Forthcoming in The Ethics of Ability and Enhancement (London: Palgrave Macmillan) A MORE “INCLUSIVE” APPROACH TO ENHANCEMENT AND DISABILITY David Wasserman, National Institutes of Health Stephen M. Campbell, Bentley University Introduction Discussions of enhancement and disability tend to draw a sharp line between modifications to the individual and modifications to her environment. According to one popular conception, an enhancement is an improvement to or within one’s body or mind that enables one to exceed species-typical functioning in some respect. The narrow focus on such “internal improvements” is shared by most proponents and critics of various forms of enhancement.1 An equally sharp line between the individual and her environment is drawn in disability scholarship. Thus, the so-called “medical” model of disability identifies disability with a physical or cognitive impairment that places one below species-typical functioning in some respect. It therefore treats disability as a feature of the individual, not of her environment. The social model of disability, which arose as a critical response to the medical model, sees disability as emerging from the interaction between the individual’s condition and her environment.2 However, this view is standardly enlisted in support of modifications to the environment rather than modifications to the bodies or minds of disabled people. Thus, like the medical model, it embraces the strong distinction between environmental modifications and bodily modifications. But, unlike the medical model, it is sharply opposed to the push for human enhancement, narrowly conceived. We seek to complicate this picture by highlighting three types of enhancement that defy the narrow conception insofar as they go beyond mere bodily modification. They call for a broader, more inclusive understanding of enhancement. In arguing for this broader understanding, we also raise questions about the social model of disability. Without entirely rejecting a presumption in favor of environmental modifications, we contend that a sharp dichotomy between changes to the individual and the environment obscures significant conceptual complexities and moral tradeoffs and ignores the extent to which technology itself may blur the boundaries between the individual and her environment. 1 Our discussion will focus on physical impairments and enhancements related to mobility. This is an area where recent technology is bringing about dramatic improvements, all along the spectrum from prosthetic limbs to driverless cars. Focusing on these technologies will allow us to challenge narrow understandings of enhancement and disability without entering into the controversies over certain kinds of enhancement, especially intellectual and moral enhancement.3 Questioning a Narrow Conception of Human Enhancement It is certainly understandable that the enhancement debate has focused on “internal improvements.” The focal point of that debate is the actual or anticipated applications of biotechnology to individual bodies and minds. Such developments are quite recent. Most of the technological advances in human history, from agricultural cultivation to electronic communication, did not appear to modify their human beneficiaries, or did so only indirectly. Fritz Allhoff et al. defend a conception of enhancement as improvement to or within the body, including implanted devices such as brain chips. The internal/external distinction they favor is not based on the notion of a natural or organic body, since it includes (some) wearable tools as well: [w]e might reasonably understand the distinction between human enhancement and mere tools by looking for an always-on (i.e., on-demand or permanent) feature, as opposed to the temporary or contingent access of our daily gadgets and tools (e.g., a mobile phone that can be easily lost, stolen or left behind).4 They argue for a narrow conception on the grounds that treating enhancement as “the mere use of tools would render the concept impotent, turning nearly everything we do into cases of human enhancement.5 In contrast, we will argue that a narrowly focused conception of human enhancement, however understandable, is misguided. The position of Alhoff, et al., strikes us as mistaken for several reasons. First, it ignores the fact that, in many cases, a feature can be “always on,” “permanent” or “on demand” only in a congenial environment. This is not to deny that the range of congenial environments may be wider or narrower for a given feature. But dependence may also vary across environments: some features may be more permanent, accessible and reliable in certain environments; other features in others. Electronic implants may depend on the vagaries of transmission as much as mobile phones do. In general, the functioning of specific “internal” devices may be as environmentally contingent as the functioning of “external” ones. Accessibility and reliability do not track an ordinary external/internal distinction. Internal equipment can be controlled or influenced by external 2 agents or forces, and external equipment can be reliably accessible to and controllable by the individual. An individual with the latest Google translation app may have a more enhanced ability to converse in a foreign language than an individual with an implanted chip containing an earlier version. And a breakdown in an internal chip may be