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Ethical Analysis of the Concept of Disability

Simo Vehmas

Abstract
The concept of disability from an ethical viewpoint was examined. Whether disability results from
the way society is built and the way ideas and judgments considering disability are established in
a communal interaction was discussed (i.e., is disability socially created and constructed?). Although views on disability emphasizing its social nature are basically sound, they are also insufficient
because they fail to consider the normative dimension attached to the concept of disability. The
core of the concept of disability is ethical, which is why a moral philosophical examination of the
concept is needed. Three possible ethical theories of disability (universal, objective, subjectivist,
and communitarian) are briefly presented and discussed and a preliminary outline of a basis for a
sound ethical model of disability presented.

The traditional and common view of disability

is to see it as an individual tragedy and condition
that inevitably implies either suffering or limited
opportunities for people with impairments. Impairment, which is assumed inevitably to result in disablement, may in itself be a fatal impediment to
human flourishing or full human life. Thus, an
individual with impairments is not a full human
being; he or she is a truncated and defective human being (Kuhse & Singer, 1985, pp. 141, 143;
Nussbaum, 1990, pp. 219225). Western philosophy, among many other academic disciplines, has
traditionally treated disability as an individuals unfortunate state of functioning and being. This has
resulted in, for example, modern bioethics to the
conclusion that impairments can provide relevant
reasons for withdrawing life-saving medical treatment, terminating pregnancies, avoiding conception, and acquiring genetic information in order to
prevent the birth of a child with impairments
(Buchanan, Brock, Daniels, & Wikler, 2000; Davis,
1997; Glover, 1977; Hudson, 2000; Kuhse & Singer, 1985). Also, the belief that having a mental or
physical impairment is an unfortunate or tragic position has led some philosophers (e.g., Buchanan et
al., 2000; Veatch, 1986) to assert that people with
impairments have bad luck, so to speak, in natures
draw, where endowments are given to people on a
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random basis. Because of this, the surrounding society is obliged to compensate for their misfortune.
On the basis of these presumptions, individuals
with impairments are seen as objects of different
kinds of rehabilitational, educational, and therapeutic practices, the aim of which is to alleviate or
cure their impairments. This tendency has
worked as a basis for various institutional services
intended to serve the assumed good of such people.
For example, special education in its varying forms
and different kinds of therapies, ranging from psychotherapy to pet therapy, are designed for individuals with impairments. The goal of these interventions is to help people with impairments function
more effectively in society; that is, to help them
become less impaired or less disabled, as it is assumed
in the medical discourse of disability (Riddell, 1996;
Skrtic, 1991). According to many disability scholars, this kind of individualistic approach to disability is biased and leads to practices and social arrangements that, in fact, oppress people with impairments. Interventions are aimed solely at the
individual, who is regarded as abnormal, while the
surrounding community is left intact. This leads to
a social and moral marginalization of people with
impairments and gives permission to debar them
from full participation in society (Oliver, 1990; Silvers, 1994, 1995).

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Social Approaches to Disability

The previous criticism has been presented by
a large number of disability theorists representing
a social approach to defining disability. Some of
them (Barnes, 1996; Oliver, 1990, 1996) have
claimed that disability is the result of oppressive
material arrangements of society. Oliver (1990)
called this position a social creationist view of
disability. In this perspective it is seen as essential
to distinguish the concepts impairment and disability. Impairment is defined as lacking all or part
of a limb, or having a defective limb, organism or
mechanism of the body, whereas disability is seen
as the disadvantage or restriction of activity
caused by a contemporary social organisation
which takes little or no account of people who
have physical impairments and thus excludes
them from participation in the mainstream of social activities (Oliver, 1996, p. 22). The core
idea of the social creationist view of disability is
that people with impairments are an oppressed
social group. This state of affairs is produced by
social oppression, not by impairments. Disability
is seen as the material product of socioeconomic
relations developed within a specific historical
context. In this approach the main attention is
directed to the disabling barriers and material relations of power (Priestley, 1998; Shakespeare &
Watson, 2001).
In North America, theorists have developed
the social constructionist perspective, in which disability is seen as a social construct. This approach
emphasizes the significance of ideas, attitudes, and
language that shape reality. This means that words
do not merely or primarily represent reality but construct and produce it. The concept of mental retardation, for example, exists in the minds of those
who use it as a term to describe the cognitive states
of other people. It is assumed to be a term expressing an objective, existing state of reality whereas,
in fact, it is a socially invented category that primarily reflects the state of mind of those people who
use the concept, not of those who allegedly have
it. This view does not deny that there are differences, either physical or mental, among people, but
it suggests that the nature and significance of these
differences depend on how we view and interpret
them (Bogdan & Taylor, 1994; Linton, 1998; Taylor, 1996). Thus, according to the social constructionist models disability is the idealist product of
societal development within a specific cultural con-

