We find that the networks of Alzheimer’s patients are more connected and that those connections are more randomly distributed than the connections in networks of healthy individuals. These results suggest that the semantic memory impairment of Alzheimer’s patients can be modeled through the inclusion of spurious associations between unrelated concepts in the semantic store. We also find that information from our network analysis of fluency data improves prediction of patient diagnosis compared to traditional measures of the semantic fluency task. (shrink)

Work injury compensation and pensions are often determined according to medical disability rating scales attributing a percentage to each impaired body part or function. Incorporated into central medical–administrative networks of committees and examinations, these produce disability as a calculable space. This article examines the specific case of the Israeli National Insurance regulations regarding work injuries of 1956 and analyzes the shifted order they set. Looking at this system in the specific historical context of transition from the British Mandate workmen’s compensation (...) system to the “disability percentages” system, provides insight into the process of structuring and stabilizing durable numerical forms and the production of centralized government. Drawing on conceptualizations regarding the sociotechnical role of classification systems, I contend that through encoding and calculating classifications of disability, heterogeneity is eliminated and an ordering based on physiology is “black boxed,” illustrating the importance of technoscientific formations in structuring the “medical model of disability.”. (shrink)

In response to criticism of the impairment argument for the immorality of abortion, Bruce Blackshaw and Perry Hendricks appeal to Don Marquis’s future-like-ours (FLO) account of the wrongness of killing to explain why knowingly causing fetal impairments is wrong. I argue that wedding the success of the impairment argument to FLO undermines all claims that the impairment argument for the immorality of abortion is novel. Moreover, I argue that relying on FLO when there are alternative explanations for (...) the wrongness of causing FAS begs the question. I conclude, therefore, that the impairment argument remains unsuccessful. (shrink)

Could it be that if a fetus is not a person abortion is still immoral? One affirmative answer comes in the form of ‘The Impairment Argument’, which utilizes ‘The Impairment Principle’ to argue that abortion is immoral even if fetuses lack personhood. I argue ‘The Impairment Argument’ fails. It is not adequately defended from objections, and abortion is, in fact, a counterexample to the impairment principle. Furthermore, it explains neither what the wrong-making features of abortion are (...) nor what features of fetuses ground their supposed moral significance. By presupposing the fetus lacks personhood and providing no alternate account of the basis of fetuses’ moral significance, there is nothing to constitute abortion’s wrongness. Attempts to modify it fail for the same reasons. Thus, the impairment argument fails to show abortion is immoral. (shrink)