In this peer commentary on L. Syd M. Johnson’s “Inference and Inductive Risk in Disorders of Consciousness,” I argue for the necessity of disability education as an integral component of decision-making processes concerning patients with DOC and, mutatis mutandis, all patients with disabilities. The sole qualification Johnson places on such decision-making is that stakeholders are educated about and “understand the uncertainties of diagnosis and prognosis.” Drawing upon research in philosophy of disability, social epistemology, and health psychology, I argue that this (...) educational qualification is insufficient to address systemic ableism and other forms of epistemic bias in quality of life judgments. (shrink)

[This piece is written for those working in social gerontology and aging studies, with the aim of bringing insights from disability studies and philosophy of disability to bear on enduring debates in those fields.] The guiding question of humanistic age-studies—What does it mean to grow old?—cannot be answered without reflecting on disability. This is not simply because growing old invariably means becoming impaired in various ways, but also because the discriminations and stigmas involved in ageism are often rooted in (...) class='Hi'>ableism. We here draw on research in the philosophy of disability as well as the interdisciplinary field of disability studies to explore the relationship between ageism and ableism. (shrink)

This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four (...) primary mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice. (shrink)

My aim in this paper is to show how the functionalist standards assumed in the AI debate are, in fact, the assumptions of a capitalist, ableist society writ large. The already established argument against the proposed humanity of AI systems implies a wider critique of the entire ideology of functionalism under which the notion of intelligent machines has taken root.

This paper has two goals. The first is to argue that the field of bioethics in general and the literature on ideal vs. nonideal theory in particular has underemphasized a primary problem for normative theorizing: the role of conditioning principles. I define these as principles that implicitly or explicitly ground, limit, or otherwise determine the construction and function of other principles, and, as a result, profoundly impact concept formation, perception, judgment, and action, et al. The second is to demonstrate that (...) ableism is one such conditioning principle and that it undermines the field of bioethics and the practice of biomedicine from achieving the aim of justice as fairness. After briefly addressing the history and critiques of principlism in bioethics, I lay out and defend my account of conditioning principles. I then argue that ableism is one such principle and demonstrate it at work through an analysis of a storied debate between Eva Kittay, Peter Singer, and Jeff McMahan. In conclusion, I contend that the ethical and philosophical dangers of conditioning principles are too easily exacerbated by ideal theory frameworks, and I do so by demonstrating how they are especially liable to generate epistemic injustice, especially contributory and hermeneutical injustice. (shrink)

Body Integrity Identity Disorder (BIID) is a very rare condition describing those with an intense desire or need to move from a state of ability to relative impairment, typically through the amputation of one or more limbs. In this paper, I draw upon research in critical disability studies and philosophy of disability to critique arguments based upon the principle of nonmaleficence against such surgery. I demonstrate how the action-relative concept of harm in such arguments relies upon suspect notions of biological (...) and statistical normality, and I contend that each fail to provide normative guidance. I then propose a critical theory of harm, one marked by substantive engagement with both empirical and reflective inquiry across the sciences, social sciences, and humanities. I conclude by discussing the implications of this theory and how it might enrich ongoing debates in bioethics, philosophy of disability, and the health humanities. (shrink)

A Zoom discussion about racism and ableism in philosophy.

It is widely known that Black people are significantly more likely to be killed by the police in the United States of America than white people. What is less widely known is that nearly half of all people killed by the police are disabled people. The aim of this paper is to better understand the intersection of racism and ableism in the USA. Contributing to the growing literature at the intersection of philosophy of disability and critical philosophy of race, (...) I argue that theories concerning white supremacy should take more seriously the ways in which it functions as a process and apparatus of making abled and disabled. I conclude by discussing how understanding white supremacy in this manner is a valuable coalitional tool in fights for social justice. (shrink)

The feminist charge that Michel Foucault's work in general and his history of sexuality in particular are masculinist, sexist, and reflect male biases vexes feminist philosophers of disability who believe his claims about (for instance) the constitution of subjects, genealogy, governmentality, discipline, and regimes of truths imbue their feminist analyses of disability and ableism with complexity and richness, as well as inspire theoretical sophistication and intellectual rigor in the fields of philosophy of disability and disability studies more generally. No (...) aspect of Foucault's corpus has been more consistently subjected to the charges of masculinism and male bias than his example of the nineteenth-century farmhand Charles Jouy who, at about forty years of age, engaged in sexual activity with a girl, Sophie Adam, was reported to authorities, and subsequently was incarcerated in Maréville for the rest of his days. My central aim in this paper is to interrupt the momentum of the accepted feminist interpretation of the Jouy case by advancing a feminist perspective on Jouy's identity and the incidents involving Jouy and Adam that takes seriously insights derived from philosophy of disability and critical disability theory and history. (shrink)