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text and the units of analysis should be cultural

values and representations (Priestley, 1998, p. 78).
These theoretical standpoints are not mutually exclusive, although their emphases differ. The
nuances of, and differences between, various social
perspectives on disability are beyond the scope of
this paper. I discuss the concepts of disability and
impairment from an ethical viewpoint by considering different interpretations, perspectives, conclusions, and problems arising from the social view
of disability. By social view, approach, or model of
disability, I refer to a way of thinking that seeks to
problematize society rather than the individual.
This includes consideration of the material relations of power arising from the development of political economy as well as ideas and judgments established in a communal interaction concerning
disability. These value judgments often form a basis for an ideology with the purpose of bringing
about, or preventing, a political change (Priestley,
1998). Thus, social creations and constructions are
closely intertwined to each other. The way the environment is built is based on assumptions and
ideas of how human beings function (i.e., social
constructions of a human being form the basis for
the material arrangements in society and, thus,
produce disablement). On the other hand, the material arrangements of society affect how human
beings and their capabilities are regarded. Because
people are accustomed to stairs instead of ramps,
they tend to think that individuals incapable of
using stairs have a disabling condition. The social
creations and constructions regarding disability,
thus, support each other.
In my discussion social creationist and social
constructionist views of disability are compatible
and complementary positions. Considering my aim
in this paper, it is expedient to see them as a whole
and not discuss issues arising from them separately.
In this sense my approach resembles that of those
philosophers (Amundson, 1992; Silvers, 1998;
Wasserman, 2001; Wendell, 1996) who utilized
various dimensions and different forms of social
approaches to disability in order to illuminate and
clarify the issue of conceptualizing disability and
impairment.
Although the common distinction between impairment and disability has convincingly been put
into question as simplistic (Shakespeare & Watson,
2001), for the purposes of the present discussion, it
is useful at this point to separate these two concepts. By impairment I refer to a condition that is
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medically defined as an organic anomaly (such as a

missing limb). Disability, on the other hand, refers
either to (a) an individuals state of functioning or
being that conflicts with, or jeopardizes, the fulfilment of his or her civic, commercial, and personal
flourishing or (b) a state of social and environmental organization that cause the disablement of some
individuals. At this point, I do not take a stand
with regard to whether disablement is a result of an
individuals shortcomings or of societys discriminative practices. I examine disability as a state, or
phenomenon, that can be reduced either to biological impairments, social creations, social constructs,
or to the joint effect of some or all these three dimensions. I argue that at its core, disability is a social concept that derives its practical forms and
meanings from a certain social and cultural context.
However, because the significance of impairment in
peoples lives seems to be one crucial and often ignored dimension in disability studies, I hope to provide an ethical framework for conceptualizing impairment and disability.
Because I do not commit myself theoretically
at this point regarding the ontology of disability, I
mainly use the term people with impairments rather
than people with disabilities or disabled people. I prefer
to use a term that identifies people with biomedically defined conditions without making any assumptions about their degree of limitation, well-being, or fair treatment (Wasserman, 2001).
My main focus in this article is to examine the
question of whether disability results from social
constructions or creations or from biological impairments and to enlighten the ethical dimensions
related to the way disability is interpreted. I attempt
to show that although the social approaches to disability are generally sound, they are also insufficient
accounts because they fail to consider the ethical
dimension of disability. I argue that in order to provide a fuller and richer picture of disability, ethical
investigation and conceptualization is needed. I
preliminarily illuminate the ethical dimension of
disability and briefly examine three possible ethical
accounts on disability and impairment. My purpose
in this brief discussion is to provide a necessary
groundwork for the ethical conceptualization of disability. In the conclusion I outline a possible basis
for a sound ethical model of disability.

Is Disability a Social Construct

and Creation?
It is evident that historical and cultural context
determines to a great degree how the criteria for
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normality, and the ideal or acceptable person, are

defined. In antiquity women were regarded as inferior to men, and the deliberative part of their soul
was considered to be without full authority (Aristotle, Politics, 1260a). Essentially, the social constructionist interpretation of disability seems to be
sound: The meanings attached to objects relate to
a particular interpretative cultural context. For instance, a tree is an object of naturea plant. However, different people and groups of people, depending on the cultural context they live in, may see
trees primarily or merely as producers of oxygen, as
building material, or as dwelling places of spirits.
That is, even the objects of nature are meaningless
to people until they are given some kind of constitutive meaning, meaning that has its roots in the
cultural and social context in which these people
live.
This seems to be even more evident in the case
of values and norms. On the basis of social constructionism, one can argue that morality does not
exist without people establishing it. The normative
dimension comes into being after things have been
regarded in the community as either good or bad.
The only things significant and real are the values
and moral norms that people have either adopted
or rejected in interaction with others. The significance of norms is primarily determined by the cultural context. By this, I do not mean to say anything about the ontological status of moral values
(i.e., whether they are facts existing out there
that can be discovered or whether they are exclusively social constructs). I simply assert that to people every (moral or amoral) meaning is a construct,
regardless of the possible metaphysical existence of
parallel meanings independent of the human world.
A social approach implies that disability is first
and foremost a social construct or creation, which
means that it can be abolished by reconstructing or
deconstructing the values and practices that sustain
disability. In order to clarify the issue, let us consider a few different kinds of impairments and
whether the disability the people with such conditions experience has purely a social origin. For example, a person born without legs seems to have,
intuitively and undoubtedly, a disabling condition:
He or she cannot walk. This conclusion can, however, be questioned by claiming that an individual
born without legs is disabled by the social and material arrangements of society. Suppose that most
people were unable to walk and used wheelchairs.
If this were the case, we would build ramps rather

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than staircases to buildings. As Silvers (1994) noted:

By hypothesizing what social arrangements would be in place
were persons with disabilities dominant rather than suppressed,
it becomes evident that systematic exclusion of the disabled is
a consequence not of their natural inferiority but of their minority social status. That is, they are inferior not because they
are too defective, but rather because they are too few. (pp. 168
169)

On the grounds of this line of reasoning, it is

logical to question, for example, the moral justification of rehabilitation enterprise by appealing to its
one-sided emphasis on normality. Thus, one can
claim that the aim of rehabilitation is to assist the
individual to be as normal as possible. As a result,
rehabilitation philosophy emphasises physical normality and,
with this, the attainment of skills that allow the individual to
approximate as closely as possible to able-bodied behaviour (e.g.
only using a wheelchair as a last resort, rather than seeing it as
a disabled peoples mobility aid like a pair of shoes is an ablebodied persons mobility aid). (Oliver, 1990, p. 54)

