Dependency is fundamental to caring relationships. However, given that dependency implies asymmetry, it also brings moral problems for nursing. In nursing theory and theories of care, dependency tends to be framed as a problem of self‐determination—a tendency that is mirrored in contemporary policy and practice. This paper argues that this problem frame is too narrow. The aim of the paper is to articulate additional theoretical ‘problem frames’ for dependency and to increase our understanding of how dependency can be navigated in (...) practices of long‐term care. It does so by way of an empirical ethical analysis of how care professionals tackle the problem of dependency in group homes for people with intellectual disabilities. The paper refers to these practices of mitigating the problem of dependency as ‘dependency work’, a phrase borrowed from Eva Kittay. The analysis of dependency work suggests that for care professionals, dependency is a threefold problem: one of self‐determination, one of parity and one of self‐worth. These findings suggest that patient autonomy cannot be a full solution to the problem of dependency in long‐term care relations. But they also show that dependency as such is not a problem that can be solved, as attempts to mitigate it only serve to tighten the dependency relationship further. This is the paradox of dependency work. (shrink)

The goal of inclusion is more or less credible depending in part on what it is that learners have in common. I discuss one characteristic that all learners are thought to share, although the learners I am concerned with represent an awkward case for the aspiration of inclusivity. Respect is thought of as something owed to all persons, and I defend the view that this includes persons with profound and multiple learning difficulties and disabilities. I also consider the implications of (...) respecting profoundly disabled learners for teaching and learning, and three aspects in particular: treating the profoundly disabled learner as a person; the close relationship between teaching and caring for a vulnerable learner; and individualised learning as an element of a successful teaching and learning environment. (shrink)

The goal of inclusion is more or less credible depending in part on what it is that learners have in common. I discuss one characteristic that all learners are thought to share, although the learners I am concerned with represent an awkward case for the aspiration of inclusivity. Respect is thought of as something owed to all persons, and I defend the view that this includes persons with profound and multiple learning difficulties and disabilities. I also consider the implications of (...) respecting profoundly disabled learners for teaching and learning, and three aspects in particular: treating the profoundly disabled learner as a person; the close relationship between teaching and caring for a vulnerable learner; and individualised learning as an element of a successful teaching and learning environment. (shrink)

What does dependency reveal about human learning? All humans are dependent, largely because we are variously vulnerable and disabled at more than one stage in our lives. In this paper the subject of dependency is approached largely in the context of our vulnerable and disabled states, including in particular, states of profound disability. The primary contention is that our dependent states should feature in accounts of how we learn, and of relations between learner and teacher, in ways that compare with (...) the attention given to personal autonomy and independence. (shrink)

What does dependency reveal about human learning? All humans are dependent, largely because we are variously vulnerable and disabled at more than one stage in our lives. In this paper the subject of dependency is approached largely in the context of our vulnerable and disabled states, including in particular, states of profound disability. The primary contention is that our dependent states should feature in accounts of how we learn, and of relations between learner and teacher, in ways that compare with (...) the attention given to personal autonomy and independence. (shrink)

In this paper I argue that reflection on competence and enfranchisement in relation to profound disability forces re-examination of the grounds of citizenship, with implications for theories of distributive justice in education. The primary purpose is less to point up that some people are disenfranchised without injustice; it is more to advance the view that, since enfranchisement is not an option for some profoundly disabled people, we require a conception of citizenship that is more sensitive to their distinctive needs and (...) interests. (shrink)

Dependency functions as a keyword in care theory. However, care theorists have spelled out the ontological and moral ramifications of dependency in different and often conflicting ways. In this article, I argue that conceptual disputes about dependency betray a fundamental discordance among authors, rooted in the empirical premises of their arguments. Hence, although authors appear to share a vocabulary of dependency, they are not writing about quite the same phenomenon. I seek to elucidate these differences by teasing out and comparing (...) different conceptions of dependency found in the literature. Borrowing a phrase from Eva Kittay, I trace four “paradigm cases” of dependency: the infant, the physically disabled person, the profoundly intellectually disabled person, and the refugee. These paradigm cases serve as the empirical touchstone from which theorists extract their conceptions of dependency. Each paradigm case, moreover, permits a particular ethical sensibility toward care. How we understand and value dependency thus seems to determine how we understand and value care, and vice versa. In this way, I contend, our normative orientation toward care might influence what sorts of dependency we see—and, by extension, which forms of dependency we fail to notice. (shrink)

