Is disability mere difference? Greg Bognar 1,2 1 Department of Philosophy, Stockholm University; Stockholm Centre for Healthcare Ethics (CHE), Stockholm, Sweden 2 Department of Politics and Philosophy, La Trobe University, Melbourne, Victoria, Australia Correspondence to Greg Bognar, Department of Philosophy, Stockholm University, Universitetsvägen 10 D, Stockholm 10691, Sweden; greg.bognar@ philosophy.su.se Received 21 May 2015 Revised 16 September 2015 Accepted 19 October 2015 To cite: Bognar G. J Med Ethics Published Online First: [ please include Day Month Year] doi:10.1136/ medethics-2015-102911 INTRODUCTION Some philosophers and disability advocates argue that disability is not bad for you. Rather than treated as a harm, it should be considered and even celebrated as just another manifestation of human diversity. Disability is mere difference. To most of us, these are extraordinary claims. Can they be defended? DISABILITY AND QUALITY OF LIFE What do people mean when they claim that disabil- ity is mere difference? This is not always clear. Surely, they cannot mean that all disabilities are mere differences. There are some disabilities that are so bad that life with them is plainly not worth living. Jonathan Glover reports the case of an infant born with a severe case of dystrophic epi- dermolysis bullosa, a genetic condition due to which any contact with the skin causes severe blis- ters and scarring. The condition can extend to the patient’s digestive and respiratory tracts, resulting in constant, unbearable pain. Having to live with such a condition is worse than non-existence. Since death can be a benefit for someone in this condi- tion, having this disability must be a harm. 1 Or suppose there was a disability that causes no pain but cuts life short. Other than causing prema- ture death, this imagined condition does not have any negative impact on quality of life. (Real proger- oid syndromes also cause morbidity.) Surely, a person who has this imaginary disability and who wants to go on living would be harmed when she dies early because of it. And if dying prematurely when you want to live on does not harm you, then it is hard to see what does. Therefore, the claim that disability is mere difference cannot apply across the board. It must apply only to some disabilities. One problem is that those who make the claim that disability is mere difference almost never add any qualifications. They do not seem to mean, for instance, that all disabilities are mere differences except for sufficiently severe cases of those disabil- ities—such that, for instance, short-sightedness could be considered a mere difference but complete blindness should count as a disability. Neither do they classify conditions according to whether they are disabilities or mere differences—such that, for instance, paraplegia could be considered a mere difference but multiple sclerosis that causes the same limitation should count as a disability. In defences of the mere difference view, there is usually no attempt to clarify which conditions the author has in mind. Typically, only some paradig- matic cases are discussed. Under the circumstances, the best that sceptics of the mere difference view can do is to focus on these paradigmatic cases in order to grant their opponents the strongest form of their argument. I will follow this practice. If there are good reasons to think that disability is harmful in the paradigmatic cases, then there is surely no reason to accept the mere difference view in more extreme cases. There are different reasons why someone might hold that disability is no harm. The following list introduces some of the arguments that may be used to defend the mere difference view. One argument might be that people who live with disability do not consider their condition a disadvantage. Those who have no experience of disability are mistaken to believe that it is a harm to be disabled. They simply make an erroneous value judgement. This argument rests on an empirical claim about how people with disabilities evaluate their condi- tion. Evidently, it needs to be supported by social science showing that a sufficiently high proportion of those who have a particular disability evaluate the burden of that disability in a particular way. This needs to be shown for all relevant disabilities. I am unaware of such scientific findings. To be sure, there is a lot of evidence that people with a particu- lar kind of disability evaluate the burden of that disability differently from others—often (but not always) considering it less bad. 2 But that is not the same as not considering it a burden at all. The best I can tell, there is no evidence for this more radical claim. But even if there were corroborating results in social science, a problem would remain: it may be that it is the people with disabilities who do not consider their condition a harm that make the erro- neous value judgement. On most plausible accounts of well-being, you can be mistaken about your own well-being. 3 So even if every person with disability considered their disability no harm, that would still not get you to the mere difference view—unless you also assumed that their evaluations are to be trusted. In the parlance of the social sciences, it would have to be the case that their evaluations are both reliable and valid. This leads to a different argument. Perhaps the advocates of the mere difference view have some particular theory of well-being in mind—one that entails the proposition that disability is no harm. For instance, they might accept a simple version of hedonism, on which well-being consists in feelings of pleasure or happiness. On this sort of view, if other things being equal a person with a disability is just as happy as a person who is identical in all relevant respects except that she does not have the disability, then the disability is no harm. It is merely a difference between the two people. I doubt that proponents of the mere difference view would want to defend their position merely as a by-product of some theory of well-being— Bognar G. J Med Ethics 2015;0:1–4. doi:10.1136/medethics-2015-102911 1 Feature article JME Online First, published on November 13, 2015 as 10.1136/medethics-2015-102911 Copyright Article author (or their employer) 2015. 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