Informed consent is a central concept for empirical and theoretical research concerning pregnancy management decisions and is often taken to be one of the more fundamental goals of the profession of genetic counseling. Tellingly, this concept has been seen by disability communities as salutary, despite longstanding critiques made by disability activists, advocates, and scholars concerning practices involved in genetic counseling more generally. In this chapter, we show that the widespread faith in informed consent is misleading and can be detrimental to (...) the practice of genetic counseling as guided by concerns of justice and equity. We proceed in two steps. First, we explain how informed consent is flawed as a practical concept. Second, we show how the inadequacy of informed consent illuminates the animating core of disability critiques of genetic counseling: the issue of ableism. We argue that the problem of ableism cannot be solved with informed consent because it is not merely a problem of information, but also of epistemic schemas. We suggest that what we call critically informed consent is better suited to move genetic counseling from being aware of the problem of ableism to becoming actively anti-ableist. (shrink)

In analyzing oppressive systems like racism, social theorists have articulated accounts of the dynamic interaction and mutual dependence between psychological components, such as individuals’ patterns of thought and action, and social components, such as formal institutions and informal interactions. We argue for the further inclusion of physical components, such as material artifacts and spatial environments. Drawing on socially situated and ecologically embedded approaches in the cognitive sciences, we argue that physical components of racism are not only shaped by, but also (...) shape psychological and social components of racism. Indeed, while our initial focus is on racism and racist things, we contend that our framework is also applicable to other oppressive systems, including sexism, classism, and ableism. This is because racist things are part of a broader class of oppressive things, which are material artifacts and spatial environments that are in congruence with an oppressive system. (shrink)