How do we know which institutions provide good care? Some scholars argue that the best way to think about care institutions is to model them upon the family or the market. This paper argues, on the contrary, that when we make explicit some background conditions of good family care, we can apply what we know to better institutionalized caring. After considering elements of bad and good care, from an institutional perspective, the paper argues that good care in an institutional context (...) has three central foci: the purpose of care, a recognition of power relations, and the need for pluralistic, particular tailoring of care to meet individuals? needs. These elements further require political space within institutions to address such concerns. (shrink)

This article is a feminist intervention into the ways that disability is researched and represented in philosophy at present. Nevertheless, some of the claims that I make over the course of the article are also pertinent to the marginalization in philosophy of other areas of inquiry, including philosophy of race, feminist philosophy more broadly, indigenous philosophies, and LGBTQI philosophy. Although the discipline of philosophy largely continues to operate under the guise of neutrality, rationality, and objectivity, the institutionalized structure of the (...) discipline implicitly and explicitly promotes certain ontologies, epistemologies, and methodologies as bona fide philosophy, while casting the ontologies, epistemologies, and methodologies of marginalized philosophies as mere simulacra of allegedly fundamental ways of knowing and doing philosophy and thus rendering these marginalized philosophies more or less expendable. This article is designed to show that legitimized philosophical discourses are vital mechanisms in the problematization of disability. (shrink)

In this paper, I argue that disabled people have a right to assistive technology, but this right cannot be grounded simply in a broader right to health care or in a more comprehensive view like the capabilities approach to justice. Both of these options are plagued by issues that I refer to as the problem of constriction, where the theory does not justify enough of the AT that disabled people should have access to, and the problem of overextension, where the (...) theory cannot adequately identify an upper limit on the AT that people have a right to. As an alternative to these justificatory frameworks, I argue that disabled people are owed access to AT at the expense of nondisabled people as a matter of compensatory justice. That is, I defend the position that disabled people are owed AT as part of due compensation for the harms they experience from being disadvantaged by society’s dominant cooperative scheme and the violation of their right to equality of opportunity that such disadvantage entails. I also propose a method for identifying an upper limit to what this right to AT requires. In this way, I argue that compensatory justice avoids both the problem of constriction and the problem of overextension. (shrink)

: Using Judith Butler's notion that bodies are materialized via performances, "resignifying" disability involves a "democratizing contestation" of staircases because they exclude those in wheelchairs. Paleoanthropologist Maxine Sheets-Johnstone shows how consistent bipedal locomotion, together with the knowledge that we will die (upon which mutuality is based), are ingredients of our pan-hominid speciation, not contingent constructions. As axiologically important as contestation is, it forecloses the possibility of achieving a mutuality with others, that is wonderfully possible.

Using Judith Butler's notion that bodies are materialized via performances, “resig-nifying” disability involves a “democratizing contestation” of staircases because they exclude those in wheelchairs. Paleoanthropologist Maxine Sheets-Johnstone shows how consistent bipedal locomotion, together with the knowledge that we will die, are ingredients of our pan-hominid speciation, not contingent constructions. As axiologically important as contestation is, it forecloses the possibility of achieving a mutuality with others that is wonderfully possible.