To equate shoes with a wheelchair as mobility

aids seems to result in an unfortunate analogy. One
could claim that a person who cannot walk could
hardly move around at all without a wheelchair. An
able-bodied person, however, can move without
shoes, although in some circumstances with difficulty. The idea of a hypothetical society in which
most people were unable to walk is relevant regarding unjust social arrangements. On the grounds of
this hypothetical example it is, however, problematic to conclude that disability (limitation in mobility in the present context) is solely created by
society. The mobility of a person who cannot walk
has to be made possible separately in any society by
building ramps, elevators, decent sidewalks, and so
on. Thus, the mobility of a person who cannot walk
requires a more or less developed infrastructure. If
this line of reasoning is used it can be argued that
inability to walk in itself, at least to some extent,
disables the individual.
This argument is based on the assumption that
mobility as such is a fundamental human function
and that restricted opportunities for practicing it inevitably results in disablement. Yet, there is an obvious flaw in this reasoning, which is a consequence
of ignoring the social origins of considering mobility
as a fundamental human function. It is the communal values and practices that decide whether a
certain form of functioning is considered essential
in the context of humanity. If a person without legs
does not consider his or her condition as disabling,

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it seems highly problematic to discount the persons

own experience by appealing to some objective
standard that condemns him or her to an inferior
form of humanity. In addition, many individuals
without legs can indeed move by, for example,
crawling and do not find it dehumanizing, but for
themselves a natural way of moving. They only
need wheelchairs for longer distances in the same
way that people with legs prefer using bicycles or
cars for longer distances. The difference regarding
mobility is that of quantity: Getting from one place
to another may require a longer time and more effort from chain-smokers, overweight people, and
people with physical impairments than for other
people. Thus, individual characteristics do not primarily determine when a person is physically disabled but, rather, the communal normative standards of proper mobility.
The example of crawling presented in the previous paragraph is problematic in the sense that to
some people, wheelchair users crawling suggests animal-like behavior. In the light of the history of
disablement, this can trigger offense in many readers. Why is it, then, that crawling suggests animallike behavior and is, thus, potentially an offensive
example? The answer, I think, has to do with the
interrelated nature of social creations and constructions. First, society does not consider the human
variety in mobility; instead, the environment is arranged in a manner that suits only the majority of
population. This process of social organization leads
to the disablement of some people. Second, the way
the environment has been built affects how people
view the variety in mobility. Atypical mobility is
easily interpreted as species atypical functioning, animal-like and undesirable for human beings. The
social creations, therefore, have an effect on social
constructs. On the other hand, social constructs inevitably influence the way society is built. Our environment is usually built on the basis of the assumptions of what is a typical, normal, and desirable way of moving for humans. Social constructions can in themselves label some people as
inferior, but they also work as a basis for social creations that disable some people. In conclusion, the
reason why we view crawling as animal-like behavior or walking as the way of moving for human beings are the social constructs that result from the
ableist discourse.
These considerations apply to mental retardation as well. According to Bogdan and Taylor
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(1994), mental retardation is a social construct and

a metaphor that
exists in the minds of those who apply the label, and not in
those to whom the label is applied. The answer to the question,
Who is mentally retarded?, depends on the classification procedures used to define people as such. (p. 48)

That is, certain people have been categorized

as mentally retarded by so-called normal people, not
by people with mental retardation. Also, all definitions depend and are based on the classification
practices, which stem from the prevailing cultural
beliefs and norms. The majority of those people
who are seen to suffer from mental retardation are
disabled in that particular culture, but would not,
perhaps, be disabled in some other culture. Their
disability is primarily related to cultural factors and
is, therefore, a contingent disability: It is determined and produced by accidental and arbitrary factors.
In sum, the definition of disability always takes
place in social interaction, where normal people define dichotomically, in relation to themselves, persons differing from them as disabled. When physically or mentally deviant people are defined, normality is also defined. In other words, when the
majority of people are able to describe the difference between themselves and the anomalous minority, not only are deviance and abnormality being
constructed, but normality and normal people as
wellor first and foremost, perhaps (Linton, 1998,
pp. 2225). In disability research this could be explained by the fact that most of the research has
been, and still mainly is, carried out by those who
have the power (nondisabled individuals) upon
those who do not (disabled individuals) (Oliver,
1992). Yet, it would be nave to assume that people
with impairments are exempt from the tendency to
stereotype and objectify; after all, people with and
those without impairments have both been
schooled in the same ableist discourse. Thus, even
many people with impairments themselves have
started to believe what the traditional explanations
of disability tell them; problems that they experience in everyday living are a direct result of their
own personal inadequacies or functional limitations
(Linton, 1998; Oliver, 1992; Stone & Priestley,
1996).
Although every meaning and definition in
communal life is socially constructed, all the dimensions related to them cannot be reduced to social practices. First, pain that pertains to some imqAmerican Association on Mental Retardation

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pairments is pain notwithstanding the environment; to some people, having impairments implies
the kind of pain, limitation, and suffering that cannot be removed by environmental factors (French,
1993; Morris, 1991; Wendell, 1996). Bodily experiences like pain, however, are also intimately connected to ones cultural environment. Wendell
(1996), for example, noted partly on the basis of
her personal experience, that pain is an interpreted
experience . . . sometimes and in part a product of
the interpretation of sensations (p. 171). Personal
interpretations do not take place in a vacuum; they
are connected to cultural, societal, and religious
values, which means that the definition and experience of pain depends, at least to some extent, on
cultural factors. Second, authors have suggested
that it is practically impossible to eliminate all the
limitations or hardships associated with many impairments by any environmental arrangements
(Asch, 2000; Ferguson, 1987; French, 1993; Shakespeare & Watson, 2001). These points include a
strong normative dimension because they assume
certain things to be in themselves undesirable or,
inevitably, to cause undesirable limitations to individuals. The next thing, then, is to consider
whether certain impairments are undesirable despite the environment (i.e., do they automatically
result in disablement?). For instance, as Ferguson
(1987) suggested, is there indeed something profoundly unfortunate about severe cognitive limitations (p. 54)?