The following paper is one of the most extensive documented analyses to date of state violence against neurodivergent people and the poor in Germany. It examines, with an unusual density of data, a series of social court and administrative law proceedings in which a neurodivergent applicant attempted to make fundamental rights – in particular access to autism diagnostics, disability-related accommodations, subsistence-securing benefits, and health protection – practically effective. What becomes visible is how the German state harms the health of neurodivergent (...) people through unsuitable or failing administrative structures (Bürgergeld system / social courts / medical care), while protective mechanisms structurally fail. In the context of the WCA scandal in England, this study reveals a repetition of the same situation of endangerment that there led to numerous deaths and suicides. What emerges is a dramatic picture of the state’s inability to prevent foreseeable health damage and deaths among neurodivergent people that are caused by state action, which raises the most serious concern. Parallels to the Contergan/Thalidomide scandal also become apparent, particularly regarding the authorities’ treatment of the victims, but also with respect to the scale of health damage. This paper stands in the context of the ten-year investigation already published in the book Speed’s Work, which documents massive violence against the poor, neurodivergent people, and other marginalized groups – violence of which state authorities, public prosecutors, and ministers knew that it caused health damage, yet continued nevertheless. Judges, politicians, public prosecutors, and other employees of the state were and remain involved in this violence to this day. The starting point of this new investigation is the massive diagnostic emergency in the field of autism, which exists internationally and is enormous in Germany as well. In the course of this investigation, 1,667 affected individuals competed in one quarter, through a lottery procedure, for 25 diagnostic places at Humboldt University in Berlin, effectively making access to medically necessary autism diagnostics dependent on chance. Because the diagnosis is a prerequisite for almost all further social law claims, a systemic effect arises: without diagnosis no rights – without rights no stabilization – without stabilization no possibility of enforcing the diagnosis. Since only few studies to date have examined the consequences of this emergency in detail, this paper provides an important empirical basis beyond Germany. On the basis of eight court proceedings, several urgent proceedings before Social Courts and Higher Social Courts, internal administrative statements, reactions by court presidents, as well as the refusal of intervention by the Office of the General Public Prosecutor despite risk to life, the study examines how shifts of jurisdiction, fragmentation of legal domains, formal narrowing of claims, and delay condense into a de facto suspension of effective legal protection. The central thesis is that what appears here is not primarily an individual wrong decision, but a systemic constellation in which access to justice is formally opened while materially being structurally blocked. The data reveal a simulation of legality in which state action loses any connection to social reality and individuals are sacrificed in order to stabilize the system. Fundamental structural flaws become visible in social law, as well as in the criminal liability of institutions and their accountability (corporate crime and organizational liability / corporate manslaughter and corporate homicide). It becomes clearly visible how the UN Convention on the Rights of Persons with Disabilities (CRPD) is disregarded at crucial points in Germany, or simply cannot be enforced. The data of the long-term investigation show that a General Public Prosecutor in Germany can watch, without consequence, as an autistic person is gradually forced into mortal danger through the withdrawal of fundamental rights by authorities. As the practical test carried out here reveals, no real functioning protection exists against indirect killing through state measures. Germany also collects no data at all on deaths caused by the state, meaning that what occurred in England (600 suicides) remains statistically invisible in Germany. The question of what state violence against the poor and people with disabilities actually means for those affected has so far been insufficiently investigated. Why autistic people internationally have an estimated life expectancy reduced by up to 16 years can partly be better understood on the basis of the data presented in this study. This study places the frequently occurring, foreseeable health damage among neurodivergent people into the space of the highest urgency, as well as the failure of authorities to react to threats to health and even threats to life, and it likely provides for the first time a scientific basis for assessing the enforceability of the fundamental rights of neurodivergent people in a European country such as Germany. Methodologically, the work (qualitative research) combines legal analysis with documented lived impact. The author acts not only as an external observer but also as part of the experimental arrangement (“provoked empiricism”): applications, complaints, and danger notifications function as empirical measuring instruments in order to make visible how institutions react under conditions of known vulnerability. The emotional dimension – in particular the medically described risk posed by continuous administrative stress in autism – is treated not as rhetorical exaggeration but as part of the evidentiary basis. In the light of international human rights concepts, the events are classified as forms of Structural Violence, Procedural Violence, Epistemic Violence, and Safeguarding Failure. Particular attention is given to the question of whether and why foreseeable health damage is knowingly accepted despite awareness of the situation. This work serves as a human-rights basis aimed at preventing further suffering as far as possible, and as a submission for examination by the responsible EU and UN institutions in Brussels and Geneva, as well as by the German Federal Constitutional Court. This paper has also been submitted to the General Public Prosecutor of Brandenburg together with a criminal complaint, as well as to the Federal Ministry of Labour and Social Affairs in Berlin. Through this documentation, testimony is intended to be given to the fatal situation of neurodivergent people. At the same time, the present investigation functions within the author’s overall body of work as a methodological bridge between theoretical work, documentation, and institutional experience. It reconstructs not only concrete legal conflicts but also makes visible how structural blockages themselves become an epistemic environment that shapes the form, tone, and persistence of neurodivergent research. In this way, the paper contributes to clarifying the conditions under which self-determined neurodivergent knowledge production emerges and shows why its forms of expression are often misunderstood or delegitimized when this contextual structure is not taken into account. (shrink)

This chapter canvases a number of ways that issues surrounding disability intersect with social epistemology. We begin with a discussion of how social epistemology as a field and debates concerning epistemic injustice in particular would benefit from further (a) engaging the fields of disability studies and philosophy of disability and (b) more directly addressing the problem of ableism. In section two, we turn to issues of testimony, “intuitive horribleness,” and their relationship to debates concerning disability and well-being. We address (...) how the regular lack of uptake of disabled people’s testimony can lead to a number of structural rather than merely individual epistemic injustices, and we also consider how the very nature of some disabilities make testimonial issues more complicated. We conclude by discussing various norms of social interaction and how they can systematically disadvantage Autistic people in particular with respect to all the issues discussed herein. (shrink)

On 26 July 2016, Satoshi Uematsu murdered 19 and injured 26 at a caregiving facility in Sagamihara, Japan, making it the country’s worst mass killing since WWII. In this article, I offer an analysis of the Sagamihara 19 massacre. I draw on the work of Julia Kristeva and Emmanuel Levinas to argue that claims about disability experience are insufficient to justify normative projects. In short, disability is normatively ambiguous.

I introduce the concept pathophobia, to capture the range of morally objectionable forms of treatment to which somatically ill persons are subjected. After distinguishing this concept from sanism and ableism, I argue that the moral wrongs of pathophobia are best analysed using a framework of vice ethics. To that end I describe five clusters of pathophobic vices and failings, illustrating each with examples from three influential illness narratives.