Care ethics takes as central the discerning of needs in those being cared for and attempts to meet those needs. Perceptive caring agents are more likely to be able to identify needs in those for whom they are caring. The identification of needs is no small matter, not least in teaching encounters. This paper modestly proposes that at least some of the needs a caring agent should attempt to meet are a function of the identity of the patient of caring (...) action. Taking Nel Noddings’ account of care ethics as representative, I present it in outline. This leads to the needs-identification problematic. Following this I turn to Soran Reader’s account of needs. I interpret this to offer what I designate as identity as ‘what-ness’. Such an understanding of identity-based needs is a starting point for the caring agent but a more nuanced account, of identity as ‘who-ness’, is argued to be preferable. Identity as ‘who-ness’, as expressed in Paul Ricoeur’s work, advances the discussion, culminating in his concept of the ‘capable human being’. Having brought this aspect of Ricoeur’s thought into conversation with care ethics, I offer an account of identity-based needs conducive to the broader aims of the care ethical project. Finally, I consider what this bolstered account of care ethics might say about a brief and illustrative teaching encounter. (shrink)

Understanding and empathy on the part of those in privileged positions are often cited as powerful tools in the fight against oppression. Too often, however, those in positions of power assume they know what it is like to be less well off when, in actuality, they do not. This kind of assumption represents a thinking vice we dub synecdoche epistemic arrogance. In instances of synecdoche epistemic arrogance, a person who has privilege wrongly assumes, based on limited experiences, that she can (...) know what it is like to experience a particular form of oppression. We argue two main points. First, synecdoche epistemic arrogance can lead to a variety of moral harms. Second, synecdoche epistemic arrogance is often tied to other troubling epistemic patterns, which we discuss in the context of disability and race simulations. Overall, the essay helps demonstrate how synecdoche epistemic arrogance can contribute to injustice. (shrink)

Bei der Bemühung um die Emanzipation von körperlich oder geistig beeinträchtigten Menschen kommt es häufig zu einer vehementen Kritik an einem "medizinischen Konzept" von Behinderung. Diesem wird aus Sicht einer "Bürgerrechtsperspektive" entgegengehalten, es gelte nicht, die Menschen zu korrigieren, sondern die Umwelt so zu verändern, dass Betroffene ungehindert am gesellschaftlichen Leben teilhaben können. Nach Auffassung der "Normalisierungskritik" sind es Stereotypen und Stigmata, die es Behinderten erschweren, ein selbstbestimmtes Leben zu führen. Beide Ansätze ignorieren oder bagatellisieren jedoch aus systematischen Gründen die (...) Art und Weise, in der Betroffene ihre physische oder psychische Schädigung subjektiv erfahren. Deshalb kann auch nicht auf die erheblichen Unterschiede reflektiert werden, die zwischen verschiedenen Formen der Behinderung bestehen. Es ist jedoch verfehlt, die Feststellung, dass Behinderte häufig in spezifischer Art bedürftig sind, mit paternalistischer Herablassung gleichzusetzen. Gerade für ein zuträgliches Verhältnis von Medizinern und Behinderten ist es wichtig, exakt jene Differenzen zu berücksichtigen, die zwischen akuten Krankheiten und verschiedenen Formen chronischer Beeinträchtigung bestehen. Nur so können Ärzte dazu veranlasst werden, von einer allzu "interventionsfreudigen" Haltung Abstand zu nehmen. (shrink)

Given that many people with disabilities have been excluded from political deliberation and subjected to infantilizing and degrading treatment from others, many members of the disability rights movement are understandably critical of policies and practices that speak on behalf of people with disabilities and presume to know what is really in their best interest. Yet, this analysis argues that a general principle of anti-paternalism is not desirable for disability politics. In particular, people with cognitive disabilities are sometimes unable to make (...) important decisions by themselves, and may require assistance from family members or more cognitively able and verbally fluent citizens to make their political voices and choices heard. Drawing from John Locke and Alasdair MacIntyre, this article reconsiders the relationship between paternalism and autonomy, suggesting that autonomous decisionmaking and expression are best thought of as collaborative processes undertaken between people with a range of capacities. (shrink)

