Le handicap mental d’un enfant est la source de diverses souffrances très primitives. L’auteur développe l’hypothèse qu’une équipe doit contenir ces souffrances diffuses et peu représentables, qui entraînent tensions, insécurité et malaise dans l’entourage. Les équipes sont ainsi prises dans des positions de symbiose pathologique avec l’enfant et oscilleraient entre chronicité et activisme. Un exemple à propos « d’un enfant insupportable » montre que l’intervention clinique peut arriver à contenir ces souffrances et à modifier les alliances inconscientes éducateur-famille.

ABSTRACT Mentally handicapped people have been taken in philosophical work as an obvious exception to the canons which are applied to other, ‘rational’individuals. This paper argues that mentally handicapped people should be accorded the same rights as others. If there are human rights, then mentally handicapped people are entitled to them as humans; and if there are rights which apply in general to citizens, the same rights apply equally to mentally handicapped people. The argument for the inclusion of mentally handicapped (...) people as citizens is first, that there is a presumption of inclusion: if citizenship is accorded to all other individuals, there is no reason why citizenship should not be accorded to mentally handicapped people on the same basis as others. Second, mentally handicapped people cannot successfully be excluded without effectively challenging the presumption of inclusion applied to other groups. Third, and perhaps most important, there are positive reasons why mentally handicapped people, as a particularly vulnerable group, need to have rights to protect them against particular abuses. (shrink)

An examination of traditional sources for the Roman Catholic under-standing of marriage reveals that the ends of marriage might be ordered differently, given different contexts. This permits one working within that tradition to see marriage as a political and cultural entity existing independently of the individuals who participate in it. Marriage is also the standard with respect to which sexual activity is judged to be proper or not, a standard that applies to all human beings by virtue of their rational (...) nature. Understanding this allows one to understand how some people, including some of the mentally handicapped, might legitimately be prevented from marrying and even from engaging in genital sexual activity. It also allows one to solve some theoretical difficulties regarding contraception and homosexuality and connected with the fact that sterile couples cannot procreate and yet are permitted to marry. (shrink)

What happens when we discover that a severely mentally handicapped girl, resident under our care, is heavily pregnant? What options are open to us in her management? What are the legal and ethical issues involved? How do we ensure that she receives the best possible care and protection and will the involvement of the police actually make the situation worse? Few of us have had the experience of working through such dilemmas, and little help can be found in consulting 'experts' (...) who are awaiting the result of 'test cases' in the High Courts. This article highlights some of the problems we encountered with such a case. (shrink)

The moral standing of involuntary sterilization has long been subject to debate but has only recently been looked upon with disfavor. When sterilization of a mentally handicapped minor is entertained, issues of eugenics, medical ethics, and legal precedent specially arise. Ethics consultants and ethics committees have been asked to consider such cases.

Doctors are regularly confronted with requests for sterilisation of mentally handicapped people who cannot give consent for themselves. They ought to act in a medical vacuum because there doesn't exist a consensus about a model for decision making on this matter. In this article a model for decision making is proposed, based on a review of the literature and our own research data. We have attempted to select and classify certain factors which could enable us to arrive at an ethically (...) justifiable method of making a medical decision. In doing so we distinguish two major criteria: heredity and parenting competence, and six minor criteria: conception risk, IQ, age, personality, medical aspects and prognosis and finally support and guidance for the mentally handicapped person. The major criteria give rise to a "situation of necessity". In this situation the physician is confronted with a conflict of values and interests. The minor criteria are of an entirely different ethical order. They can only be considered once the major criteria have created a "situation of necessity". Ultimately it comes down to deciding whether the benefits of sterilisation outweigh the drawbacks and whether the means are appropriate to the end, where efficient contraception is the end and irreversible sterilisation is the means. (shrink)

