Michael Stingl's sensitive paper links two debates now dominating contemporary Western societies: the debate on euthanasia and the debate on healthcare reform. The link is important for both practical and theoretical reasons. Given the rise of national expenditures for healthcare, most governments have a strong interest in cost containment. In various countries we see reduced accessibility to healthcare services and facilities, albeit for different reasons. Sometimes healthcare is largely a matter of private insurance, as in the United States; sometimes shifts (...) are made toward rising financial copayments for the use of particular services, as seems to be the case in Canada and in many European countries; sometimes accessibility is reduced by waiting lists, characteristic of systems with socialized medicine such as in Britain and the Netherlands. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 91-97 [Access article in PDF] The Ambiguities of "Meaning":A Commentary Hans S. Reinders "Death, Disability, and Dogma" by Jennifer Clegg and Richard Lansdall Welfare (2003) is a rich paper that presents an unexpected but interesting mixture of observations and perspectives on mourning, grief and bereavement in the lives of people with intellectual disabilities.In a number of ways, the notion of meaning is prominent (...) in the paper. The authors observe that recent literature on grief and bereavement because of loss of loved ones does not confirm the "stage theory of loss." Instead there is a "multiplicity of possible responses to bereavement," which is partly explained by the role of cultural diversity. Cultural diversity is particularly involved in the development of "meanings" about loss (2003, 69). However, looking into the literature on grief and bereavement among persons with intellectual disabilities, the authors found that literature "dogmatic" in that it sticks to the traditional theoretical framework of "grief work" (2003, 74). The authors offer an explanation for this "stuck discourse": The approach to grief and bereavement among people with intellectual disabilities is framed within the philosophy of normalization. This leads professionals to downplay limitations to the potential of their clients in ways that encourage the denial of disability. The meaning assigned to intellectual disabilities, this is to say, is primarily positive. This positive outlook promotes the "belief in the apparently limitless potential of the client group to develop skills and autonomy if only they are given the right help" (2003, 71). The authors read this promoting of positive meaning as a counter strategy: our culture in general does not seem to be convinced of a valued meaning of life for persons with intellectual disabilities. Therefore, the professional world of service systems adopts a strategy of "separitism" (2003, 77), which explains why approaches to phenomena like grief and bereavement are "stuck" with ideas that are inadequate. The professional community attending those with intellectual disabilities is too much a world on its own. There should be more interaction between generalists and specialists on the subject of grief and bereavement.So far the general argument of the paper. Because my own area of research is not in the fields of clinical psychology or psychiatry, it cannot be my task to comment on Clegg and Lansdall-Welfare's presentation of the research on grief and bereavement in these fields. Nonetheless, there are a few points in their review of the literature that I will briefly address, but only to prepare the way for the major topic of this commentary, which is the issue of meaning as it relates to intellectual disability.Intuitively, my sympathy would lie with social critics arguing for caution with regard to the [End Page 91] medicalization of mourning and grief (Clegg and Lansdall-Welfare 2003, 67-79). The loss of loved ones will oftentimes be a traumatic experience, but when it is, I tend to see the symptoms of distress following that experience as a sign of mental health, more than anything else. Losing a parent, sibling, or someone else who has been part of one's life, is not only missing the other person, it is missing a part of oneself. That being the case, it is only to be expected that, in some sense, life will never be again what it was. Replacing notions of recovery from a traumatic experience by notions of "adaptation and accommodation" (2003, 68) appears to me the more sensible approach.Therefore, I tend to be suspicious about notions such as "pathological grief." From a philosophical point of view, such a notion seems to betray a modernist conception of the human subject in control of its own action. Following that conception, human beings need to transform that which happens to them by means of their own action so that they have made it part of themselves. Being overcome with grief one is in an emotional state that as such is "pathological"—as Immanuel Kant had it—the main characteristic of which is its heteronomy. A person overcome by grief is controlled by passion instead... (shrink)

This paper presents Hans Ulrich's account of Christian ethics as an ethics of `vocation'. It is interested in how Ulrich's account of vocational ethics is developed as a critique of professional ethics. Professional ethics is seen as reflecting the structures of ethical deliberation of the social order that produces it, thereby failing to move beyond the realm of `works'. In contrast, the distinguishing characteristic of Ulrich's vocational ethics is shown to be that it is a response to the Word `from (...) outside'. Consequently, a Christian account of professional ethics needs to show how it can retain a `theological difference' that enables it to respond to the Word that `breaks in' to start something new. The paper discusses the transformation of professionalism in a neo-liberal service economy in order to find out how this `breaking in' actually proceeds. Its test case is providing services to people with intellectual disabilities. (shrink)

Assuming that theological anthropologies are put to work for particular historical projects, this essay examines recent contributions in this area in view of the project of inclusion. It claims that theological arguments in support of both the end and means of inclusion neglect the fact that from the perspective of creation, inclusion is the default position, and therefore requires no argument. Disability experience is not merely something that needs to be overcome. An alternative strategy is to consider an ecological view (...) on disability by looking at the notion of ‘weeds’ as a conceptual byproduct of human design. The essay concludes that this perspective generates different questions that enable us to think about disability in terms of the goodness of being. (shrink)