more disruptive and costly than a breakdown in an app. Moreover, we may sensibly regard both the app and implant users as having the capacity to converse in the foreign language. We could see the translation app as extending the mind of one, the translation chip as enriching the mind of the other. Finally, it is a commonplace in the philosophy of action that conduct and capacity can be described at varying levels of generality.6 For example, we can describe the act of walking either more narrowly, in terms of various combinations of its various component voluntary actions, or more broadly, in terms of “locomoting,” or even more broadly, as getting from place to place. The broader the description of the conduct or capacity, the more likely it is to encompass the use of what Allhoff et al. regard as mere tools. While walking can be done unaided or with a cane or walker, “locomoting” can also be done with a wheelchair; and a vast array of vehicles can get us us from place to place. The narrow conception of enhancement tends to rely on narrower levels of description. But we have yet to see a good argument for limiting the discussion of enhancement this way.7 Enhancement at a narrow level of description need not result in enhancement at a broader level of description. Some athletic and gymnastic abilities, for example, require a balance between the strength or flexibility of the component body parts that might be impaired by the enhancement of only one of them. In part for this reason, training for one kind of athletic or gymnastic event may interfere with training for another. There need not be such a direct conflict between efforts to enhance more narrowly described functions, like walking, and efforts to increase more broadly described functions, like getting from place to place – efforts that can involve the use of external devices such as bicycles, segways, and express buses. But such efforts may compete for individual commitment, institutional priority, and public funding. Broader levels of description have the advantage of being more “inclusive”. As recent work in the philosophy of disability has argued, the broader the level of description, the less likely the activity is to be precluded by more narrowly defined impairments (Wasserman, 2001). Thus, someone paralyzed below the hip cannot walk, but can get from place to place in a wheelchair, car, or other vehicle. We are not claiming that there is a correct level of description for all purposes, or that broader levels of description are more apt regardless of context. Indeed, the broadest levels of description, such as “achieving goals” or “engaging in purposeful activity” would be far too general to be helpful in almost any practical context. Our claim is merely that broader levels are 3 appropriate and useful in assessing the various means by which humans can now, or will soon be able to, do things with technology.8 Three Types of Broad Enhancement Without providing a precise definition of broad enhancement, we will limit our discussion to modifications which require both “internal” and “external” changes.9 The internal changes may be as minimal as learning to operate a complicated device, by hand or by thought; the external changes may be as minimal as creating public repositories of detachable prosthetics or extenders, accessible at different times to a variety of users (like bikeshare stands). In requiring some change in the individual as well as the environment, our notion of enhancement is narrower than Allen Buchanan’s (see n.8), which includes scientific advances from which an individual may benefit in an entirely passive way. There are three ways of improving function that call for the broader understanding of enhancement we are proposing. The first, most familiar, is the use of “assistive technology” – technology designed for individual use and targeted for people with disabilities. Such technology does not modify the body but does enhance its functioning, broadly construed. Assistive devices are operated using typical functions – pushing a walker, rolling a simple wheelchair, or using an electronic chair by moving a stick, pressing a button, or even blinking one’s eyes. Assistive technology involves no modification of the individual, except to the extent that it is seen as extending her body In contrast, the second type of enhancement involves such bodily modifications as attaching a prosthetic, extender, or exoskeleton. These parts need not resemble, or function the same way as, typical parts; indeed, they may serve the individual better if they do not. More than assistive devices, they may be seen as extensions, or even parts, of the user’s body. At the same time, they often have features that make them seem less like body parts and more like tools: they may, for example, be detachable and adjustable. These two types of broad enhancement come together in a third: brain-machine interfaces (BCIs). BCIs enable an individual to manipulate objects at a distance from his body by using a computer that “reads his thoughts,” or more accurately, responds to patterns of neural activity he has been trained to generate. Although BCIs currently use implants or electrodes, in the near future they will be able to operate without any physical connection. In what follows, we suggest that all three types of modification raise questions about the boundary between the body and the environment. In the case of the first and third, this is in part because they often can work only with complementary modifications to a previously uncongenial environment. In the case of the second, this is because the prosthetics, extender, or exoskeleton, 4 even if temporarily attached and integrated with the biological body, usually can be separated from its user and often made available to others. 