ABSTRACT In this paper we compare philosophical and contemporary psychological approaches to mental handicap. Careful comparison between the disciplines reveals major differences and indicates that much further work is needed which would be fruitful for both sides. The two disciplines concentrate on different questions: philosophy tends to look chiefly at mental handicap in relation to issues of personhood and is not very clear about what mental handicap is; psychology on the other hand is much (...) more specific about mental handicap, but shows little concern with critically examining value issues. Our main intention is to explore the different ways in which mental handicap is defined and seen as a class. We conclude that class definition embodies a significant normative component and a large element of social construction. To ignore this and attempt to make normative judgements on the basis of class membership is thus highly problematic. Since within philosophy, these normative issues are often discussed in terms of personhood, this category is also critically examined and the conclusion is reached that it too has normative and social components which can lead to ethically dubious judgements being made about ‘the mentally handicapped’. (shrink)

Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate, or should they be considered a vulnerable group in need of protection? I discuss three cases of possible living organ donors who are developmentally disabled, from three different cultures, the United States, Germany, and India. I offer a brief discussion of three issues raised by the cases: (1) cultural diversity and cultural relativism; (2) autonomy, rationality, and (...) self-interest; and (3) the proper use and role for clinical ethics consults. (shrink)

Book reviewed in this article: Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church. By Stanley Hauerwas.

The central theme of Byrne’s book is the fundamental moral standing of people who are mentally handicapped. Most ethical theories and ordinary moral practice deem it uncontroversial that we owe special concern and respect to ordinary adult human beings; this concern and respect is the locus of most widely recognized moral obligations. Yet many theoretical approaches to ethics explicitly or implicitly call into question whether the same ethical treatment ought to be extended to the mentally handicapped. In seeking and providing (...) explanation for the ethical status we accord human beings, ethical theories point to valuable traits of humans—their rational capacities, reflective self- awareness, capacity for autonomy, the richness of experience these capacities make possible, and so on—traits that mentally handicapped individuals typically possess only in a truncated form, or lack altogether. Byrne’s goal is to rebut this widely accepted theoretical approach and to develop an alternative justification of the special ethical status of humans, one that applies in equal measure to all members of our species, including the mentally handicapped. (shrink)

This work examines contemporary views on medical ethics, such as preventing death, defining family relations, and reproductive and disabled issues.

ABSTRACT Some beings, including children, animals and the mentally handicapped, seem to deserve moral consideration, despite the fact that they are not rational or moral agents. These so‐called marginal cases create a problem for theories that heavily stress the role of moral and/or rational agency in ethics: the latter seem unable to account for the former's moral status. This paper discusses the recent and original attempt of Loren Lomasky to solve this problem. It is argued that Lomasky's arguments are self‐defeating (...) because they can only succeed by relying on common‐sense morality and, thus, by giving up the heavy stress on the role of rational agency in ethics. (shrink)

Much of the discussion since the Arthur case has centred round the rights of handicapped infants to medical treatment. Little has centred round the question of how far one person can rightly be required to sacrifice her life for another, when she has not been consulted beforehand. This may be due to the fact that most of the discussants are men, while nearly all the carers are women. This small study attempts to redress this balance by asking mothers who have (...) cared for 20 years, whether they felt it was worthwhile. (shrink)

ABSTRACT In his book The End of Life James Rachels argues that in a situation of forced choice if we must choose between a more and a less complex human being we have good reason to choose in favour of the normal human. He argues also that since some humans have less complex mental abilities than some animals it will sometimes be right to choose a non‐human animal in preference to a human being. I do not consider Rachels’belief that (...) sometimes non‐human animals are to be preferred to retarded humans; I focus rather on the seemingly less contentious belief that in situations of forced choice, we should choose human beings with more rather than less complex lives. I reject this contention both because Rachels does not seem to have offered a worthwhile argument in its favour and also because I find his cavalier approach to the lives of people with intellectual disabilities morally offensive. En route I argue against his simplistic separation of human lives into the categories ‘simple’and ‘complex’on the basis of whether the individuals in question fall into what he seems to take as given—the clear cut categories ‘mentally retarded’and ‘normal’[1] [2]. (shrink)

The following case was presented by a trainee general practitioner, working in inner London, to her release course for discussion. It is told, as it was presented, in the immediate aftermath of the events described. The names and some of the details have been altered.