Toward an Ethical Model of Disability

Disability is essentially a social phenomenon
and concept. It is constructed in particular social
contexts, and they determine the meaning it carries. Disability is also a normative concept that reflects the ideas concerning what kind of beings humans ought to be, both mentally and physically, and
how society ought to be constructed in order to
treat its members equally. The term disability implies
that individuals considered as disabled lack essential
human abilities or possibilities to qualify as persons
(in a morally significant sense) or to live a good
life. Whether disability can accurately be explained by social and environmental factors, or by
biological factors, determines when disability is
actually a concept describing society or the characteristics of some of its individuals. In either case,
however, having a disability implies an undesirable state of functioning or being of an individual

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either to him or herself or to other people and society.

Physical or mental abilities are essential constituents of humanity, not merely because these
abilities differentiate us from most non-human animals, but because they make possible the communal and relational aspect of human life. The concept disability reflects the idea that persons considered as disabled lack certain abilities, or possibilities, that could contribute to their well-being as
humans and as contributing members of a community. Abilities and possibilities are considered
good and useful whereas disability is seen as an impediment regarding human well-being.
Sociological or psychological research, for example, can illuminate on what basis certain phenomena, ways of being or functioning, are defined
as disabilities, but the essential core of the concept
of disability is ethical. The tenets of the traditional
individual approach to disability imply that disability is a matter of an individuals insufficient abilities.
This inevitably places persons with impairments
into an unfortunate and even tragic position. In the
social approaches to disability, impairment and disability are not linked together as strongly as in the
individual approach. Instead, proponents of these
approaches emphasize that these two phenomena
are distinct. Supporters of the social views do not
regard impairments as such as necessarily undesirable conditions. Disability, however, seems to be
considered an undesirable state of functioning, or
phenomenon, arising primarily or at least in part
from unjust social arrangements. Thus, all individualistic and social approaches to disability contain
a strong normative dimension that implies what is
good or bad for an individual and what is right or
wrong as regards social arrangements.
The crucial point, then, is to examine the relevance and soundness of the norms that cause us
to define certain phenomena, conditions, and ways
of functioning as disabilities. The crucial starting
point from a traditional, moral, philosophical viewpoint is the question: What individual conditions
or ways of functioning can, on sound normative
grounds, be considered to result in disablement in
the sense that they would jeopardize our well-being,
pursuits of a good life, or capability of acting as
responsible moral agents? That is, can we define
plausible criteria for a morally desirable way of functioning and being a human being? An account that
attempts to answer these questions would have to
be based on a view of good human functioning, and

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a conception of being human. In the words of Nussbaum (1990):

What are the features of our common humanity, features that
lead us to recognize certain others, however distant their location and their forms of life, as humans and, on the other hand,
to decide that certain other beings who resemble us superficially
could not possibly be human? (p. 219)

Because society plays an essential role in the

creation and construction of disability, the questions of definition cannot be detached from the issue of how a just society ought to be arranged. From
this perspective the crucial question would be, is
disability an indication and the result of social and
political systems? If it is, in what manner, and to
what extent, is society obliged to redress the systems
and arrangements that have disabled some of its
members?
If these questions concerning well-being and
justice are found relevant, there are at least three
alternative ways to answer them: (a) universal, objective theory of humanity, which can distinguish
disabled people from the nondisabled people on
the grounds of their biological characteristics; (b)
a subjectivist theory of disability that would make
an individuals personal experience the central,
and the only relevant, criterion (i.e., if an individual feels or thinks that he or she is disabled, then
he or she is disabled); and (c) a communitarian
theory of disability in which disability would be
defined according to the prevailing cultural traditions and communal practices. I will now take a
brief, critical look at these three possible ways of
defining disability.

Universal, Objective Theory of Disability

At first glance, the view that impairments are
good or desirable conditions from the individuals
perspective seems to be a highly counterintuitive
position. For example, causing impairment to
anyone, especially to ones child, is generally and
reasonably considered as prima facie immoral
(Vehmas, 2002). This is because impairments are
not, in fact, seen as neutral factors regarding human well-being. What are the reasons for this
conclusion?
Nussbaums (1988, 1990, 1992) aim was to provide a basis for giving answers to this question by
arguing that there is an intrinsic value in the possession or exercise of certain cognitive, sensory, and
motor functions because they are essential components of humanity and the human good. In her theory the tasks and obligations of society cannot be
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understood apart from a rather substantial account

of the human good and what it is to function humanly. The aim of political planning is the distribution to the societys individual people of the conditions in which a good human life can be chosen
and lived. This distributive task aims at making
people able to function in certain human ways that
are in accordance with a good human life. In order
to provide an account of the human good and what
it is to function humanly, an ethical investigation
is needed.
Nussbaums (1990) Aristotelian thick vague
conception of the human being and thick vague
conception of the good draw the general outlines
of the good life by first determining what are the
things that make us human beings. For this purpose
she gives us an open-ended list containing 10 essential features of human beings, including being
able to move about from place to place and being
able to use the five senses (Nussbaum, 1990, p.
225). She also wrote that practical reason and affiliation are the human functions that organize and
arrange all of the others, giving them in the process
a characteristically human shape:
All animals nourish themselves, use their senses, move about,
and so onand all of this as beings in one number. What is
distinctive, and distinctively valuable to us, about the human
way of doing this is that all these functions are, first of all,
planned and organized by practical reason, and, second, done
with and to others. (p. 226)

