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by Anita Silvers, David Wasserman and Mary B. Mahowald
Rowman & Littlefield, 1998
Review by Ed Brandon on Feb 28th 2001

Disability, Difference, DiscriminationDespite Marx's taunt, philosophers don't appear to have done much to change the world. But if Anita Silvers is to be believed (pp. 10-11), the Radical Philosophy movement that started in the UK in the 70s has apparently put its stamp upon public policy and influenced profoundly important legislation in the USA: the Americans with Disabilities Act (ADA) of 1990. The key contribution is a matter of seeing the problems disabled people have as much more a creation of the unthinking majority than as intrinsic obstacles to full participation in social life. Silvers offers us a general diagnostic tool (pp. 129-131): ask how things would have been done if most people were characterised by deafness, or the effects of polio, or whatever disability is in question. Buildings would have had ramps, helpful not only for those in wheelchairs; TVs would all be close-captioned; and we wouldn't be besotted with computer icons. These are the kinds of development mandated by the ADA (though with the usual escape clauses where costs would be prohibitive for the entity concerned, etc.). It seeks to permit the disabled to live as fully as productive citizens as the rest of us.

This book is a detailed discussion among the three authors of some philosophical issues thrown up by the ADA, primarily how its demands, or rather the demands deriving from the basic principles inspiring it, should be conceived within a theory of justice. Each contributor provides a long essay, and then comments on the others' initial paper. The book is rounded off by an all-too-brief afterword by Lawrence Becker.

Anita Silvers begins with a 133-page piece that usefully puts the questions of justice in a broader context of thought about disability. She demonstrates the baneful consequences of the way recent medicine has monopolised thought and practice about disability and has erected a cult of normality as not merely a statistical fact but a normative constraint and standard. Her discussion makes clear the dangers of unfettered genetic testing. She is also good on the unwelcome consequences of compensation schemes, a matter that has application in many other contexts. Her take on the response to disability within the theory of justice is that it should be viewed, not as a matter of compensatory distribution of privileges to those who are deficient through no fault of their own, but as a matter of reforming social practice so as not to exclude people who are different in these ways - just as others have recognised the equal rights of gays or blacks. One might say that just as many think desirable social policies should be ultimately race- or gender-blind (though on the way to this goal we may need to make some special adjustments or reparations) so Silvers wants us to aim for policies and practice that are functionality-blind in not privileging any particular group (hearing versus deaf, etc.).

Wasserman focuses his discussion on the way disability works in the thought of prominent theorists of social justice: Rawls and his followers, Dworkin, Sen, and others. Unlike Silvers, he sees a crucial place for distributive concerns. His paper provides many valuable comments on and qualifications of the assumptions and arguments of what is now perhaps the major productive site in political philosophy.

Mahowald presents a self-consciously feminist perspective, and concludes her piece by looking at possible conflicts between advocacy for the disabled and for women. One area concerns prenatal testing and abortion of fetuses found to have particular disabilities or genetic features; another arises from the fact that caregivers are themselves usually women.

The comments in round two allow some progress: claims can be clarified, objections answered or advanced. One of the valuable points that go beyond this particular debate may be noted: Wasserman stresses the importance of recognizing more clearly our interdependence. Speaking of the subsidies farmers or poets or the disabled enjoy, he remarks that it is not the subsidy that demeans but the disrespect and contempt with which it is often distributed (p. 276).

These discussions will be of interest to philosophers investigating the demands of justice. But others may find issues on the periphery of the book's focus more provoking. It is easy to wish people had written a different book, but in this case one has the excuse of the book's own afterword: Becker remarks that in his experience of disability issues, appeals to love or justice do not in the long run pay off for anyone concerned (p. 293) and he goes on to sketch an approach based on game-theoretical considerations, but without the space to give concrete illustrations of how it might work.

The writers concentrate on the physical disabilities of (otherwise) healthy people; they note but do not do much with the contrast between people who have lived (nearly) all their life with a disability and those who have lost a normal ability at a comparatively advanced age. They emphasize the fact that most people with disabilities are not totally incapacitated. Philosophers tend to invoke disability of an extreme kind; this may serve to make their point, but it allows them to forget the less extreme majority.

But in thus selecting their emphases, the writers seem to avoid those issues that might suggest that some element of normativity ought to reside in our conception of normality. In arguing that even positivists can appreciate Socrates' care for his soul, Popper (note 44 to chapter 10 of The Open Society and its Enemies) remarked that most of us would prefer a moderate amount of physical pain rather than suffer mental illness. There comes a point at which an injunction to try to view things from someone else's perspective, with their tastes and values, becomes unfeasible. (This is not to say we may treat the mentally ill any way we like; but it does suggest that Silvers' diagnostic tool might deliver much less clear guidelines in this type of case, and that treatments that bring a person closer to normality are here desirable in a way they may not be for the congenitally deaf, for example.) To insist that some disabled people are perfectly healthy may be to miss something we might want to preserve in a view of what conditions are, if possible, to be avoided or ameliorated. But it is a virtue of this book that it makes one realize that the unreflective answers of ordinary common sense are no more reliable here than in most other areas of human thought.

Ed Brandon is, by training, a philosopher, and now is working in a policy position in the University of the West Indies at its Cave Hill Campus in Barbados.