Historically, philosophers have had little to say about justice and disability. However, in recent years and in response to disability rights movements, philosophers have started to consider the claims to justice of persons with mental and physical impairments. Importantly, some have charged that without extensive revision, social contract accounts of justice – which enjoy immense popularity among political philosophers – cannot address the needs and interests of persons with disabilities. In this article, I explain why social contract accounts are thought (...) to flounder when it comes to justice for persons with disabilities. Then I assess the merits of recent attempts to construct theories of justice inclusive of persons with disabilities. In particular, I consider Nussbaum’s capabilities approach, Kittay’s justice as caring, and various restatements of the social contract. (shrink)

My purpose in this essay is to locate disabled women within the women's movement as well as the disability movement in India. While foregrounding the existential realities for disabled women in the Indian scene, I underscore the reasons for their absence from the agenda of Indian feminism. I conclude by reflecting on the possibilities of inclusion within Indian feminist thought.

My purpose in this essay is to locate disabled women within the women's movement as well as the disability movement in India. While foregrounding the existential realities for disabled women in the Indian scene, I underscore the reasons for their absence from the agenda of Indian feminism. I conclude by reflecting on the possibilities of inclusion within Indian feminist thought.

Proponents of the legalization of assisted suicide often appeal to our supposed right to "die with dignity" to defend their case. I examine and assess different notions of "dignity" that are operating in many arguments for the legalization of assisted suicide, and I find them all to be deficient. I then consider an alternative conception of dignity that is based on Aristotle's conception of the conditions on the best life. I conclude that, while such a conception of dignity fits best (...) with our intuitions about the conditions under which a life has dignity, it supports the legalization of assisted suicide only under very limited circumstances. (shrink)

Philosophy Compass, Volume 17, Issue 4, April 2022. -/- In a moment where needs for care are acute and their provision precarious, feminist care ethics has gained new relevance as a framework for understanding and responding to necessary interdependence. This article reviews and evaluates two long-standing critiques of care ethics in light of this recent research. First, I assess what I call the pluralist feminist critique, or the dispute over the ability of care ethics to address the needs and histories (...) of a range of marginalized subjects. I identify two forms of this critique: the first disputes the biased starting points shaping the development of the theory, and the second concerns the weaponization of care in support of domination. Although these critiques are well-established, I draw attention to recent responses that move care theory in generative directions. I argue that the pluralist feminist critique demands both self-critical transformation in dialog with other feminist schools of thought and a robust account of care ethics' normative authority. I then take up critiques those levied by mainstream ethicists concerned with care theory's adequacy as an ethical approach. I show that recent work on normative authority, conceptual uniqueness, and the grounding of responsibility must be engaged before care theory can be dismissed as “under-theorized.” In articulating these two sets of critiques and evaluating recent rebuttals to them, I argue for a pluralist feminist theory of care within which strands informed by varying philosophical schools and methods can coexist. (shrink)

This paper queries the absence of disabled voices in contemporary citizenship literature. It argues that the language and imagery of the citizen is imbued with hegemonic normalcy and as such excludes disability. Feminist perspectives, such as those which argue for a form of maternal citizenship, largely fail to acknowledge disability experiences. Exclusionary practices are charted and links are made between gender, race and disability in this process. A citizenship which acknowledges disability is fundamental to re-imaging local, national and international collectivities.

Sufficientarians face a problem of arbitrariness: why place a sufficiency threshold at any particular point? One response is to seek universal goods to justify a threshold. However, this faces difficulties (despite sincere efforts) by either being too low, or failing to accommodate individuals with significant cognitive disabilities. Some sufficientarians have appealed to individuals’ subjective evaluations of their lives. I build on this idea, considering another individualized threshold: ‘tolerability’. I respond to some traditional challenges to individualistic approaches to justice: ‘expensive’ tastes, (...) and adaptive preferences. Finally, I end by offering some suggestions about how this relates to policymaking. (shrink)