1) Employing Assistive Technology to Improve Activity Performance Often, there is a choice between training that improves an impaired species-typical function and training that circumvents it by the use of unimpaired functions and assistive devices. The latter may be more effective at improving activity broadly conceived, and may often enable the individual to do better in that activity than she could using species-typical functions. Disability critics challenge the traditional presumption in physical rehabilitation for restoring speciestypical function like leg motion when only slight gains in mobility are likely to be achieved that way, and significantly greater gains are likely from mastering other means of locomotion, using assistive devices like walkers or wheelchairs.10 To enable people with mobility impairments to get around, though, it is not enough to provide individuals with assistive devices and training in their use. Those devices have limited value in making their users mobile without complementary environmental modifications, such as ramps, elevators, curb-cuts, and wide doors that open electronically. Conversely, such environmental features can be useless in the absence of the corresponding technologies they were designed to accommodate. So, even though we can distinguish the individual and environmental components of an inclusive environment, the enhancement should be seen as encompassing both. 2) Broadening the Type of Bodily Modifications A second type of broad enhancement modifies the body, at least in the limited sense that it is temporarily attached to it and moves in coordination with it. This category includes standard prosthetics, which attempt, with growing success, to mimic the appearance and performance of natural body parts. But this type of modification also includes attachable parts that do not look or function like biological parts, like the running “blades” of Oscar Pistorius. Some of these attachments, like Hugh Herr’s bionics, are modeled after biological limbs and joints, although they do not look like them.11 They function similarly, but in some cases, more efficiently, than those body parts, more efficiently and they can be designed not only as prosthetics for individuals with impaired or missing parts, but as supplements for individuals with the standard complement of parts.12 Without addressing the complex and contested issue of what it means to regard an object as an incorporated body part rather than a mere tool, it is clear that these inorganic additions will have features that biological body parts lack. Most will be detachable, many by the user herself. Some will have adjustable dimensions, color and texture. Some will be available for nondisabled as well as disabled users, with different attachment features. And some may be flexibly designed 5 for a variety of temporary users, to be borrowed or rented, rather than owned. All of these features would make the attachments seem less “internal” to the current user. 3) Moving Distant Objects: Brain-Machine Interfaces Emerging technologies for the computer-mediated control of objects outside the corporeal body require only normal psychological functioning. They can be employed by any human being, however physically impaired, who has the cognitive capacity to reliably produce specific thoughts or images that a computer can translate into signals to a detached movable device. The paralyzed user of a BCI will not be enhanced in a narrow sense, but her ability to manipulate objects at a distance will vastly exceed the species-typical ability to reach, grasp, and move objects. BCIs present an interesting case that defies easy classification. On the one hand, they may look like assistive devices, even if they gain widespread use. They are customized to individual users, and do not necessarily require any modification of the user’s body. On the other hand, the mental control their trained users can exercise, as well as the “internal” feedback they provide, may make them appear more like such bodily extensions as physical prosthetics and exoskeletons.13 To the extent that they enable users to manipulate distant objects by their thoughts, and receive detailed feedback from those objects, BCIs may tend to be seen as extensions or parts of their bodies.14 In the near future, though, the possibilities for their full “incorporation” are limited – less by their distance from the body or their inorganic composition than by their shared use and control. It is difficult to see how a computer network with multiple users could be partitioned or otherwise incorporated into their discrete bodies. Although BCI hardware may become individual property as the devices move from the lab to the market, the networks that operated them may have to be coordinated in ways that limit or preclude personal ownership. But even if they are seen as individual possessions, BCI devices may make physical impairments less of an impediment for a wide variety of activities. Moreover, unlike current prosthetics, BCIs are likely to be sought by people without physical impairments.15 Their widespread use and efficacy in an increasing number of tasks is likely to further diminish the salience and practical importance of impairments – at least those that do not limit the capacity to engage in computer-mediated communication. 