Three of the articles included in this issue of the Journal of Medicine and Philosophy - Ron Amundson and Shari Tresky's "On a Bioethical Challenge to Disability Rights"; Rachel Cooper's "Can It Be a Good Thing to Be Deaf?"; and Mark T. Brown's "The Potential of the Human Embryo" - interact (in various ways) with the concepts of disability, humanity, and personhood and their normative dimensions. As one peruses these articles, it becomes apparent that terms like "disability," "human being," and (...) "person" carry with them great normative significance. There is, however, much disagreement concerning both the definition and the extension of such terms. This is significant because different terms and definitions are associated with different sets of normative requirements. In what follows we reconstruct the argument of each of the articles, and then offer some brief critical analysis intended to stimulate further thought about and discussion of the issues that each raises. (shrink)

The morality of abortion is a longstanding controversy. One may wonder whether it’s even possible to make significant progress on an issue over which so much ink has already been split and there is such polarizing disagreement (Boyle 1994). The papers in this issue show that this progress is possible—there is more to be said about abortion and other crucial beginning-of-life issues. They do so largely by applying contemporary philosophical tools to moral questions involving life’s beginning. The first two papers (...) defend the pro-life view from recent objections involving miscarriage and abortion doctors. The third shows how the social model of disability and the concept of transformative experience applies to classic debates like abortion and euthanasia. The final two papers address how rights and harms apply to children and to beings that do not yet exist. All five papers make a noteworthy contribution to the moral issues that arise at the beginning of life. (shrink)

In this paper, I explore the links between liberal political theory and the evaluative nature of medical classification, arguing for stronger recognition of those links in a liberal model of medical practice. All judgments of medical or psychiatric "dysfunction," I argue, are fundamentally evaluative, reflecting our collective willingness or reluctance to tolerate and/or accommodate the conditions in question. Illness, then, is "socially constructed." But the relativist worries that this loaded phrase evokes are unfounded; patients, doctors, and communities will agree in (...) the vast majority of cases about what counts as illness. Where they cannot come to agreement, however, we are faced with precisely the sort of dispute about values and ways of life that the institutions of the liberal state are designed to accommodate. I accordingly sketch a model of medical practice, based loosely on Jürgen Habermas's political theories, designed to maximize both our awareness and our understanding of these disputes. (shrink)

Social Constructivism about the disease concept has generally been taken to ignore the fundamental biological reality underlying diseases, as well as to fall foul of several apparently compelling objections. In this paper, I explain how the metaphysical relation of grounding can be used to tie a socially constructed account of diseases and their classification to their underlying biological and behavioural states. I then generalize the position by disambiguating several varieties of normativism, including a particularly strong ‘placeholder’ version of social constructivism, (...) and showing that the grounding approach is available to each. I go on to provide what I believe to be the first attempt at a full semantics for disease-talk and disagreement, before using the placeholder to demonstrate on that basis that the most troublesome objections to normativism can be avoided even by very strong versions of the position. (shrink)

This paper asks what it means to say that a disorder is a “real” disorder and then considers whether culture-bound syndromes are real disorders. Following J.L. Austin I note that when we ask whether some supposed culture-bound syndrome is a real disorder we should start by specifying what possible alternatives we have in mind. We might be asking whether the reported behaviours genuinely occur, that is, whether the culture-bound syndrome is a genuine phenomenon as opposed to a myth. We might (...) be wondering whether the condition should rightly be considered a disorder, as opposed to some sort of non-disorder condition. We might want to know whether the culture-bound syndrome is really a distinct disorder, in the sense that scientific classification systems should include it as a separate category, or whether it is just a variant of a universally occurring disorder. I argue that some specific difficulties can arise with determining whether a culture-bound syndrome is a real disorder in each of these three senses. However, the frequent assumption that real disorders will necessarily occur universally, and that those that occur only in certain environments are suspicious is not generally justified. (shrink)