According to Nussbaum (1990), life without

these previously stated elements is less than human, a fortiori surely not a good human life (p.
227). McMahan (1996) shared the normative premises regarding impairments with Nussbaum and
supported them with the following considerations:
People who are born blind, for example, are thereby deprived of
certain dimensions of well-being: they cannot perceive the sublimity of an Alpine landscape, create or appreciate works of visual art, and so on. . . . people born autistic are incapable of
forming deep personal relations. Although in some cases deprivations of these sorts are on balance compensated for, there are
many other cases in which they are not. (pp. 34)

Why do we think that people born blind or

autistic need some sort of compensation for their
deprivations? Because appreciating works of visual art and forming deep personal relations are
of vital importance to us, to so-called normal
people. Certain functions are regarded as speciestypical and vital for human well-being because
they are sources of shared experience and social
interaction and also because our social life and
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culture are built around some of those functions

(Wasserman, 1996, p. 133). This is why people
do not feel themselves impaired, for example, in
lacking a sixth sense or the acoustic range or olfactory sensitivity of a typical dog. Functions and
faculties are regarded as species-typical and good
for people on the basis of cultural and social accommodation, regardless of how much these, or
some other functions and faculties, could in themselves enrich our lives.
In other words, people who have never been
able to perceive the sublimity of an Alpine landscape would not feel deprived of anything at all
unless they were told that they suffered from a deficiency (this, of course, does not apply to people
who become blind after being sighted). Also, an
individual incapable of forming deep personal relations does not necessarily suffer from this deprivation. His or her deprivation can actually be the
deprivation of other people. It makes perfect sense
that the parents of a child with autism feel deprived
due to the lack of interaction with their child. The
child, however, may not have this problem. The
subjective experience of deprivation and disability
may be primarily that of the parents, not of the
child. It is noted, however, that many people with
autism do suffer due to a sense of alienation from
other people and experience frustration, depression,
and a sense of apprehension (Jones, Zahl, & Huws,
2001). To what extent these experiences can be reduced to communal values, practices, and expectations as opposed to autism in itself, is often hard to
tell.
In the case of individuals with severe cognitive
impairments, MacMahan (1996) provided the following reasons for their unfortunate state of being:
First, their disabilities may obviously be instrumentally disadvantageous. They are wholly dependent on others for their continued existence and for whatever other goods their lives contain
and are therefore precariously vulnerable to neglect and abuse.
Second, their permanently infantile condition may seem objectively degraded. . . . Their misfortune is the indefinite extension
into adolescence and adulthood of a state of being that is appropriate only to infancy. Third, and most importantly, individuals born with only very rudimentary cognitive and emotional
capacities necessarily have a highly restricted capacity for wellbeing. . . . [They] are incapable, for example, of deep personal
and social relations, creativity and achievement, the attainment
of higher forms of knowledge, aesthetic pleasures, and so on.
Their signal misfortune is thus that they are excluded from many
or most of the various dimensions of a good life. (pp. 78)

As for the first reason MacMahan (1996) gave

for the unfortunateness of cognitive impairments,

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one must ask: Are we not all dependent on others

and, therefore, vulnerable to neglect and abuse?
The well-being or ill-being of all individuals depends primarily on their relation to other people
(Vehmas, 1999). If people close to me decided to
exploit my vulnerability, I would probably feel distress no matter what kind of intellectual competence I had. Humanity and human well-being are,
thus, mainly granted to us by other people; the humanity of all individuals, and their well-being depends on other peoples recognition.
The crucial point behind all MacMahans
(1996) remarks, in fact, seems to be the idea that
the condition of individuals with severe cognitive
impairments is objectively degraded and that they
have a restricted capacity for well-being. One basic
problem in both MacMahans (1996) and Nussbaums (1990) position is how they view the concept of well-being, and in Nussbaums case the concept of flourishing as well. Well-being is essentially
a subjective concept by its very nature; well-being
concerns unavoidably what is good or bad for the
subject in question (Sumner, 1995, p. 767). There
are, of course, objective factors that weigh on ones
chances for a happy or good life. Intellectual competence, for example, may be one of them. The environment and relationship with others, however,
may count a great deal more than intellectual competence when assessing ones well-being (Vehmas,
1999, p. 115).
For Nussbaum, however, the Aristotelian concept of flourishing is an objective one, contrary to
well-being. Flourishing refers to the kind of happiness and subjective well-being that is brought about
by living according to the objective ideals that form
the idea of a good life; one has to practice an intellectually contemplative and politically active life;
develop ones virtuous dispositions, such as practical
reason (phronesis) and fortitude; and carry out in
practice the virtues that one ought to hold in order
to qualify as a virtuous person and, thereby, be able
to live a good life. That is, subjective well-being
does not necessarily imply a good life. What matters
from Nussbaums theoretical viewpoint is the objective concept of flourishing and whether one lives
according to it. Subjective well-being counts morally only as long as it is the result of flourishing.
This position, however, gives rise to at least as many
problems as it purports to solve. First, Aristotles
objective account of morality and the good life is
merely one theory among many others, and, at least
so far, there is no consensus as to why we should