Purpose: The millennia long struggles of various oppressed groups have over time illuminated widespread social injustices, organically leading to the recognition of yet further injustices captured by the umbrella of discriminatory isms, such as racism, sexism, classism, ableism, anti-Semitism, ageism, heterosexism, and many others. In recent years, the debate has become increasingly fierce, polarized, and even physically violent. Approach: One of the premises of the present work is that in part, the aforementioned unconstructive behaviours are a result of the (...) different understandings of what constitutes an ism and the lack of a thoughtful consideration of this issue in the mainstream social debate as much as in the academic literature. Findings: I present evidence for this, and critique the dominant lines of thought in this realm showing them all to fall short of both the fundamental philosophical as well practical desiderata in how isms ought to be understood. Originality: I propose an alternative which does not suffer from the same weakness: one based on the denial of equivalence of sentience. I show how the adoption of this understanding leads to constructive ways of addressing isms effected injustice. (shrink)

The proliferation of work by autistic writers continues apace, defying a long and multidisciplinary tradition of constructing autistic people as lacking the capacity for narration. To study neurodivergent literature, then, is to witness the refusal of these exclusionary narrative conventions, and to register the ideological presuppositions that underpin pathologization. In this article, I engage with recent insights from Neurodiversity Studies to explore the connections between narrative neuronormativity and other discourses of oppression, especially those that have generated racialized, gendered, and colonial (...) narratives of desubjectification. Focusing on the neuroqueer movement—an emergent practice of disidentification that refuses the interpellations of neuronormativity, ableism, heteronormativity, and cisnormativity—I discuss the concept of allism, arguing that this satirical critique of pathologization harbors a deconstructive force that denaturalizes the dialectic of recognition. Pursuing the discursive context and theoretical implications of this critique, I provide a short genealogy of narrative neuronormativity, connecting the operation of the dialectic in the early novel to the clinical texts of child psychology. To demonstrate the neuroqueer subversion of this tradition, I then read An Unkindness of Ghosts, by Rivers Solomon, a text that stages a disidentification with storytelling. Protagonist Aster’s neuroqueer refusal indexes the concomitance of the construction of Blackness as an ontological foil for whiteness and the construction of autism as a standard of disordered sociality that neuronorms can be measured against. My reading of Unkindness suggests that the extant techniques of literary narratorship are political instruments that will, unless repurposed, continue to disseminate these dispossessive dialectics. (shrink)

In the essay “Cézanne’s Doubt,” Merleau-Ponty explores the relationship between Paul Cézanne’s art and his embodiment. The doubt in question is ultimately about the meaning of his disabilities. Should Cézanne’s disabilities or impairments shape how we interpret his art or should they instead be treated as incidental, as mere biographical data? Although Merleau-Ponty's essay isn’t intended to be phenomenological, its line of questioning is as much about lived experience as it is about art criticism, art history, and aesthetics. I here (...) offer a reading of “Cézanne’s Doubt” as an exploration of one of the more fundamental issues for phenomenological methodology: the relationship between normality and the normate. I first defend this phenomenological and disability-centric or crip reading of the essay. I then argue that insofar as one takes oneself to be “normal” and insofar as doing so underwrites phenomenological inquiry, the problematic of the normate, not just that of normality, is central to phenomenology. (shrink)

How have and how might philosophers contribute to linking disability and activism in these peri-COVID-19 times, especially in forms of public engagement that go beyond podcasted talks and articles aimed at a public audience? How do we harness philosophical thinking to contribute positively to those living with disability whose vulnerabilities are heightened by this pandemic and the ableism highlighted by collective responses to it?

J.L. Austin argues that ordinary language should be used to identify when it is appropriate or inappropriate to make, accept, or reject knowledge claims. I criticize Austin’s account: In our ordinary life, we often accept justifications rooted in racism, sexism, ableism, and classism as reasons to dismiss knowledge claims or challenges, despite the fact such reasons are not good reasons. Austin’s Ordinary Language Epistemology (OLE) classifies the discounting of knowledge claims in classic cases of epistemic injustice as legitimate ordinary (...) maneuvers. I provide recommendations for revision of OLE and offer a means of distinguishing between dismissals in cases of epistemic injustice and their legitimate counterparts. (shrink)

