Abstract
In this paper, I argue that disabled people have a right to assistive technology (AT), but this right cannot be grounded simply in a broader right to health care or in a more comprehensive view like the capabilities approach to justice. Both of these options are plagued by issues that I refer to as the problem of constriction, where the theory does not justify enough of the AT that disabled people should have access to, and the problem of overextension, where the theory cannot adequately identify an upper limit on the AT that people have a right to. As an alternative to these justificatory frameworks, I argue that disabled people are owed access to AT at the expense of nondisabled people as a matter of compensatory justice. That is, I defend the position that disabled people are owed AT as part of due compensation for the harms they experience from being disadvantaged by society’s dominant cooperative scheme and the violation of their right to equality of opportunity that such disadvantage entails. I also propose a method for identifying an upper limit to what this right to AT requires. In this way, I argue that compensatory justice avoids both the problem of constriction and the problem of overextension.
Similar content being viewed by others
Notes
Throughout this paper, I use identity-first rather than person-first language when referring to disabled people. For a relevant discussion of this terminology, see [1, pp. 5–6].
Several examples of BCI-equipped AT are deployed to support my arguments below.
Elizabeth Barnes offers a thorough, if not completely comprehensive, survey of the landscape of this literature as part of the first chapter of The Minority Body [1, pp. 9–53].
This is not an altogether original strategy and was deployed by Barnes in her 2014 article “Valuing Disability, Causing Disability” [9], prior to her articulation of her own metaphysical view of disability in The Minority Body.
Improving, restoring, or maintaining health is a necessary condition for medical necessity, but it may not be a sufficient condition—in an environment of scarce medical resources, there may be other considerations such as cost or efficacy that also contribute to whether an intervention is considered medically necessary. Even if an intervention improves, restores, or maintains health, there may be alternatives that are as efficacious in achieving this goal and cost less. Thus, the pricier option may not be considered medically necessary.
Conversely, one may argue that some or even most alternative modes of function ought to count as restoring health if functionality is examined at the correct level of analysis. However, this argument presents what I take to be an intractable line-drawing problem. For a more detailed analysis of this difficulty, see my discussion of the “level of analysis” objection insisting that AT that employs a different mode of function can and should be regarded as restorative of health if it is examined at the correct level of analysis [10, pp. 1131–1132].
Departure from normal mode of function and lack of mimicry are not sufficient for being AT though. There are many technologies—such as jumbo jets and smart phones—that improve normal function by way of a different mode without conferring disability group identity.
Another way to frame this point is to note that assistive technology is not intrinsically medically necessary on the Boorsian view of health—unlike curative technology that often tends to restore both mode and level of function—but some AT may be instrumentally medically necessary.
As noted above, an intervention’s capacity to restore or maintain health is a necessary but not sufficient condition for medical necessity. So it may be possible for a theory of health care justice that adopts a normative definition of health to balance a person’s interest in being healthy against other social goods when making choices about what counts as medically necessary. However, the WHO’s definition of health is so broad that it would not allow for such tradeoffs between health and other facets of human well-being because health would be inclusive of all such facets.
Another prominent normative account that is far more nuanced than the WHO’s is offered by Lennart Nordenfelt, who defines health in terms of a person’s ability to accomplish “vital goals” [21]. However, it strikes me as quite similar to the capabilities approach discussed in detail below and so I have foregone extensive discussion.
For a legalistic argument favoring what seems to be a human rights approach to the provision of AT that has the potential to be philosophically grounded in the capabilities approach, see Johan Borg et al. [25].
Notice how, in many ways, the capabilities approach runs parallel to normative accounts of health when it comes to the issue of distributive justice for AT. For an interesting analysis of the intersection between normative theories of health and the capabilities approach, see the paper by Sridhar Venkatapuram [29].
Of course, this notion of average is quite different than the naturalistic statistical average of normality because, unlike a Boorsian theory of health, the capabilities approach is concerned with socially mediated capabilities and not biological functions.
Of course, there may be other plausible theories that could ground such a right which I do not have space to fully address. Perhaps it is enough to have cleared the way for compensatory justice as one such alternative by showing the problems that arise with medical necessity and the capabilities approach, which are very prominent in the literature describing what disabled people are owed as a matter of justice.
My pointing out that at least some of the disadvantages experienced by disabled people are socially constructed should not call into question my commitment to using an ordinary-language conception of disability in this paper. One need not be a social modelist to recognize that structural ableism exists and harms disabled people.
I would include the built environment as part of this dominant cooperative scheme.
For a critical analysis of universal design, see Aimi Hamraie [45].
In fact, Wasserman’s argument bears some resemblance to Buchanan’s argument above that nondisabled people have a legitimate interest in maximizing the benefit they can garner from a dominant cooperative scheme.
Notice that there is no clear way to resolve the competing claims of Deaf and blind people to fair equality of opportunity within the dominant cooperative scheme in this example. Both groups seem to have an equally valid argument that they have been wronged by their exclusion from dominant modes of communication as a result of prejudicial attitudes of disrespect that assume they are unworthy of social inclusion. This trade-off in access needs cannot simply be framed as morally defensible because of the incommensurability involved.