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adopt Aristotles theory (let alone Nussbaums application of it) as the ultimate criterion for a good
human life. Second, it seems very curious to detach
goodness or badness altogether from individuals
preferences. There is no value, for example, in
knowledge, rational activity, love, or the awareness
of beauty if they are entirely devoid of pleasure. So,
the badness of a pain consists in its being disliked;
it is not disliked because it is bad. What is of value,
or is good for someone, requires an individuals desire for it (Parfit, 1986, pp. 499502).
Third, is it possible to separate meaningfully
flourishing and subjective well-being from each other the way Nussbaum (1990) does? Subjective wellbeing, as well as the ideas of objective criteria for
flourishing, are inevitably culture-bound; the customs, traditions, and values of a community affect
how actions and ways of living are considered morally. Also, the contents of objective values and virtues (such as knowledge, rational activity, and beauty) are formed in a cultural context and, to a large
extent, produced by it as well. It seems also highly
difficult and arbitrary to evaluate exactly when an
individual is not practicing his or her practical reason independently enough as opposed to being unconsciously and uncritically following the moral
mores he or she has been taught. Further, how can
we determine what kind of subjective well-being is
not in accordance with flourishing?
Thus, well-being and flourishing too are relative concepts. This being the case, where do we
draw the limit between acceptable and unacceptable moral ideals? It seems that Nussbaums (1990)
objective thick vague conception of the good is
not a very helpful tool if one is to consider all the
dimensions in individual and social lives. This, in
fact, applies to all moral theories: Any categorical
norm or theory is too rigid to account for the distinct particularities of human life. That is, human
life is too complex for almost any universal moral
theory to capture, which is why these theories can
only generate prima facie guidelines for action. This
is why purely objective conceptual accounts on disability would inevitably be insufficient.

A Subjectivist Theory of Disability

If the concept of well-being is considered to be
of crucial importance in the normative definition
and conceptualization of disability, an individuals
subjective experience would seem to be the most
weighty factor. That is, in order to avoid paternalistic ideas and concomitant practices, the individual
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him or herself should have the one and only relevant voice in determining whether he or she is disabled, whether he or she has a disabling impairment. In some sense, this seems a promising alternative. It would prevent the flaws of the medical
model of disability based on the absence of subjectivity of people with impairments, an approach that
has been, for example in disability research, argued
to result in promoting, rather than solving, the
problem of discrimination and oppression (Barnes,
1996; Oliver, 1992; Stone & Priestley, 1996). Some
disability scholars can be seen to stand for a subjective account on disability. Their position emphasizes cognitive interaction and affective experience as the basis of disablement; disability is the
product of personal experience and negotiation of
social roles between individuals. This means that a
person is disabled if he or she feels so, and it also
means that the subjective experience of disablement is an elementary constituent of his or her selfunderstanding. The process is largely determined by
how the individual positions him or herself in relation to other people, their identities and characteristics (French, 1993; Morris, 1991; Priestley,
1998).
A normative subjectivist position, however,
causes serious problems, of which one is the submission to social injustice. Consider the following
example. Females in certain poor regions of India
suffer from diseases of malnutrition in greater numbers than males do. This is the result of traditional
distributional inequalities, reinforced by culturally
learned values. When questioned, these women
may not only say that they feel good and are doing
well, but they may also say that their position is in
accordance with their deeply held conceptions of
what is good and right for women (Nussbaum,
1988, p. 175). Similar kinds of examples could be
presented of people with impairments who have
adopted the arrangements of their environment as
the basis of their subjectivity, arrangements (regarding, for example, education and work) that place
them in an inferior position to other people.
Thus, in some cultures the upbringing of certain people has been hedged around with discrimination and inequality, with the result that the people that are actually discriminated against do not
acknowledge this negative experience, have adapted to the prevailing circumstances, and have the
subjective experience of doing well. Obviously, we
do need some sort of objective valuational procedure that will have the power to criticize the evalqAmerican Association on Mental Retardation

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uations made by people who have accustomed

themselves to discrimination. In the case of discrimination, Nussbaums (1988) following comment
seems justified and relevant:
Just as people can be taught not to want or miss the things their
culture has taught them they should not or could not have, so
too they can be taught not to value certain functionings as constituents of their good living, where their culture has an interest
in, or cannot avoid, denying them access to these functionings.
(p. 176)

A subjectivist position also has problems with

regard to distributing goods, assuming that the subjective experience of disablement could work as a
basis for the right to obtain extra financial support
from society. If disability would be a relevant factor
in considering distributive justice, the issue automatically involves other people, their resources, and
interests. This being the case, subjective experiences cannot possibly be sufficient reasons for allocating resources. If they were, we would end up in a
hopelessly relativistic situation, where all subjective
voices should count equally; none of these voices
could be said to be better or worse than any other.
Subjectivism excludes in this kind of situation the
possibility of rational persuasion and negotiation.
To conclude, a subjectivist normative theory of disability would inevitably be an insufficient and unsound account.