Les entretiens familiaux proposés aux familles des adolescents handicapés mentaux constituent un dispositif important de la prise en charge. L’instauration d’un espace libre d’échange et de travail psychique avec la famille a le plus souvent un impact positif sur le parcours de l’adolescent. Cependant, les défenses parentales érigées contre la souffrance liée au handicap de l’adolescent sont susceptibles de rendre ce travail difficile voire de le mettre en échec. Les éprouvés contre-transférentiels permettent, dans ces situations, la formulation d’hypothèses compréhensives (...) concernant les interactions parents-adolescent handicapé. (shrink)

La catégorie des anormaux, dont Foucault fait la généalogie dans son cours de 1974-1975 au Collège de France, a complètement disparu au début du XXe siècle. Par l'extension illimitée de l'anormal qu'elle permettait et par la somatisation de toutes les pathologies physiques ou mentales qui la soutenait, cette catégorie peut cependant être rapprochée de notre notion actuelle de « handicap », et tout particulièrement des handicaps psychiques. Ce rapprochement permet d'apprécier ce qui a changé dans notre rapport aux normes. (...) L'intégration sociale et la modification des anormaux a remplacé leur exclusion et contention. Mais l'inquiétude des normes est toujours aussi forte, et s'articule désormais autour d'une recherche de sécurité dont le handicap est l'expression. La méthode généalogique permet ainsi l'étude des lignes de fracture de cette notion, révélatrice des problèmes que produisent notre volonté de prendre médicalement en charge de supposés incurables. (shrink)

Background: This study aimed to examine magical ideation and absorption traits across non-clinical and clinical groups to determine their potential adaptive and maladaptive functions.Method: We enrolled 760 healthy participants from neighboring communities. Moreover, we recruited 318 patients, which included 25, 183, and 110 patients with schizophrenia spectrum disorders, anxiety disorders, and mood disorders, respectively. Potentially adaptive and maladaptive sociocognitive functions were measured to determine the role of magical ideation and self-absorption in patients with psychiatric disorders.Results: The degree of magical ideation (...) and absorption gradually increased in the following order: anxiety disorders, mood disorders, and schizophrenia spectrum disorders. Furthermore, enhanced self-absorption-related enhanced consciousness traits were essential indicators of the presence of self-integration weakness in patients with schizophrenia spectrum disorders.Conclusion: Magical ideation and psychological absorption may be considered as mental model construction functions, which result in both gains and handicaps in social adaptation. (shrink)