This Introduction to the collection of essays surveys the philosophical literature to date with respect to five central questions: justice, care, agency, metaphilosophical issues regarding the language and representation of cognitive disability, and personhood. These themes are discussed in relation to three specific conditions: intellectual and developmental disabilities, Alzheimer's disease, and autism, though the issues raised are relevant to a broad range of cognitive disabilities. The Introduction offers a brief historical overview of the treatment cognitive disability has received from philosophers, (...) and explains the specific challenges that cognitive disability poses to philosophy. In briefly summarizing the essays in the collection, it highlights the distinctive contributions the collection makes to ethics, political philosophy, bioethics, and the philosophy of disability. We hope that the richness of the topics explored by these essays will be a spur to further investigation. (shrink)

This essay explores various philosophical approaches to cognitive disability within feminist philosophy. In doing so, it addresses three broad questions: What positive contributions can feminist philosophy make to the philosophy of cognitive disability? How have feminist philosophers critiqued the presence and absence of cognitive disability in philosophy? And what challenges does cognitive disability pose to feminist philosophy itself? The essay begins with definitions and models of disability and then turns to feminist work on cognitive disability in moral and political philosophy, (...) bioethics, and epistemology. It concludes with some methodological considerations. (shrink)

This paper examines five groups of women that were instrumental in the emergence of the category of “feeblemindedness” in the United States. It analyzes the dynamics of oppression and power relations in the following five groups of women: “feebleminded” women, institutional caregivers, mothers, researchers, and reformists. Ultimately, I argue that a feminist analysis of the history of mental retardation is necessary to serve as a guide for future feminist work on cognitive disability.

This paper examines five groups of women that were instrumental in the emergence of the category of "feeblemindedness" in the United States. It analyzes the dynamics of oppression and power relations in the following five groups of women: "feeble-minded" women, institutional caregivers, mothers, researchers, and reformists. Ultimately, I argue that a feminist analysis of the history of mental retardation is necessary to serve as a guide for future feminist work on cognitive disability.

The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their ‘sameness’. As a result, most care providers try to enable people with intellectual disabilities to live and participate in ‘normal’ society, ‘in the community’. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81–90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically different take on what social inclusion (...) for people with intellectual disabilities looks like: places known as ‘sheltered living institutions’. We argue these places can be seen as ‘communities of difference’ catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness. (shrink)

Despite being assailed for decades by disability activists and disability studies scholars spanning the humanities and social sciences, the medical model of disability—which conceptualizes disability as an individual tragedy or misfortune due to genetic or environmental insult—still today structures many cases of patient–practitioner communication. Synthesizing and recasting work done across critical disability studies and philosophy of disability, I argue that the reason the medical model of disability remains so gallingly entrenched is due to what I call the “ableist conflation” of (...) disability with pain and suffering. In an effort to better equip healthcare practitioners and those invested in health communication to challenge disability stigma, discrimination, and oppression, I lay out the logic of the ableist conflation and interrogate examples of its use. I argue that insofar as the semiosis of pain and suffering is structured by the lived experience of unwelcome bodily transition or variation, experiences of pain inform the ableist conflation by preemptively tying such variability and its attendant disequilibrium to disability. I conclude by discussing how philosophy of disability and critical disability studies might better inform health communication concerning disability, offering a number of conceptual distinctions toward that end. (shrink)

Having and raising children is widely regarded as one of the most valuable projects a person can choose to undertake. Yet many disabled people find it difficult to share in this value because of obstacles that arise from widespread social attitudes about disability. A common assumption is that having a disability tends to make someone unfit to parent. This assumption may seem especially relevant as a factor in decisions about whether to allow, encourage and assist disabled people to reproduce and (...) raise children. Yet there are reasons to doubt whether there is such a close connection between having a disability and lacking the ability to raise a child well. The aims of this paper are, first, to identify and clarify some values that are relevant to questions about allowing, encouraging and assisting disabled people to procreate and raise children, second, to give an overview of how these values can help us to address certain legal questions that arise for disabled people who aim to procreate and parent, third, to raise concerns about how to properly assess the parenting capacities of people with disabilities, and fourth, to suggest some ways in which having a disability can actually make someone a better parent. (shrink)