This paper provides suggestions for educators who have a desire to learn about, or are already committed to, challenging ableism and disablism. As philosophy teachers, we have the opportunity to facilitate student reflection regarding disability, which puts students in a position to make decisions about whether to retain their habitual ways of comporting themselves toward disabled people or to begin the process of forming new perceptual practices. I contend that existential phenomenology, as formulated by Maurice Merleau-Ponty and Linda Martín (...) Alcoff, provides insights regarding the habitual formation of perceptual practices that are useful for thinking about ways that perception may be informed by ableism and disablism. Jessica Cadwallader demonstrates how their insights can be usefully applied to thinking about perceptions of disability. Through analysis of past encounters with people with disabilities, Cadwallader suggests that students change their habitual ways of responding to people with disabilities. While such reflections may be valuable for making habitual perceptual practices explicit, I would suggest that this is only a condition for the possibility of changing ablist perceptual practices rather than the change itself. Students are likely to enter the classroom lacking the insight that they are even engaging in perceptual practices informed by cultural narratives rather than simply perceiving people with impairments as they are. I argue that an approach to teaching on disability that thematizes perceptual practices regarding disability, and takes experiences of disabled people into account, would be more effective than the one Cadwallader describes. Understanding the ways that people with disabilities experience being constructed as a problem through ableist perceptual practices could help students recognize their own potential to impact others in positive and negative ways. (shrink)

This paper develops a mechanism-focused ethical account of a recurring institutional failure mode: punitive non-reception. Punitive non-reception occurs when distress disclosure is met with procedural distance, credibility deflation, or access narrowing — not as a one-off interpersonal misattunement, but as a repeatable response pattern under risk governance rationality. The central claim is that punitive non-reception can operate as a self-reinforcing feedback loop in high-risk contexts. The paper integrates work on epistemic injustice and epistemic violence, ableism and disability ethics, moral (...) injury and institutional betrayal, and stress dysregulation. It also draws a careful boundary between affective use of conversational systems and clinical pathology, warning against stigmatizing spillover. The paper concludes by articulating a minimal ethic of reception: in foreseeable-risk contexts, non-punitive and accessibility-aware reception pathways are not optional. (shrink)

Products and technologies reflect injustices in the world such as racism, sexism, and ableism. And all too often, they exacerbate those injustices in overt and insidious ways. How can we understand and address the harms brought forth by design and technology? Where is the nexus of accountability and justice? This field review begins with provisional definitions of design and justice, followed by an overview of scholarship that surfaces how technologies both create and worsen injustices. In response, it offers two (...) necessary conditions for advancing social justice in and through design. The first is making design processes more inclusive through democratic strategies such as participatory and codesign methods. The second, which the review identifies as a major gap in research and practice, is recognizing design as a mode of practical ethical inquiry in ways that enables designers to deal with the inherent ethical uncertainty of design situations. In conclusion, the review outlines educational and institutional barriers to ethical design and offer suggestions for future investigation. (shrink)

According to 4E cognitive science, our cognitive capacities depend on, and have been transformed by, the environments we have made. Most early works of 4E cognitive science tend to focus on the upside of agent-environment interactions: they have made us smarter and allowed us to do more, despite the same, limited brain (and body) power. However, the recent critical turn focuses on the downsides of agent-environment interactions. Critical 4E cognitive science, as we call this emerging research program, adopts the 4E (...) frameworks and concepts but with a critical lens: questioning its hidden assumptions and leveraging its theoretical resources for social criticism. In particular, we distinguish two kinds of normative critique that bring out the downsides of agent-environment interactions. Prudential critiques focus on how agent-environment interactions can shape an agent’s cognition to undermine their own interests. Political critiques focus on how agent-environment interactions can shape an agent’s cognition to contribute to the reinforcement and exacerbation of unjust social forces. (shrink)

Structures of oppression and administrative systems in white supremacist settler colonial societies rely on epistemological foundations to orient them toward their goals of containment and land dispossession. Structural gaslighting refers to the justifying stories and mythologies produced in these societies to normalize, obscure, and uphold structures of oppression. Such epistemic legwork often works by naturalizing socially produced inequalities through positing biological or cultural deficiencies in the target populations. This paper develops the concept of structural gaslighting introduced in Berenstain (2020) as (...) “any conceptual work that functions to obscure the non-accidental connections between structures of oppression and the patterns of harm that they produce and license” and explores its relationship to scientific and philosophical knowledge production. Case studies including historical and contemporary forms of scientific racism, philosophical justifications for ableist violence, and the link between disableization and dispossession for the purpose of settler colonial land theft are considered. (shrink)