One might recall the scene in the film The Matrix in which Keanu Reeve’s character “Neo” becomes an expert in Kung Fu instantly via such an upload from a BCI [50].
References
Barnes, Elizabeth. 2016. The minority body: A theory of disability. Oxford: Oxford University Press.
Vogel, Bob. 2016. The iBOT returns: Lighter, leaner and covered by insurance? New Mobility, November 1, 2016. http://www.newmobility.com/2016/11/ibot-returns.
Watanabe, Laurie. 2009. Independence technology discontinues the iBOT. Mobility Management, February 1, 2009. https://mobilitymgmt.com/Articles/2009/02/01/Independence-Technology-Discontinues-the-iBOT.aspx.
Fernandes, Joana. 2017. Study highlights insurance payment issues for off-label deep brain stimulation. Parkinson’s News Today, March 3, 2017. https://parkinsonsnewstoday.com/2016/11/23/study-highlights-insurance-issues-dbs-deep-brain-stimulation.
American Academy of Otolaryngology–Head and Neck Surgery. 2018. Cochlear implants. https://www.entnet.org/content/cochlearimplants. Accessed August 15, 2018.
Daniels, Norman. 1985. Just health care. Cambridge: Cambridge University Press.
Daniels, Norman. 2008. Just health: Meeting health needs fairly. Cambridge: Cambridge University Press.
Silvers, Anita. 2003. On the possibility and desirability of constructing a neutral conception of disability. Theoretical Medicine and Bioethics 24: 471–487.
Barnes, Elizabeth. 2014. Valuing disability, causing disability. Ethics 125: 88–113.
Stramondo, Joseph A. 2019. The distinction between curative and assistive technology. Science and Engineering Ethics 25: 1125–1145.
Boorse, Christopher. 1977. Health as a theoretical concept. Philosophy of Science 44: 542–573.
Amundson, Ron. 2000. Against normal function. Studies in the History and Philosophy of Biology and Biomedical Sciences 31(1): 33–53.
Durocher, Evelyne, Rosalie H. Wang, Jerome Bickenbach, Daphne Schreiber, and Michael G. Wilson. 2019. “Just access”? Questions of equity in access and funding for assistive technology. Ethics and Behavior 29: 172–191.
Egan, Mary Yvonne. 2019. Can Norman Daniels help you get a wheelchair? A commentary on Durocher. Ethics and Behavior 29: 192–195.
Silvers, Anita. 1998. A fatal attraction to normalizing: Treating disabilities as deviations from “species-typical” functioning. In Enhancing human traits: Ethical and social implications, ed. Erik Parens, 95–123. Washington, DC: Georgetown University Press.
World Health Organization. 2020. Constitution of the World Health Organization. In Basic documents, 49th ed, 1–19. Geneva: World Health Organization. https://apps.who.int/gb/bd/pdf_files/BD_49th-en.pdf.
Amundson, Ron. 2005. Disability, ideology, and quality of life: A bias in biomedical ethics. In Quality of life and human difference: Genetic testing, health care, and disability, ed. David Wasserman, Jerome Bickenbach, and Robert Wachbroit, 101–124. New York: Cambridge University Press.
Amundson, Ron, and Shari Tresky. 2007. On a bioethical challenge to disability rights. Journal of Medicine and Philosophy 32: 541–561.
Amundson, Ron, and Shari Tresky. 2008. Bioethics and disability rights: Conflicting values and perspectives. Journal of Bioethical Inquiry 5: 111–123.
Silvers, Anita. 2002. Bedside justice and disability: Personalizing judgment, preserving impartiality. In Medicine and social justice: Essays on the distribution of health care, 1st ed, ed. Rosamond Rhodes, Margaret P. Battin, and Anita Silvers, 235–247. New York: Oxford University Press.
Nordenfelt, Lennart. 1995. On the nature of health: An action-theoretic approach, 2nd ed. Dordrecht: Springer.
Kukla, Rebecca. 2014. Medicalization, “normal function,” and the definition of health. In The Routledge companion to bioethics, ed. John D. Arras, Elizabeth Fenton, and Rebecca Kukla, 515–530. New York: Routledge.
Engelhardt, H. Tristram, Jr. 1996. The languages of medicalization. In The foundations of bioethics, 2nd ed, 189–238. New York: Oxford University Press.
Danovich, Tove, and Maria Godoy. 2018. Why people with disabilities want bans on plastic straws to be more flexible. National Public Radio, July 11, 2018. https://www.npr.org/sections/thesalt/2018/07/11/627773979.
Borg, Johan, Stig Larsson, and Per-Olof Östergren. 2011. The right to assistive technology: For whom, for what, and by whom? Disability and Society 26: 151–167.
Kaposy, Chris. 2009. The public funding of abortion in Canada: Going beyond the concept of medical necessity. Medicine, Health Care and Philosophy 12: 301–311.