In our country, mildly mentally disabled students are being educated in general education classes by means of integration. An individualized education program (IEP) is being prepared for these students when needed. However, the impact of BEP on students with intellectual disabilities in religious education has not yet been sufficiently discussed. The purpose of this research is to examine the impact of the IEP on the achievement of religious education of mentally disabled students and the level of religious learning of these (...) students. For this purpose, in addition to the education given in the general education class for the 6 mildly mentally disabled integration students studying in the 4th grade of primary school, 2 hours of education were carried out in the support education room per week during the education and training year. Semi-experimental study was designed according to the single-tasked multiple-start model. Education process was evaluated by Achievement Test, the Teacher Observation Form, the pre-test based on the Self-Assessment Form, post-test and retention tests. As a result, it has been seen that BEP has a positive effect on the achievement of religious education of mentally disabled students (ZEKÖ). In this framework, it has been found that students are influenced by the society, especially by their peers, when they are given time they constitute religious knowledge, they understand normal individuals religious behaviours, they are more emotional, they forget religious information that is not used in everyday life and when they accomplish they increase self-confidence and self-esteem and internalize values.SummaryPeople differ in their creation. This difference is greater in people disabled. In terms of individual traits and educational qualifications, individuals with disabilities who are severely different from their peers and who have difficulty in playing the roles they should play are evaluated in several groups. One of these groups is mentally disabled. Mentally handicapped people have various rights as normal individuals. One of these rights is the right to education. National and international laws guarantee the educational rights of individuals with intellectual disabilities. Similarly, Islam and his best practitioner, the prophet Muhammad, did not consent to the transformation of the mentally disabled into begging masses or to their isolation, but rather to integrate them into society. According to Islam, individuals with intellectual disabilities have the “capacity to acquire rights“, even if they do not have "capacity to act". This right requires them to receive an education that takes into account their differences, just like normal individuals. Because of their learning characteristics, mentally retarded students differ from their peers, therefore they cannot benefit from the educational activities organized for normal students. So, these students need a special education to ensure that the mentally disabled are successful and live in society without being dependent.Inrecent years, in our country as well as in the world, the principle of "least restricted education environment" is taken into consideration for mentally handicapped people who need special education, which approaches to co-education with their peers. This approach is tried to-be applied at all educational levels. Due to the diagnosis and evaluation in the Guidance and Research Center, a large number of mentally retarded students are placed in normal schools. These students, like other courses, take the Religious Culture and Moral Knowledge Course together with the normal students. However, depending on their learning, they have the right to receive separate training as 1-3 people at-the support training room. The instructional adaptations necessary for the education of these students made by the Guidance and Research Centers are carried out by the teacher who plays the basic role in the education of the students. One of the important elements in the education of these mentally retarded students who need special education is the individualized education program. This program is prepared by the cooperation and joint decision of all stakeholders who may contribute to student’s education. The status of the student to participate in the learning and teaching activities, the amount and the quality of the education to be received in the support education room are made within the framework of this program.One of the most important courses in the education of mentally retarded students who are educated by inclusion is the Religion Culture and Moral Knowledge course. Because this course has the potential to make serious contributions to the socialization of students and to maintain their lives independently. However, there are a limited number of studies investigating the quality of religious education at-the scientific level. Furthermore, it has not been observed that these studies have been quasi-experimental. This study aims to reveal the quality of education for the mentally handicapped students. For this purpose, it aims to determine the contribution of religious education in the support education room to the success of the student depending on the individualized education program. It also makes it possible to make conclusions about how mentally handicapped people use their mental skills to learn religion. Depending on the aim of the study, during the 2015-2016 academic year, primary school 4th grade students and 6 mentally disabled inclusion students were educated. The quasi-experimental study was designed according to the single-subject multiple-start model. The process of the education, in other words, the development of mentally retarded students towards religious learning; were evaluated by Success Test, Teacher Observation Form and Self-Assessment Form based on pre-test, post-test and retention tests.Findings of the study; Faith, worship, the prophet Muhammad, Qur’an and its commentary, are classified according to the fields of morality, religion, and culture. The post-test achievement scores of the students in all learning areas were higher than the pre-test achievement scores. This shows that religious education in the support training room based on individualized education plan contributes positively to the success of the student. The results of the retention test are close to the results of the final test. In addition, it was determined that the students were affected by the society, especially by their peers, structured the religious knowledge when given time, they understood the religious behaviors of the normal individuals, became more emotional, forgot the religious information that is not used in daily life, increased their self-confidence and self-esteem as they succeeded and internalized the values. Based on these results, the following recommendations have been developed.Support Education Rooms should be functionalized and special attention should be given to individual or group-based religious education based on the nature and objectives of the subject in these rooms.In religious education, by taking into account the performances of mentally retarded inclusion students (MHIS), the relevant dimension of religion should be given importance according to their contribution to their normal lives and they should be consistent and patient in this process.Since MHIS has different levels of learning and perception and different developmental characteristics at every stage of life, it should prioritize their proper use of their existing capacities based on their religious education, interests and curiosities.Since MHIS is influenced by the emotion dimension rather than the information dimension of religion, religious education for them should be oriented towards life, which is not academic, literal or doctrinal, but rather their life and feelings.Similar studies with different study group students must be done and the results of the study should be interpreted comparatively. 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Through Quebec universities, the population of students with emerging disabilities is higher than the population of students with physical disabilities. Within our university, the social work’s departement has the largest proportion of students with emerging disabilities. The varied challenges faced by these students with mental or neurodevelopmental disorders during their theoretical training tend to increase during internships, leading to extensions, dropouts or failures. The aim of this article is to describe the structure that has been developped to support these (...) social work students. (shrink)