Riassunto: L’impianto cocleare è una neuroprotesi che consente un recupero parziale dell’udito nella persona sorda. Nonostante la sua generale efficacia nel contrastare alcuni dei problemi legati alla sordità, il suo utilizzo è stato fortemente osteggiato da quella parte della comunità sorda che vede nella sordità una forma di identità culturale e non una patologia. Questo articolo inquadra in una prospettiva neuroetica le preoccupazioni della comunità sorda – difficilmente comprensibili agli udenti – esaminando le analogie fra il rifiuto dell’IC e il (...) disagio che si osserva nella popolazione generale relativamente al Potenziamento Cognitivo. Nel PCog, individui sani insoddisfatti delle proprie prestazioni, o comunque desiderosi di migliorarle, ricorrono ad interventi artificiali per potenziare le proprie funzioni cognitive. L’analisi evidenzia come, nel rifiutare l’IC, la comunità sorda possa voler tutelare un insieme di valori non così diverso da quello che la comunità generale richiama spesso nelle sue preoccupazioni rispetto alla diffusione dei PCog. Parole chiave : Impianto cocleare; Potenziamento cognitivo; Sordità; Cultura sorda The cochlear implant as cognitive enhancement? A neuroethical perspective on some issues raised by the deaf community: The cochlear implant is a neuroprosthesis that allows for partial recovery of auditory function in individuals who are deaf. Despite its general efficacy, its use has been strongly opposed by a part of the deaf community that perceives deafness as a form of cultural identity, rather than a pathology. This article considers the concerns of the deaf community – which are often difficult for hearing people to understand – from a neuroethics perspective, proposing that such opposition to CI is analogous to the general population’s unease with regard to Cognitive Enhancement. CE allows healthy individuals who are unsatisfied with – or would like to improve – their performance to use artificial interventions that enhance cognitive functions. The analysis reveals that, when opposing CIs, the deaf community may be protecting a set of values similar to those that the general community often evokes when voicing concerns about CE diffusion. Keywords: Cochlear Implant; Cognitive Enhancement; Deafness; Deaf Culture. (shrink)

The paper focuses on the question of whether it is morally permissible to use reproductive technologies to select children with congenital deafness. I review the arguments that have been presented to support the claims that the lack of hearing is not overall bad, that disability is caused by social discrimination rather than impairment, that the community of deaf people gives its members plenty of opportunities to lead a happy life, and that procreative decisions need not improve the world. I argue (...) that although the claims are, to a certain extent, reasonable, they fail to establish the conclusion that selecting for deafness is morally permissible. I further argue that the decision to select a deaf child is morally wrong because it results in imposed and needless dependency, that the happiness of a deaf child is conditioned by their confinement to a relatively small community, and that the deaf parents who reject their child’s potential biculturalism are motivated by questionably self-regarding reasons. (shrink)

This thesis argues that the nature of disability is, currently, fundamentally misunderstood. Current approaches to disability are nounal and seek to determine the locus of disability with the intention of better understanding the phenomenon of disability. In contrast, this thesis offers an adverbial perspective on disability and shows how disability is experienced as an increased and personally irremediable impediment to daily-living tasks or broader goals. This thesis holds that impediment is not a function of either biological individuality or the Social, (...) but of a specific relation between the individual and their environment. The following delineates the Picture Theory of Disability — a mechanism for the evaluation of the experience of disability and a heuristic device for the proper interpretation of disability. The theory is born of Humean sentimentalism and elements of Wittgenstein’s Picture Theory of Language, and shows when, where, and how disability is experienced. (shrink)

Spanish Translation of "He/She/They/Ze" (Ergo, 2018).

This paper uses the fictional case of the ‘Babel fish’ to explore and illustrate the issues involved in the controversy about the use of cochlear implants in prelinguistically deaf children. Analysis of this controversy suggests that the development of genetic tests for deafness poses a serious threat to the continued flourishing of Deaf culture. I argue that the relationships between Deaf and hearing cultures that are revealed and constructed in debates about genetic testing are themselves deserving of ethical evaluation. Making (...) good policy about genetic testing for deafness will require addressing questions in political philosophy and anthropology about the value of culture and also thinking hard about what sorts of experiences and achievements make a human life worthwhile. (shrink)