Book Description

My dissertation seeks to defend the "mere difference" view of disability from the charge that it leads to objectionable implications in healthcare justice. The mere difference view, briefly put, conceptualizes disability as a morally neutral human trait, analogous to race, sex, gender, ethnicity, and sexual orientation, that ought to be treated in society as such. Its main claim is that disability is not a categorically or definitely bad state to be in but is instead simply another variation of human diversity. Disability as mere difference is a powerful counter to demeaning, pitiable depictions of disabilities as misfortunes and disabled lives as personal tragedies. It is meant to capture and validate the embodied experience and non-tragic identities of disabled people as represented in disability rights and pride movements. For numerous philosophers, this view raises the following worry: if disability were mere difference and not a bad or harmful state to be in, then there apparently would be no moral grounds to support medical research and interventions to prevent, reverse, or remove disability, such as maintaining or restoring the non-disability status of citizens who have become disabled due to some injury or physiological process. This objection is often raised to maintain the bad difference view of disability. In response, I argue that embodiment provides a context of choice that not only makes it possible for us pursue a certain range of life options, but also makes them meaningful in relation to how we understand ourselves and the good life. Abrupt or dramatic changes in a person's embodiment, even though the new embodiment may not be intrinsically or definitely bad, can be inimical to the agency of the modified individual by upending their context of choice. If the state has a responsibility to secure the agency of its citizens and certain physiological states are important conditions for agency--such as providing a stable context of choice--then the state has a moral obligation to secure the physiological conditions for agency through medical interventions. My goal is to provide a plausible account that both contributes to the destigmatization of disability while providing justification for a robust set of entitlements regarding the provision of healthcare resources. In Chapter one, I argue for the mere difference view and elaborate the particular objection that it restricts what medical care and resources citizens are entitled to receive from the state. Chapter two presents the idea that embodiment is an important context of choice for autonomy. Building upon feminist insights on the relation of the body to autonomy and repurposing Will Kymlicka's notion of context of choice, I argue that specific embodied forms not only enable us to pursue a certain range of life options but make them meaningful to us. For this reason, treating or preventing disability through medical interventions may be justified as a practice of identity-maintenance and, in turn, autonomy-maintenance. Chapter three addresses a serious worry that subsidizing healthcare institutions to actively prevent, ameliorate, and eliminate disability expresses a negative social meaning that disability is a devalued embodied form of life, which reinforces the harms of attitudinal and structural ableism. This is an iteration of the expressivist argument that is often deployed in issues of selective reproduction and disability avoidance. I will defend the expressivist argument against prominent objections, recognizing that such devaluations are indeed sometimes expressed. Yet rather than rectifying this social harm by eliminating those practices, I recommend altering the broader social context that imbues disabled life with negative social meaning. This move helps to provide identity and agency maintenance across body types. Chapter four engages with hard cases for my position and offers a justification for providing citizens access to medical resources to alter or augment their bodies in ways that fit with their identity, like gender transition care for transgender people.