A Communitarian Theory of Disability

Communitarianism is a political doctrine that
emphasizes the good of the community and the
health of the group. According to communitarians,
the emphasis on individual rights in Western culture must be supplemented and corrected by a focus
on responsibilities, and the good of the community
and integrity of its traditions should be promoted
by a variety of means, including the deliberate use
of public policy. In this position, people are seen
essentially as social and historical creatures, whose
capacities, values, aspirations, and identities result
from them being born and raised in particular communities. What constitutes a true community is a
matter of dispute among the communitarians.
MacIntyre (1985) denied that a modern nation
state could be a community in a real sense. The
only genuine communities today are nonpolitical,
such as religious and ethnocultural groups, which
sustain traditions and practices that embody and
promote a common good for their members.
According to MacIntyre, an individuals moral
identity is intertwined with his or her social roles

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and is determined by them. Our social identities are

formed in relation to the various roles we hold (e.g.,
I am someones daughter or son, a member of this
or that profession). This implies that the good life
is not the same for all individuals everywhere; ones
cultural and historical context along with ones particular social identities determine the contents of
the good life. As MacIntyre (1985) noted:
Hence what is good for me has to be what is good for one who
inhabits these roles. As such, I inherit from the past of my family,
my city, my tribe, and my nation a variety of debts, inheritances,
rightful expectations, and obligations. These constitute the given
of my life, my moral starting point. This is in part what gives
my life its own moral particularity. (p. 220)

Community is in MacIntyres (1985) theory a

set of practices. As in chess or football, societal and
political life requires that people learn and obey the
established rules. Each person cannot play by his or
her own rulesotherwise the community would
end up in chaos. In order to live the good life, one
must be a good member of the community: act according to ones social roles and their concomitant
moral norms. This is not possible if one does not
follow the rules and traditions of ones community.
Even transforming community and its practices has
to take place in a manner in which the communitys
traditions, customs, and values are respected.
Communitarianism is based on the assumption
that community requires likeness; it is rooted in
what is common (Moon, 1998). When applied to
the definition of disability and the position of people with impairments in the community, communitarianism may have at least the following kind of
implications. The conditions set upon the members
of the community apply equally to all of them. Individuals with impairments should acknowledge
that they are members of the community, occupants
of certain roles, and that they have to adapt to the
culture they were born into and in which they live.
If their aptitudes imply limited opportunities, as
well as an inferior social status, because of the communal practices, they simply have to accept that
fact and try to be as good members of the community as possible.
This kind of position would inevitably lead
into the kind of oppression and the tyranny of
normal people many disability scholars have
been talking about. Although it is not something
MacIntyre himself would probably condone
(MacIntyre, 1999), his original reconstruction of
morality seems prey to oppressive and relativistic
worries. Contemporary culture contains a multi-

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plicity of traditions. When we are born into one

of them, we can only regard a decision to remain
within it or to leave it for another. Within the
communitarian framework, it seems very difficult
to evaluate the relative validity of one tradition
with respect to its rivals; we end up in a situation
with an arbitrary choice between traditions (Mulhall & Swift, 1992, p. 91). To conclude, without
some objective criteria for arranging human communities, a communitarian model would result in
an arbitrary situation where any tradition could be
justified, even if it resulted in the oppression of
people with impairments. Communitarians have
expressed some important points about issues such
as identity, but, as such, it is an insufficient basis
for the conceptualization of disability.

A Combined Ethical Theory of

Disability: A Preliminary Proposal
Traditional ethical theories consist of assumptions and norms about what makes us distinctively
human. For example, in philosophy the concept of
a moral being signifies a being that merits moral
rights and is capable of acting morally. Philosophers
have argued that only rational beings can be moral,
which implies that non-human animals as well as
some people with severe cognitive impairment,
mental illness, or brain damage are amoral beings.
Their behavior, even if harmful or otherwise undesirable, is not seen as immoral, but rather as a
regrettable, unavoidable consequence of their not
knowing better. In everyday morality and in moral
philosophy (at least in the works of such classics as
Plato, Aristotle, Kant, and Mill), rationality and
practical reason are attributed to adult human beings whose intelligence is normal (Sapontzis,
1987, chapter 3).
One can reasonably argue that people with impairments are, in the light of ethical theories and theories of social justice, marginal human beings. Philosophical practice presents people with impairments in
the light of pessimistic extremities, not in the light of
their daily routine. By doing so, philosophy depicts
living this way as a fringe existence (MacIntyre, 1999,
chapter 1; Silvers, 1998, pp. 23; Vehmas, 2004). This
leaves us three alternatives. The first is to accept the
tenets of Western moral philosophy and admit that
people with impairments indeed are morally less human than others. The second alternative is to reject
altogether these ethical theories that marginalize, both
socially and morally, people with impairments. The
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third option is to question and revise, in the light of

impairment and disability, these theories that are, after
all, supposed to say something essential about all kinds
of human lives.
Thus, impairment and disability are highly relevant to philosophical practice because they raise
fundamental issues about the significance of variations in physical and mental functioning for human
well-being, for personal and social identity, and for
social justice. On the other hand, recent Anglo
American philosophy should be of interest to disability scholars because of its close analysis of concepts critical to the conceptualization of disability,
such as health, normality, disease, well-being, discrimination, justice, and equality (Wasserman,
2001, p. 219).
I have suggested in this article that in order to
conceptualize and define disability and impairment
satisfactorily, ethical investigation is needed. Although the social approaches to disability seem to
be sound accounts on the whole, they miss something crucial by ignoring the scrutiny of the normative dimension of disability. I have outlined
three possible ethical theories of disability: a universal, objective theory; a subjectivist theory; and a
communitarian theory. My brief discussion of these
possible theories was aimed at showing that they
would inevitably be insufficient. This is understandable due to the ignorance of philosophical discourse
regarding the various dimensions of disability. What
we need, then, is dialogue of philosophy and disability studies in order to conceptualize disability
satisfactorily from an ethical viewpoint.
To correct the mistakes of the possible ethical
theories of disability that I have outlined in this
paper, one should develop the kind of combined
normative theory of disability that would consider
factors from all three theories; objective, subjectivist, and communal aspects that have moral relevance. The development of such a theory would
have to be based on a thorough examination of the
possible implications of the major ethical theories
on the definition of disability. That is, one should
take into account, at least, virtue-based, duty-based,
and outcome-based ethics. Also, an ethical examination of disability requires understanding of different impairments and how they affect peoples wellbeing in different cultures.
One basic mistake in the arguments of many
philosophers is to see disability, and its significance
regarding peoples well-being, from a strictly individualistic perspective. For example, Singer, who is
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probably the best known philosopher writing about