[This piece is written for those working in communication studies and in healthcare writ large, with the aim of bringing insights from disability studies and philosophy of disability to bear on discussion concerning disability in those fields.] Despite being assailed for decades by disability activists and disability studies scholars spanning the humanities and social sciences, the medical model of disability—which conceptualizes disability as an individual tragedy or misfortune due to genetic or environmental insult—still today structures many cases of patient–practitioner communication. (...) Synthesizing and recasting work done across critical disability studies and philosophy of disability, I argue that the reason the medical model of disability remains so gallingly entrenched is due to what I call the “ableist conflation” of disability with pain and suffering. In an effort to better equip healthcare practitioners and those invested in health communication to challenge disability stigma, discrimination, and oppression, I lay out the logic of the ableist conflation and interrogate examples of its use. I argue that insofar as the semiosis of pain and suffering is structured by the lived experience of unwelcome bodily transition or variation, experiences of pain inform the ableist conflation by preemptively tying such variability and its attendant disequilibrium to disability. I conclude by discussing how philosophy of disability and critical disability studies might better inform health communication concerning disability, offering a number of conceptual distinctions toward that end. (shrink)

Philosophers often treat racist and sexist slurs as a special sort of puzzle. What is the difference between a slur and its correlates? In attempting to answer this question, a second distinction has been overlooked: that between slurs and insults. What makes a term count as a slur? This is not an unnecessary taxonomical question as long as ableist terms such as ‘moron’ are dismissed as mere insults. Attempts to resolve the insult/slur distinction by considering the communicative content of slurs (...) are not promising. A better solution is offered by speech act theory, and this paper develops a novel way to describe ordinary slurring utterances as oppressive speech acts. This can both explain the difference between slurs and insults, and challenge the dismissal of ableist terms. (shrink)

Insofar as many older adults fit some definition of disability, disability studies and gerontology would seem to have common interests and goals. However, there has been little discussion between these fields. The aim of this paper is to open up the insights of disability studies as well as philosophy of disability to discussions in gerontology. In doing so, I hope to contribute to thinking about the good life in late life by more critically reflecting upon the meaning of the body, (...) ability, and the variability of each. My central argument is that we should conceptualize age‐associated bodily variations and abilities not in terms of individual capacity, but in terms of what I call “the extended body.” It is in light of the meaning of embodiment and ability in general that we must think differently and more capaciously about the meaning of late life in particular. (shrink)

The guiding premise of this chapter is that we, as teachers in higher education, must consider how the content and form of our teaching can foster inclusivity through a responsiveness to neurodiverse learning styles. A narrow pedagogical focus on lectures, textual engagement, and essay-writing threatens to exclude neurodivergent students whose ways of learning and making sense of the world may not be best supported through these traditional forms of pedagogy. As we discuss in this chapter, we, as engineering ethics educators, (...) designed and implemented a new engineering ethics exercise with which we aimed to promote inclusivity at the levels of form and content. At the content level, students were invited to critically engage with inclusivity-undermining ableist assumptions in technology development. This took shape, at the formal level, through a hands-on ‘material tinkering’ workshop in which students collaboratively and creatively altered (or ‘hacked’) artifacts used in contexts of disability and healthcare, so as to operationalize values of inclusivity and accessibility. Our hunch was that this hands-on tinkering workshop would simultaneously encourage a meaningful way of engagement with these ethical issues and values, while also enacting a more inclusive learning environment by enriching the range of pedagogical activities and learning formats available to our students. As we aim to show in this chapter, we believe this hunch largely panned out - though there are clear areas for future improvement pertaining to the pilot exercise itself and the research we conducted on the exercise. We begin by offering a description of our tinkering exercise. We discuss the exercise’s source of inspiration (2.1) and its implementation (2.2), which is visually captured via photographic documentation. We then discuss (3) how we utilized a triangulated research method to assess the pedagogical value of the exercise. After we discuss our findings, we conclude by identifying areas for future improvement (4). (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

The historical relationship between health care professionals and people with disabilities is fraught, a fact all the more troubling in light of the distinctive roles clinicians play in both establishing and responding to that which is considered normal or abnormal by society at large. Those who wish to improve their clinical practice might struggle, however, to keep up with developments across numerous disability communities as well as the ever-growing body of disability studies scholarship. To assist with this goal, I offer (...) an overview of recent disability theory, outline a set of responsibilities clinicians have to disability communities, and provide recommendations for clinicians who hope to justly treat patients with disabilities and improve their care and health outcomes. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments and (...) biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

