Disabilities and Objective Lists

Derek Parfit has coined the term “objective list theories” to refer to accounts that assess well-being in terms of a set of goods and activities that are objectively good for people (Parfit 1984: 493ff). Some of the more contentious questions about the relationship between disability and individual well-being concern what objective goods are indispensable for a good life and at what level of generality they should be described. Although “objective list theories” may suggest a simple checklist, they are better seen as recognizing (i) that there is an irreducible plurality in the goods of life and (ii) that their contribution to well-being cannot be expressed in terms of a common metric, like utility. Both (i) and (ii) distinguish objective list theories as a special case of objective or substantive-good theories of well-being. Martha Nussbaum, an influential objective list theorist, includes the following among her valuable capabilities and functionings: health, nourishment, shelter, sex, mobility; the ability to use one’s senses and to imagine, think, and reason; family and other relationships, attachments and love; living a life one has thought about and in some way chosen; laughter, play, and living in contact with the natural world (Nussbaum 1998: 135–156). It is difficult to see what unifies all these different categories, but item by item there would probably be widespread agreement on their value and importance for individual well-being.
Given that several of the items on Nussbaum’s ’98 list cannot be enjoyed by many people with disabilities, it follows that if high levels of well-being cannot be attained by someone who cannot enjoy all of the items on the list, then high levels of well-being are not attainable by many people with disabilities. If that implication is false, then the list must be changed. For example, even if it is necessary to include substantive goods or normative ideals in an account of individual well-being, it is not clear that all of the categories in Nussbaum’s list, for example, are necessary for high levels of well-being. As Jerome Segal (1998) points out, most of us would agree that a life can go very well without one or more of the capabilities Nussbaum regards as essential. Indeed, the most successful of lives of people lacking a single capability may go as well as the most successful lives of people with a standard complement of sensory and motor functions. Although a life could hardly go well without at least some of these capacities, we have no clear basis for establishing a minimum set.
In understanding how disability may be compatible with high levels of well-being, understood in objective terms, it is helpful to distinguish intrinsic from instrumental value. An activity may valuable for itself, e.g., seeing as a rich sensory experience; or instrumentally, for what it achieves or contributes to, e.g., seeing as a means of finding an object. As intuitive as the distinction seems, it is difficult to make clearly. First, there is deep disagreement about what is of ultimate value. Second, it is possible to parse many activities and conditions indefinitely into instrumentally valuable means and intrinsically valuable ends, e.g., making money or friends can be seen as an end in itself, or as a means to obtaining comfort and security (see SEP entry on intrinsic vs. extrinsic value).
The social model of disability encourages us to recognize that many of the activities precluded by certain disabilities can be seen instrumentally, as means to valuable ends—ends that can be achieved by other means that are not precluded by those disabilities. As Asch contends (2003),

اقتباس :: Those who maintain that disability forecloses opportunity, and that any foreclosed opportunity diminishes life, focus too narrowly on the activity and do not see it as a means to an end, e.g., … walking instead of mobilizing or exploring; talking instead of communicating.

As Asch suggests, much of what we value in seeing, talking, and walking is instrumental. We value them as ways of achieving communication with other people, reading, and moving from place to place, are themselves be bearers of intrinsic value. (Of course, we also recognize that these activities have instrumental value as well, e.g., for finding social partners and business opportunities). None of these valuable activities, however, is precluded by deafness, blindness, or paraplegia. Each can be achieved in alternative ways, by signing, reading braille, or operating a wheelchair. If these considerations are on the right track, they show that the instrumental value of species-typical functioning is exaggerated, because its ends can frequently be achieved in multiple ways, many of which are available to people with fewer, impaired, or atypical functions.
Disability scholars do not deny that typical sensory and motor functions can have great intrinsic as well as instrumental value, but they argue that their intrinsic value is often understood too narrowly. If, for example, we see the intrinsic value in sight not specifically in visual experience, but in sensory and aesthetic experience, then that value is not precluded by blindness.
It may be true that someone who cannot see or hear lacks experiences of great intrinsic value that are available to someone who can see or hear. However, the broad characterization favored by disability scholars seems most appropriate for assessing the role of intrinsic value in how well our lives go. For example, one obvious source of intrinsic value for standard sensory functions and activities is aesthetic—the beauty, richness, and complexity of the experiences they enable. But we do not regard color-blindness, tone-deafness, or impairments of smell or taste as inimical to well-being, although they preclude vast ranges of rich aesthetic experience. There is no reason to doubt that someone who has never had, or has long lost, those sensory functions (as opposed, say, to an visual artist or food critic who relies on them for her vocation) can lead a life as rich and rewarding aesthetically as someone who has those functions, despite lacking admittedly valuable experiences. This suggests that we cannot infer from the fact that there is great value in a function that those who lack it have lives that go significantly less well. It is only plausible to claim that a good life needs to contain certain kinds of valuable experiences and activities if those kinds of experience and activity are characterized very broadly. We will have more to say about this below, in reviewing the debate over whether disabilities can be seen as “neutral” characteristics.
Finally, even granting the significance of objective goods for well-being, it is not only their possession that makes a life go well. Also relevant is how a life seems to the person living it, and this reintroduces subjective elements. Common sense supports the view that individual well-being must have a subjective as well as an objective aspect; “two strands”, as Jonathan Glover puts it (Glover 2006: Chapter 3). Roughly speaking, well-being consists partly in having certain substantive goods and partly in being happy with (or being content with, or enjoying, or taking pleasure in) one’s life. But these strands may not be readily separable: the positive valuation of objective goods may be necessary for the possession of those goods to count towards well-being, or for their absence to count against it. Moreover, any plausible objective list must include enjoyment or pleasure, either as a free-standing good or as an aspect of valued states, activities or relationships.