disability, argued that disability is the result of individuals impairments, results in an impoverished
human existence, and can thus be a morally significant factor in the sense that individuals (especially
fetuses and infants) with impairments are less entitled to life than others (Kuhse & Singer, 1985;
Singer, 1993, 1995). Accounts based on individualistic and atomistic ideas of disability and human
well-being are incorrect because people are relational
beings whose survival, let alone flourishing, is in
debt to other people. No account of the human
condition that ignores the impaired nature of all
human lives, our vulnerabilities and afflictions, and
the extent of our dependence on particular others
can be credible (MacIntyre, 1999, p. 1; Vehmas,
1999, pp. 114115).
Moral philosophy has constructed a division
between people on the basis of disability where individuals with impairments are seen as them, as
other than us. In this dichotomy, we are normal and they are abnormal; we pay the costs
and they get the benefits (MacIntyre, 1999, p. 2;
Veatch, 1986, pp. 166168). This dichotomy is patently false; all people are impaired in some sense
and face limitations in their lives. It is, however,
also true that the level of impairments and limitations varies from the trivial to the profound (Shakespeare & Watson, 2001).
So, what is needed is the kind of an ethical
account in which attention is paid to the social and
communal nature of disability, well-being, and human lives in the first place. From that perspective,
a virtue ethical approach seems a promising foundation because it sees human lives and morality in
the context of a community, not individualistically.
According to the modern virtue ethics perspective,
values and virtues are shaped, and have a meaning,
in a cultural context. They are not necessarily constituents of the universal human telos as classical
ethics of virtue (Aristotle) saw it. Quite the opposite, to seek a universally valid basis for ethics and
to formulate universal moral principles is an endeavor doomed to failure because morality is a historically determined human institution that can be
properly understood only if it is seen as such: all
morality is always to some degree tied to the socially
local and particular . . . the aspirations of the morality of modernity to a universality freed from all
particularity is an illusion (Macintyre, 1985, pp.
126127).
Thus, from a virtue ethics perspective (espe-

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cially MacIntyres (1985), morality is particular and

historically determined. This, in fact, is a universal
feature of human life. This approach to ethics that
emphasizes the cultural nature of morality fits in
nicely with the social approaches to disability in
which disability is seen as socially constructed, culturally shaped and produced. In the same way as it
seems odd to detach morality from a particular context, it is absurd to assume that we could plausibly
construct a universal definition of disability, beyond
cultural and social contexts. Without understanding
the particular material and ideological circumstances of a community, we cannot possibly know what
disability is all about.
According to MacIntyre (1985), peoples telos
is communally defined. When I discussed communitarianism earlier in this paper, I pointed out that
to base a moral theory, or theory of disability, in
what is considered normal for people, is to end up
in an account that discriminates against the marginalized members of the community. MacIntyre
(1988, p. 367) stressed that a neutral perspective
(regarding morality and rationality) is a conceptual
impossibility; the notion of understanding presupposes understanding from a certain viewpoint. This
implies that we cannot evaluate the moral norms
of other cultures from a neutral viewpoint but, rather, from our own tradition. In the same way, defining humanity, human well-being, or the good life
cannot take place beyond our experiences and subjectivity. The way people without impairments view
people with impairments and their chances for wellbeing and good life inevitably is based on their experience and point of view as nondisabled persons.
Thus, when defining disability, without hearing the
subjective voices of those seen as disabled, we can
only construct an external, the kind of objective
model that does not explain much of individuals
experiencesit would merely be a projection, our
view of them.
To conclude, although I have not offered here
an exhaustive scrutiny of the ethical conceptualization of disability, I have tried to show that we
cannot construe a plausible universal, normative account of disability. Definition, let alone normative
conceptualization, always takes place in a social
context with varying traditions, values, and requirements. It seems that it is not, after all, essential to
ask what individual conditions compromise peoples
well-being or pursuit of a good life. Rather, a more
crucial issue is how other people, the surrounding
environment altogether, should regard people with

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impairments. What kind of theoretical foundation,

and consequent practical arrangements, should we
produce in order to create the kind of reality where
people with a variety of characteristics (including
impairments) are not a nuisance, but equal, valuable contributors to the communal life? Perhaps the
well-being of the marginalized groups of society
ought to be seen as an essential indicator of the
flourishing of the whole society. As MacIntyre
(1999) pointed out: For it is insofar as it is need
that provides reasons for action for the members of
some particular community that that community
flourishes (p. 109).

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Received 3/13/01, first decision 5/27/01, accepted

9/4/03.
Editor-in-charge: Steven J. Taylor

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I thank Peter Herissone-Kelly, Matti Hayry, Tuija Takala, and Gregor Wolbring for their critical comments on
this paper.

Author:
Simo Vehmas, PhD, Postdoctoral Researcher, Department of Moral and Social Philosophy, University of Helsinki, PO Box 9, 00014 Helsinki, Finland. E-mail: Simo.vehmas@Helsinki.fi

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