Bioethics: Physical Disability
• Bioethics – and moral and political philosophy more generally – replete with discussion of disability.
• Disability also a very important category politically – e.g. the national disability insurance scheme.
• But what is physical disability?
o Obvious answer: X is disabled if and only if X’s body has some atypical feature or features that
give rise to ongoing disadvantage/hardship of some sort or other for X.
o Problem 1: overly inclusive – c.f. members of oppressed racial minorities.
o Problem 2: definition implies that disability is fundamentally bad for the person who is disabled.
Many disabled people themselves deny this.
• So, just one key question for today: what is physical disability?
• Caveat: focus only on physical disability today. Take up cognitive disability next week.
II. The Social Metaphysics of Disability
• Metaphysics: roughly, questions concerning the fundamental nature of things – e.g. causation, existence,
• The nature of disability is a question in social metaphysics – i.e. a question concerning the fundamental
nature of some social phenomenon.
• First issue: what should we want from a theory of the nature of disability? Barnes (2016, pp. 10-3);
o The theory must deliver the correct verdict in paradigm cases of disability and non-disability.
E.g. people in wheelchairs must count as disabled, members of minority racial groups
(without other health conditions) must not count as disabled.
o The theory must not prejudge normative issues.
I.e. a theory of the nature of disability ought not presuppose that disability is somehow
bad for the disabled.
• First – any such theory would imply that disabled persons who insist that their
disability is not bad for them are mistaken about the nature of their condition.
• Second – any such theory would risk ruling out paradigm cases of disability
(should it turn out that those conditions are not necessarily bad).
Notice: rules out the view that disability is simply any physical condition that makes
someone’s life go worse.
o The theory must be unifying or explanatory.
There are many different kinds of conditions it’s appropriate to treat as disabilities.
One possible account of disability would hold, simply, that a person is disabled if and
only if they have one or more of those conditions.
Such a theory might, in principle, be extensionally adequate (i.e. it might classify as disabled
all and only those persons with genuine disabilities).
But it would not be explanatorily adequate – such a theory would not tell us what disability
• Barnes (2016, p. 12): “Individual disabilities do not, prima facie, have that much
in common with each other. A successful account of disability needs to tell us
what unifies these disparate cases – it needs to explain what (if anything) it is that
individual disabilities have in common with each other.”
o The theory must not be circular.
That’s to say, the theory cannot appeal to what it is supposed explain in doing its
Barnes (2016, p. 13) gives the example of a theory that holds that X is disabled if and
only if X possesses some property that is characteristically subject to ableist prejudice.
Problem: ableism is (in part) prejudice against the disabled.
So the theory is circular – it amounts to saying that a person is disabled if and only if
they’re the subject of prejudice directed towards the disabled. It presupposes what it is
supposed to explain.
II.i. Naturalistic Accounts of Disability
• Naturalistic theories of disability all aim to characterise disability in terms of natural or objective features
of disabled persons’ bodies.
• Normal Functioning
o Views of this kind – following figures like Daniels (2001) – characterise physical disability in
terms of a departure from human beings’ ‘normal functioning’.
Think: a ‘normally functioning’ human being can see, so the blind are disabled etc…
o Simple normal functioning account: X counts as disabled iff X’s body departs in some way from
normal human functioning.
o Barnes (2016, p. 14): account over-generalises – paradigm non-disability cases count as disabilities.
E.g. Michael Phelps.
o So – need to get more precise about which kinds of departures from normal functioning count.
o Refined normal functioning account: X counts as disabled if and only if X’s body departs in
some way from normal human functioning in a manner which hinders their ability to survive or
o Barnes (2016, p. 15): doesn’t solve the over-generalisation problem. For instance;
Accepting that sexual orientation has some biological basis, being gay counts as a
disability – departure from the statistical norm that does not contribute to reproduction.
Certain atypical genetic combinations predispose people to cancer. Clearly bad for
survival – but obviously not a disability.
• Lacking Typical Physical Abilities
o Simple ability theory: X is disabled iff X lacks a physical ability most people have.
o Barnes (2016, p. 16): captures too much. Most people can roll their tongue. But, clearly, the
inability to do so is not a disability.
o Significant impact ability theory: X is disabled iff X lacks a physical ability that most people have,
and the lack of this ability has a substantial impact on X’s daily life.
o Barnes (2016, p. 17): over- and under-generalises.
Under-: some disabilities are not robustly correlated with a lack of a significant ability.
E.g. one who suffers with rheumatoid arthritis does not lack abilities others have. Rather,
they experience chronic pain.
Over-: being petite deprives you of certain abilities (e.g. the ability to reach objects on
high shelves). The cumulative effect of this can have a significant impact on daily life.
But being petite is clearly not sufficient for disability.
o WHO: disability is a “restriction or lack (resulting from an impairment) of ability to perform an
activity in the manner or within the range considered normal for a human being.”
o Barnes (2016, p. 18): such theories are explanatorily inadequate. They shift the question from
‘what is disability’ to ‘what is impairment’?
• Barnes (2016, pp. 21-4): it is very unlikely that any naturalistic account can succeed.
o Barnes (2016, p. 22): “Attempts to explain disability in terms of some feature that disabled
bodies share are plagued by problems of over- and under-generalisation. We specify some
feature we think is distinctive of disabled bodies. But on closer examination, we see that nondisabled bodies can also have that feature, or that disabled bodies can lack that feature. I am
sceptical that there is any feature of human bodies we can point to that is had by all and only
disabled bodies, such that we can explain disability in terms of that feature. And if that’s right,
then there’s nothing about disabled bodies that by itself explains what disability is.”
Idea: disability is such a broad and diverse category that it’s very unlikely that there’s any
single, objective feature of disabled bodies that unifies it. Any attempt to identify such a
feature will lead to over- or under-generalisation.
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