6 Balancing the Costs and Benefits of Broad Enhancement Many proponents of the social model of disability question the societal preference for reducing the disadvantages associated with disability by modifying the individuals disadvantaged by their environments rather than modifying those disadvantaging environments.16 But the emergence of broad enhancements suggests that we cannot adhere to a simple policy of modifying environments rather than bodies and minds. Instead, we must examine – usually on a case-bycase basis – the benefits and costs of specific enhancements. For illustrative purposes, we will focus on BCIs. Whether they primarily modify the individual or the environment, their widespread adoption may have significant costs as well as benefits. There might be difficult tradeoffs between reducing the practical disadvantages and stigmatization of physical impairment, on the one hand, and preserving an important role for the human body, on the other. These tradeoffs are described in Stella Palikarova, who argues that the human capacity to communicate, as employed and extended by BCIs, may eventually render bodies largely superfluous. Perhaps the most indicative representation of this phenomenon was seen in the assimilation of [BCI] technology in both rats and primates, who learned to communicate with, and control, an actuator without needing to use their own limbs. Astonishingly, once the animals had learned to communicate with the actuator using only brain activity, they ceased using their own limbs to attain what they desire (i.e. food or an object) [citation omitted]. The potential consequences of using similar technology on humans are not far from the imagination….largely disembodied human beings that have become reliant upon the technological instruments that have replaced bodily functioning, resulting in obesity, muscle atrophy, and an absence of physical human contact. A society so reliant upon technology would be unable to function in the case of technological breakdown. Yet, one could say that the body itself is a kind of “machine”, in constant need of maintenance and repair. In repairing one kind of impairment (disability), are we effectually creating another? Would we be better or worse off for relying on machines and computers, instead of on our own physiology?17 Notably, these complaints resemble those now being made about the increasing reliance on the Internet and social media by millennials. While this reliance does not make physical functioning hostage to the performance of machinery in the same way as it does for BCI-users, the growing dependence of social and institutional functioning on electronic communication creates similar vulnerabilities – from the diminishing role of face-to-face interaction to the dangers of being hacked. It is, of course, easy to exaggerate the costs of decreasing reliance on the body. Few people in developed countries now earn their living “by the sweat of their brows” and the exercise of our bodies has been increasingly consigned to a recreational role. But we need not be the worse for that. We may be able to perform many of our professional tasks with electronic mediation and still enjoy an intimate face-to-face conversation or a vigorous game of touch 7 football or wheelchair basketball. We should keep in mind that while the demands of physical labor can strengthen human bodies, they can also injure, sicken and exhaust them. Moreover, BCIs may expand the range of physical interaction at the same time that they attenuate it. People unable to move their limbs may be able to deliver BCI-mediated caresses, as will people with standard limb function who are separated by long distances. The old Bell Telephone slogan – “Reach Out and Touch Someone” – may acquire more literal meaning. At the same time, clumsy mechanical caresses might be superseded by sensations delivered directly to the tactile regions of the recipient’s brains, affording a more intimate, if less physical, form of long-distance connection. Less speculatively, there are clear benefits to people with disabilities in having nondisabled people rely on the same or similar technologies for an increasing range of activities. As stressed in the literature on assistive technology and universal design, widely-used technologies are more likely than disability-specific ones to be well-manufactured, carefully maintained, and gently handled by third-parties.18 Perhaps the most salient example is the development of the “driverless” car, which is seen as an epoch-making technological breakthrough, not a disabilityspecific project. When mechanical failures occur, as they inevitably will (indeed, they already have), they will be less stigmatizing and better accommodated than those for disability-specific devices like wheelchairs, even though – and in part because – their breakdown will cause massive inconvenience. (Wheelchair users could only envy the allowances made for Washington, DC subway users when the system was suddenly closed for a weekday to permit emergency repairs. Workers who did not normally telecommute