It is generally agreed that at least those who suffer from severe mental subnormality, like idiots, are not responsible for the antisocial actions that they may commit. Even Lady Wootton agrees that in the case of idiots and imbeciles ‘the defect is so great that no dispute is likely to arise, either as to the reality of the handicap or as to its effect in impairing capacity to conform to expected standards’. 1 This passage, incidentally, contradicts some of (...) her other views, e.g. the view that we can never make judgments about people's capacity. (shrink)

Les personnes souffrant de troubles psychiques graves ont été longtemps victimes d’une stigmatisation et d’une discrimination déshumanisantes et, de fait, la reconnaissance de leur commune appartenance à l’humanité a été déniée. La notion même de personne, indissociable de la reconnaissance de l’égale dignité de tout être humain, ainsi que du respect et de l’estime qui lui sont dus, en a été profondément et durablement mise à mal. Comment redonner à la notion de personne la plénitude de son acception lorsque les (...) personnes souffrent de troubles psychiques? Comment leur assurer les conditions d’un épanouissement personnel, d’une relation à soi-même positive, en somme d’une vie plus humaine? Le présent travail s’appuie sur les travaux que le philosophe allemand Axel Honneth a consacrés à la notion de reconnaissance mutuelle pour apporter des éléments de réponse à ces questions. Ces travaux définissent un cadre théorique général qu’il semble pertinent d’appliquer à la notion de handicap psychique pour en comprendre les enjeux et montrer comment la reconnaissance mutuelle permet de redonner, dans l’expression « personne en situation de handicap psychique », toute sa plénitude à la notion de personne. (shrink)

The ability to (re)classify populations is a key component of state power, but not all new state classifications actually succeed in changing how people are categorized and governed. This article examines the French state’s partly unsuccessful project in 2005 to use a new classification—“psychic handicap”—to ensure that people with severe mental disorders received services and benefits from separate agencies based on a designation of being both “mentally ill” and “disabled.” Previous research has identified how new classifications can be (...) impeded by cultural and cognitive barriers to their adoption and struggles between professionals or administrators over their implementation. Drawing on 186 interviews, archival sources, and 13 months of observations across different French bureaucracies, I expand on this literature in two ways. First, I use the case of psychic handicap to argue that a new classification can also fail to achieve its intended effect when it constitutes a bureaucratically split personality—a combination of classifications that imply that individuals belong to two, mutually exclusive kinds of people. I show how psychic handicap embodied contradictory expectations about the behavior, characteristics, and institutional trajectory of people with mental disorders. Second, I identify how bureaucrats resolved these contradictions through mechanisms of refractory looping, outsourcing expertise, and classification by default, which in this case led to the reclassification of this population as simply “mentally ill.” This framework calls attention to how practical inconsistencies can limit the impact of new classifications, even absent overt resistance to their elaboration or implementation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations of (...) Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

La catégorie des anormaux, dont Foucault fait la généalogie dans son cours de 1974-1975 au Collège de France, a complètement disparu au début du XXe siècle. Par l'extension illimitée de l'anormal qu'elle permettait et par la somatisation de toutes les pathologies physiques ou mentales qui la soutenait, cette catégorie peut cependant être rapprochée de notre notion actuelle de « handicap », et tout particulièrement des handicaps psychiques. Ce rapprochement permet d'apprécier ce qui a changé dans notre rapport aux normes. (...) L'intégration sociale et la modification des anormaux a remplacé leur exclusion et contention. Mais l'inquiétude des normes est toujours aussi forte, et s'articule désormais autour d'une recherche de sécurité dont le handicap est l'expression. La méthode généalogique permet ainsi l'étude des lignes de fracture de cette notion, révélatrice des problèmes que produisent notre volonté de prendre médicalement en charge de supposés incurables. (shrink)

Tasubinsa is a "Special Employment and Occupational Center" constituted in accordance with Spanish Law where 90% of the workers have mental, sensorial or physical impairments of at least 30%. Its positive experience of more than 15 years provides entirely different responses from mainstream neoclassical theory (transaction cost theory, agency theory, and shareholder theory) to basic questions such as "What is a firm?", "What is its purpose?", "Who owns a firm?", and "What do a firm's owners seek?". The article discusses (...) how these different premises give rise to a distinctive corporate culture centered on the handicapped person. (shrink)