Powers, Madison, and Ruth Faden. 2006. Social justice: The moral foundations of public health and health policy. New York: Oxford University Press.
Nussbaum, Martha C. 2006. Frontiers of justice: Disability, nationality, species membership. Cambridge: Harvard University Press.
Venkatapuram, Sridhar. 2013. Health, vital goals, and central human capabilities. Bioethics 27: 271–279.
Board of Education of the Hendrick Hudson Central School District v. Rowley, 458 U.S. 176 (1982).
Silvers, Anita. 2009. No talent? Beyond the worst off! A diverse theory of justice for disability. In Disability and disadvantage, ed. Kimberley Brownlee and Adam Cureton, 163–199. New York: Oxford University Press.
American Foundation for the Blind. 2019. Screen readers. https://www.afb.org/blindness-and-low-vision/using-technology/assistive-technology-products/screen-readers. Accessed August 22, 2020.
SI Wire. 2016. UCF linebacker Shaquem Griffin named AAC Defensive Player of the Year. Sports Illustrated, November 30, 2016. https://www.si.com/college-football/2016/11/30/shaquem-griffin-ucf-defensive-player-year.
Dyer, Kristian. 2018. UCF LB Shaquem Griffin, NFL Draft prospect, accepts bid to Senior Bowl. Sporting News, January 9, 2018. http://www.sportingnews.com/nfl/news/nfl-draft-prospect-shaquem-griffin-ucf-linebacker-senior-bowl-invitation-college-football/jnyx09jxf55q14ah3duq1h40i.
Buchanan, Allen E. 1984. The right to a decent minimum of health care. Philosophy and Public Affairs 13: 55–78.
Engelhardt, H. Tristram, Jr. 1996. Rights to health care, social justice, and fairness in health care allocations: Frustrations in the face of finitude. In The foundations of bioethics, 2nd ed, 375–410. New York: Oxford University Press.
Okin, Susan Moller. 2003. Poverty, well-being, and gender: What counts, who’s heard? Philosophy and Public Affairs 31: 280–316.
Jaggar, Alison M. 2006. Reasoning about well-being: Nussbaum’s methods of justifying the capabilities. Journal of Political Philosophy 14: 301–322.
Oliver, Michael. 1990. The politics of disablement. Basingstoke: Macmillan.
Tremain, Shelley L. 2017. Foucault and feminist philosophy of disability. Ann Arbor: University of Michigan Press.
Silvers, Anita. 1998. Formal justice. In Disability, difference, discrimination: Perspectives on justice in bioethics and public policy, ed. Anita Silvers, David Wasserman, and Mary B. Mahowald, 13–145. Lanham, MD: Rowman and Littlefield.
Silvers, Anita. 1995. Reconciling equality to difference: Caring (f)or justice for people with disabilities. Hypatia 10(1): 30–55.
Feinberg, Joel. 1984. The moral limits of the criminal law, vol. 1: Harm to others. Oxford: Oxford University Press.
Buchanan, Allen. 1996. Choosing who will be disabled: Genetic intervention and the morality of inclusion. Social Philosophy and Policy 13(2): 18–46.
Hamraie, Aimi. 2013. Designing collective access: A feminist disability theory of universal design. Disability Studies Quarterly 33(4). https://doi.org/10.18061/dsq.v33i4.3871.
Wasserman, David. 1998. Distributive justice. In Disability, difference, discrimination: Perspectives on justice in bioethics and public policy, ed. Anita Silvers, David Wasserman, and Mary B. Mahowald, 147–207. Lanham, MD: Rowman and Littlefield.
Butt, Daniel. 2007. On benefiting from injustice. Canadian Journal of Philosophy 37: 129–152.
Wasserman, David, and Stephen M. Campbell. 2018. A more “inclusive” approach to enhancement and disability. In The ethics of ability and enhancement, ed. Jessica Flanigan and Terry L. Price, 25–38. New York: Palgrave Macmillan.
Swift, Jonathan. 1726. Gulliver’s travels. New York: Harper.
Wachowski, Lana, Lilly Wachowski (dirs.), and Joel Silver (prod.). 1999. The matrix. Los Angeles: Warner Bros.
Acknowledgements
Funding for this research was provided by the National Science Foundation (Grant No. #EEC-1028725). Additionally, I would like to thank the following individuals and groups for providing extensive feedback on earlier drafts of this paper that greatly improved its quality: David Wasserman, Sean Aas, J. Angelo Corlett, members of the “Ethics Thrust” of the Center for Sensorimotor Neural Engineering (especially Sara Goering, Eran Klein, Tim Brown, Marion Boulicault, Michelle Pham, and Paul Tubig), several anonymous reviewers, and the audience at the conference Philosophy of Disability: Perspectives, Challenges, and Aspirations hosted by University of Tennessee at Knoxville.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Stramondo, J.A. The right to assistive technology. Theor Med Bioeth 41, 247–271 (2020). https://doi.org/10.1007/s11017-020-09527-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11017-020-09527-8