were permitted or encouraged to do so, and employers were urged to offer unscheduled leave.19) Yet we should not discount the possibility that “ableism” will prove resilient in the face of broad enhancements that make nondisabled people dependent on the same technology as disabled ones. Perhaps a socially-recognized distinction will emerge between “us” – BCI-users – and “them” – “the BCI bound.” The need to rely on BCIs for many routine activities may be regarded as harsh bondage by those who enjoy unimpaired limb movement, even if they are well aware of how much more one can do with a BCI. The persistence of stigma is not a foregone conclusion, however. Much will depend on the way the markets develop for disabled and nondisabled users, and on the extent to which the products designed for their use are clearly differentiated. The more differentiated they are, the more likely disability-specific products are to be subject to a kind of “courtesy stigma” – Erving Goffman’s term for stigma by association.20 We certainly do not claim that stigmatization will remain as virulent as ever, merely that technology, however widely embraced and universally enhancing, may not ensure its disappearance.21 8 Conclusion In this essay, we have tried to illustrate the value of seeing the enhancement of individuals in the context of an array of technological modifications, many of which involve no changes to bodily form or function. In challenging the dichotomy of individual and environment, our account also challenges the social model of disability. To the extent that the model gives strict or very strong priority to changing the environment rather than the individual, it either discourages or fails to address the existence of broad “interactive” enhancements, which require changes to both. Such resistance or neglect would be unfortunate, because some of these enhancements might have the potential to weaken oppressive biological norms, dramatically reduce the functional significance of many impairments, and have powerful appeal for nondisabled as well as disabled users. We are confident, however, that the social model can be amended to take account of the liberating potential of these interactive enhancements without losing its emphasis on exclusionary environments and stigmatization. One final advantage to a broader focus is that it serves as a brake against rampant speculation. The deliberate modification of individual bodies and minds advocated by “bio-progressives’ and decried by “bio-conservatives” will occur, to the extent it does, in interaction with intended and unintended modifications to human environments, and with a variety of modifications that defy classification as either individual or environmental. It is misguided to attempt to evaluate individual changes in isolation, and it is highly speculative to assess the outcome of the complex interactions that will take place in the future. This does not mean that we can or should refrain from speculation altogether – we have done our share – but that in debating as well as in implementing human enhancement, we should proceed cautiously. Acknowledgments We thank Tina Rulli, Sven Nyholm, and the participants at the Jepson Colloquium 2015-2016, “Ability and Enhancement,” University of Richmond, for their comments on a draft of this paper. Disclaimer The views expressed in this essay are the authors’ own. They do not represent the positions or policies of the National Institutes of Health, U.S. Public Health Service, or Department of Health and Human Services. 9 1 Parens, Erik, ed. Enhancing Human Traits: Ethical and Social Implications. Georgetown University Press, 2000; Juengst, Eric T. "What Does Enhancement Mean?" in Enhancing Human Traits, 29- 47. 2 Wasserman, David, Asch, Adrienne, Blustein, Jeffrey and Putnam, Daniel, "Disability: Definitions, Models, Experience", The Stanford Encyclopedia of Philosophy (Summer 2016 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/sum2016/entries/disability/>. 3 Farah, Martha J., Judy Illes, Robert Cook-Deegan, Howard Gardner, Eric Kandel, Patricia King, Eric Parens, Barbara Sahakian, and Paul Root Wolpe. "Neurocognitive Enhancement: What Can We Do and What Should We Do?." Nature Reviews Neuroscience 5, no. 5 (2004): 421-425; Douglas, Thomas. "Moral Enhancement." Journal of Applied Philosophy 25, no. 3 (2008): 228-245. 4 Allhoff, Fritz, Patrick Lin, James Moor, and John Weckert, “The Ethics of Human Enhancement: 25 Questions & Answers.” Studies in Ethics, Law, and Society 3, no. 3: (2009) 1-41, 10. 5 Allhoff, Fritz,et. al,. “The Ethics of Human Enhancement,” 9. 6 Wilson, George and Shpall, Samuel, "Action", The Stanford Encyclopedia of Philosophy (Summer 2012 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/sum2012/entries/action/>. 7 Admittedly, an internal feature may make the individual appear more enhanced. This point is well made in an example from Keith Abney ("Problematizing the “Natural”: The Internal/External Distinction and Technology." Synesis: A Journal of Science, Technology, Ethics, and Policy 4 (2013): T29-36, 35): [C]ompare a person who uses Google Translate on their mobile device to communicate with the local population on their trip to a foreign land, versus a person with a Google translation chip implanted in their head. The first would be recognized by the natives merely as someone who knows how to use a computer; the latter, meanwhile, might well be taken as fluent in the foreign language, with whatever social advantages that would entail. In other words, when it comes to proximity of a technological aid to the user, the less visible the tool is to outsiders, the better. But it is hard to see why the appearance of enhancement should matter in assessing the extent to which a person is in fact enhanced. The practical advantages of this appearance do not by themselves lead to greater ability or function in the second tourist. 