Alison Gemmill et al. claim that in 2022, infant mortality in Texas increased due to its 2021 abortion restrictions. In response, various sources reported that abortion restrictions threaten infants. This is misleading. Gemmill et al.’s study showed that infant deaths increased in Texas primarily because abortion is no longer permitted when ‘congenital anomalies’ are detected in utero. Infant mortality increased because fetal mortality decreased. Comparatively, we can prevent the death of a teenager by causing their death before age thirteen. Doing (...) so does not save their life, however. Likewise, abortion restrictions may lead to more infants dying, since fewer subjects are aborted. But this does not imply that abortion restrictions harm infants. In fact, the opposite seems true, as we shall argue. Specifically, in this essay, we argue that it is reasonable to regard Texas’s 2021 abortion bans as a net benefit for infants. We also highlight ways in which ableist attitudes pervade Gemmill et al.’s study and coverage of it. Next, we discuss the impact of abortion restrictions on pregnant individuals (and their families) when their children are diagnosed with ‘congenital anomalies.’ We end by calling for bipartisan efforts to support these families and to combat infant mortality sensibly. (shrink)

Until now, philosophical debate about human embryonic stem cell (hESC) research has largely been limited to its ethical dimensions and implications. Although the importance and urgency of these ethical debates should not be underestimated, the almost undivided attention that mainstream and feminist philosophers have paid to the ethical dimensions of hESC research suggests that the only philosophically interesting questions and concerns about it are by and large ethical in nature. My argument goes some distance to challenge the assumption that ethical (...) considerations alone must be foregrounded in philosophical discussions about hESC research by introducing a critical stance on the epistemological and ontological assumptions that underlie and condition it. A central aim of the paper is to show how Foucault's insights into knowledge-power, taken in combination with Hacking's claims about styles of reasoning, can make these assumptions evident, as well as cast light on their potentially deleterious implications for disabled people. Arguing in this way also enables me to draw out constitutive effects of research on stem cells, that is, to indicate how the discursive practices surrounding research on stem cells, as well as the technology itself, contribute to the constitution of impairment. (shrink)

Ableist attitudes and structures regarding disability are increasingly recognized across all sectors of healthcare delivery. After Dobbs, novel questions arose in the USA concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. As a case study, we examine the Louisiana’s Department of Public Health August 1st Emergency Declaration, “List of Conditions that shall deem an Unborn Child ‘Medically Futile.’” We raise a number of medical, ethical, and public health concerns that lead us to argue (...) the declaration should be rescinded. The ethically objectionable declaration provides valuable lessons concerning how to uphold both reproductive and disability justice in a post-Dobbs landscape. (shrink)

In response to three papers about sex and disability published in this journal, I offer a critique of existing arguments and a suggestion about how the debate should be reframed going forward. Jacob M. Appel argues that disabled individuals have a right to sex and should receive a special exemption to the general prohibition of prostitution. Ezio Di Nucci and Frej Klem Thomsen separately argue contra Appel that an appeal to sex rights cannot justify such an exemption. I argue that (...) Appel’s argument fails, but not for the reasons Di Nucci and Thomsen propose, as they have missed the most pressing objection to Appel’s argument: Appel falsely presumes that we never have good reasons to restrict someone’s sexual liberty rights. More importantly, there is a major flaw in the way that all three authors frame their positive accounts. They focus on disability as a proxy for sexual exclusion, when these categories should be pulled apart: some are sexually excluded who are not disabled, while some who are disabled are not sexually excluded. I conclude that it would be less socially harmful and more productive to focus directly on sexual exclusion per se rather than on disability as a proxy for sexual exclusion. (shrink)