1.3 Cognitive Disability and Well-Being

The differences among standard accounts of well-being are particularly significant in thinking about the well-being of people with severe cognitive impairments. We believe that a separate discussion of this topic is warranted, but not because cognitive impairments are in a class by themselves. As we have noted, there are great differences among all types of impairments. Cognitive impairments, however, have until recently received relatively little attention in philosophy, and we give them special emphasis as a corrective.
Subjective accounts of well-being, hedonic and simple-desire accounts, appear easier to apply to people with such impairments, for two reasons. First, joy, pain, satisfaction, and frustration are more readily conveyed and assessed than the more complex mental states that informed-desire and objective list theories take into account. Second, people with cognitive impairments appear less capable of enjoying or attaining some items on standard objective lists: not merely various forms of achievement, but also a variety of social relationships and aesthetic experiences. More broadly, persons with cognitive impairments may be unable to form and pursue a conception of the good life. The conviction that persons with severe cognitive impairments can and often do enjoy relatively high levels of well-being thus seems to favor a more subjective account of well-being than that adopted for everyone else.
Even Martha Nussbaum (2006), a strong proponent of an objective account of well-being and of the capabilities of people with disabilities, fears that the premium her capabilities account places on choice may be excessive in assessing the well-being of people with the most severe cognitive disabilities, who lack the capacity to make meaningful choices in some or many domains. She favors a greater emphasis on functionings than capabilities for people with cognitive disabilities: on what they actually do or experience than on their capacity to choose among experiences, activities, and life plans. This suggests a way to modify her account so that more people with such disabilities reach a threshold of well-being. But it adopts different standards for people with severe cognitive disabilities as compared to other people, and raises the question of where and how to draw the line between those to whom each standard applies.
Some disability scholars may worry that the use of a double-standard is fraught with elitism and condescension. But it has a stubborn appeal, insofar as objective accounts seem too demanding when applied to cognitively disabled people. Jeff McMahan concedes that it seems “deeply and perniciously inegalitarian” to place people with severe congential cognitive impairments in a separate comparison class from cognitively normal people for purposes of assessing their well-being (2001: 160). But he argues that it is even less plausible and attractive to view such individuals as suffering grave misfortune, however well they do with their limited potential.
Of course, it could simply be the case that all else equal, people with severe cognitive disabilities do have lower levels of well-being than people without these disabilities. But all else need not be equal: it may be that many people with cognitive disabilities can achieve levels of well-being as high as others if they receive certain forms of support. For example, recognizing that cognitively disabled persons may require assistance if they are to develop and carry out conceptions of the good life, Nussbaum (2006, 2009) and Francis (2009) have proposed structured ways of assisting them to do so. Nussbaum suggests that people with even severe cognitive disabilities can have representatives or surrogates who enable them to participate, at least vicariously, in most social and political activities (2009; but see Wasserman and McMahan 2012 for limits on meaningful surrogate agency); Francis discusses “mental prostheses” that aid in constructing a personal conception of the good. She offers, as an example of a mental prosthesis, an actual device that allows people with Alzheimer’s to locate objects in their houses by touching an icon on their computer screen. The use of that device would not deny the user agency in locating the device, any more than a prosthetic foot would deny its bearer agency in running (Francis 2009: 203–204). Such a device could also allow cognitively disabled persons to communicate their preferences, but it is unclear how it enables them to form a conception of the good.
These are different approaches to securing the well-being of people with cognitive impairments, with different purposes. Nussbaum seeks to facilitate the exercise of, or the capacity for, valuable functionings such as social affiliation, meaningful work, and political activity. Francis’s goal is broader and less concrete: to promote the participation of people with cognitive impairments in developing conceptions of the good that accord with their desires and that offer reasonable prospects for fulfillment.
Both approaches receive some support from empirical research. Disability theorists such as Goode 1994 and Ferguson 2001 maintain that people with significant cognitive and communicative impairments can and do have the capacity to choose among alternatives if those choices can be formulated in ways they can comprehend, or if their non-impaired intimates or caregivers can learn to read the ways in which they actually express their preferences, in order to help them make their lives go the way they want.

Disabilities and Objective Lists

1.3 Cognitive Disability and Well-Being

Disabilities and Objective Lists :: تعاليق

Disabilities and Objective Lists