8 We are hardly the first to suggest a broad view of human enhancement. In Beyond Humanity? The Ethics of Biomedical Enhancement.(Oxford: Oxford University Press, 2011) Allen Buchanan embraces the very broad conception of “enhancement” that Allhoff et al., “The Ethics of Human Enhancement,” reject, e.g., classifying literacy and science as enhancements. He utilizes this broad understanding to argue that enhancement is nothing new and nothing objectionable, so we shouldn’t be so fearful of the enhancements on the horizon. 9 We will also bracket the question of whether the term “enhancement” should be limited to improvements that raise a function above the normal range, or should include improvements than raise a function to, or within, the normal range. We will use the term in the latter sense. 10 Gibson, Barbara E., and Gail Teachman. "Critical Approaches in Physical Therapy Research: Investigating the Symbolic Value of Walking." Physiotherapy Theory and Practice 28, no. 6 (2012): 474-484. 11 Herr, Hugh M., and Alena M. Grabowski. "Bionic Ankle–Foot Prosthesis Normalizes Walking Gait for Persons with Leg Amputation." Proceedings of the Royal. Society B., 279. No. 1728, (2012): 457-464. 12 Mooney, Luke M., Elliott J. Rouse, and Hugh M. Herr. "Autonomous Exoskeleton Reduces Metabolic Cost of Human Walking During Load Carriage." Journal of Neuroengineering and Rehabilitation 11 no.1 (2014): 80-90; Smith, David W. “Merging Man and Machine, Salt March 28, 2014, http://www.wearesalt.org/merging-man-andmachine/ 13 Aas, Sean, and David Wasserman. "Brain–Computer Interfaces and Disability: Extending Embodiment, Reducing Stigma?." Journal of Medical Ethics 42 (2016): 37-40.; Wasserman, David, and Sean Aas. "BCIs and Disability: Enhancement, Environmental Modification, and Embodiment." Brain-Computer Interfaces 3 no. 3 (2016): 126-132. 14 Clark A. Re-Inventing Ourselves: The Plasticity of Embodiment, Sense, and Mind. Journal of Medicine and Philosophy, 32 (2007):263–282. 15 To indulge in a bit of speculation, if BCI technology becomes widespread, people may eventually get “wired” to their home environment so that they can affect all sorts of changes (turn on/off lights; open blinds; alter the structural layout) by mental effort alone. This would represent an even more dramatic challenge to the distinction 10 between modifying the individual and the environment, and a further reduction in the functional significance of impairments. 16 Imrie, Rob. "Rethinking the Relationships between Disability, Rehabilitation, and Society." Disability and Rehabilitation 19 no. 7 (1997): 263-27; Wasserman, David, et al., , "Disability: Definitions, Models, Experience", The Stanford Encyclopedia of Philosophy 17 Palikarova, Stella., “The Ethical Integration of Brain Machine Interfaces: Toward the Cyborgization of the Disabled,” Faculty of Information Quarterly 2 no. 1 (2009): 1-18, 6. 18 Center for Universal Design, Principles of Universal Design. Raleigh: North Carolina State University; 2001; Tobias, James. “Universal Design: Is It Really about Design?” Information Technology and Disabilities 9, no.2, 2003, http://square.umin.ac.jp/DMIESemi/y2004/20040531/20040531_3.pdf ; Foley A, Ferry BA. “Technology for People, Not Disabilities: Ensuring Access and Inclusion”. Journal of Research in Special Education Needs. 4 (2012):192-200; Phillips B, Zhao H. “Predictors of Assistive Technology Abandonment,” Assistive Technology 5 no. 1, (1993):36–45; Doe T, Noakes A. “The Effectiveness of Assistive Technology in Enabling Community Integration and Independent Living: What We Know Now” in Is it Working? A Review of AT Successes and Barriers. California Foundatm nion, 2002. 19 Thorton, David “OPM Encourages Unscheduled Leave, Telework for D.C. Feds on March 16 Federal News Radio March 15, 2016 4:56 pm, http://federalnewsradio.com/opm/2016/03/metro-close-march-16/. 20 Goffman, Erving. Stigma: Notes on the Management of Spoiled Identity. Engelwood Cliffs, NJ: Prentice Hall, 2009; Aas, and David. "Brain–Computer Interfaces and Disability.” 21 We say “may not” rather than “cannot” because we cannot rule out futures in which technology really does make variations in human bodies almost irrelevant and undetectable. For example, the film Surrogates depicts a society in which almost everyone lays at home in their “experience machines” and remotely controls a robot surrogate that does all of their living for them. If nondisabled people stop using their bodies (as happens in that society), perhaps some kinds of disability, particular motor and sensory disabilities, would cease to matter. In such a society, it might not even be known who had these disabilities, since people will only interact with others’ surrogates and never encounter their actual bodies. It’s not clear that many disability categories would still be relevant in a world where this surrogate lifestyle was universal. 11