This monograph constitutes the complete formal statement of the Equilibrium Ledger Research Programme, developed over a continuous period of one year. It integrates complexity science, post-Jungian depth psychology, Bourdieusian field theory, and Maussian exchange theory into a unified structural model of non-linear consequence across historical, biological, and institutional domains. The framework introduces: • The Equilibrium Ledger as a field-level structural accounting mechanism • The Quantum Boomerang Effect as a non-chronological return dynamic • The Attractor Density Index (ADI) as a four-dimensional (...) measurement system • A formal rejection of manifestation-based causal paradigms The work advances a falsifiable, structural theory of consequence grounded in energetic distribution, field dynamics, and critical transition thresholds rather than moral evaluation. This document serves as the central reference point for a broader research system comprising over fifty associated theoretical outputs. Intellectual Property Notice Giulia Assistant® is a UK registered trademark, UK00004298171. The Equilibrium Ledger® and Giulia System® form part of a unified research architecture. The King Solomon Protocol™ is a methodological component of this system. (shrink)

This report introduces the concept of Systemic Immunity, defined as the structural capacity of institutions to absorb challenge while preserving organisational continuity through the neutralisation of accountability mechanisms. Drawing on evidence across education, healthcare, and public administration, the analysis demonstrates that institutional failure does not necessarily generate correction or reform. Instead, systems remain stable because failure is rendered structurally non disruptive at the organisational level. Harm remains visible and often severe at the individual level, yet the institution itself is insulated (...) from the forms of consequence that would otherwise compel adaptation. -/- The report argues that systemic immunity emerges through the combined operation of procedural thresholds, risk transfer, liability without accountability, administrative fragmentation, and institutional delay. Together, these mechanisms allow challenge to be absorbed, responsibility to be diffused, and consequence to be deferred, thereby preserving systemic stability even under sustained evidence of dysfunction. -/- This paper extends the Equilibrium Ledger research programme by identifying the persistence mechanism that explains why institutional systems remain stable despite repeated evidence of exclusion, harm production, and operational failure. It situates systemic immunity as a central explanatory structure within a wider analytical framework concerned with institutional governance, disability law, neurodivergent cognition, procedural exclusion, and access to rights. -/- Related works within the Equilibrium Ledger Programme include The Grassini Grimaldi Model of Institutional Filtering (Revised and Expanded Edition); Procedural Gatekeeping and Disability in Doctoral Admissions; Competence Standards versus Methods of Demonstrating Competence in Doctoral Admissions; The Collapse of Enforcement under the Equality Act in Education; The Missing Minds: Spike Profiles, Cognitive Exclusion, and the Societal Cost of Filtering Neurodivergent Intelligence from Higher Education; Two Systems, One Sector: A Comparative Analysis of Doctoral Admissions Responses to a Disabled Applicant with a Spike Profile; and The Architecture Confirmed: How the Sector’s Own Documents Prove Every Mechanism of the Grassini Grimaldi Model. Collectively, these works develop a unified analytical framework for understanding structural exclusion, institutional persistence, and the systemic management of cognitive difference within contemporary governance systems. (shrink)

This work introduces the concept of AI computational systems as temporal translation technology for neurodivergent cognition. It addresses the systemic velocity mismatch between the vertical processing structures of neurodivergent intelligence and the linear, administrative time constructs embedded within formal institutional frameworks. By framing artificial intelligence as a cognitive prosthesis that translates multi-layered, non-linear thought into structured institutional output, the paper challenges conventional metric-driven assessments of intelligence and outlines a foundational architecture for epistemic accessibility.

This paper critically analyses the disability paradox, a phenomenon in which many individuals with serious or long-term disabilities report high levels of quality of life, contrary to external assumptions that disability inevitably diminishes well-being. The study adopts a qualitative, desk-based methodology, drawing on published literature, conceptual analysis, and critical interpretations within disability studies, psychology, and philosophy. Through a review of foundational works and engagement with disability theories, the analysis explores the empirical evidence, theoretical explanations, and socio-cultural implications of the paradox. (...) Findings indicate that the disability paradox is best explained by three interrelated mechanisms: adaptation and response shift, psychosocial resources such as mastery and resilience, and social and environmental factors that reduce barriers. It also emerges that the paradox is neither universal nor uniform: it varies across individuals, cultures, genders, and dimensions of subjective well-being. Conceptually, the paradox challenges medicalised assumptions of disability as deficit and supports a relational or social model of disability. The paper recommends that future research adopt qualitative, longitudinal, and intersectional approaches to better capture the lived experiences of disabled people. For practice and policy, it advocates for a capabilities approach, focused on creating enabling environments, dismantling ableist barriers, and affirming diverse ways of living. It also cautions against framing disability and well-being as paradoxical, urging instead that flourishing in disability be seen as legitimate and expected where inclusion, dignity, and solidarity are realised. (shrink)