Disability as a test of justice in a globalising world Matti Häyry Professor of Philosophy Aalto University Simo Vehmas Professor of Disability Studies.

Disability as a test of justicein a globalising world

Matti HäyryProfessor of Philosophy

Aalto University

Simo VehmasProfessor of Disability Studies

University of Helsinki

The idea

• Most people have a moral intuition that those who are better off should do something for those who are the worst off.

• John Rawls formalised this in his Theory of Justice, but he has no monopoly on the idea; it is shared by many political theorists.

• This presentation uses the moral intuition to see which theories of justice would best comply to it, especially in a globalising world.

• We have chosen people with disabilities as an example of a group that can be the worst off.

Concepts – initial characterisation 1/3

JUSTICE

• Moral virtue – ”A good person is a just person”

• Legal idea – ”Criminals must be brought to justice”

• Social and political ideal – ”Our goal is a just society”

Views and theories of justice in the third sense aim, inter alia, at defining how rights, liberties, opportunities, and well-being ought to be

distributed in human societies.

Concepts – initial characterisation 2/3

GLOBALISATION

A world-wide economic, cultural, social, political, etc. process that changes the distribution of rights, liberties, opportunities, and well-being.

Obviously relevant to justice in the third sense.Examples of the impact of globalisation

will be given further on.

Concepts – initial characterisation 3/3

DISABILITY

People have disabilities if they have physical or mental impairments that, due to contributing social factors or due to lack of compensatory social factors, seriously and enduringly impede their everyday functioning. Both contributing and compensatory social factors range from private attitudes to physical constructions and public policies. [ ≈ British Equality Act 2010.]

Views on justice

CohenDworkin

Rawls

Nozick

Sandel Harsanyi

Sen Nussbaum

Gilligan

Main characteristics of views 1/3

Primary ideologies

Basis of justification

Normativeposition

JohnRawls

Welfare liberal Liberal egalitarian

Rational choice behind the veil of ignorance

Equal opportunities, those who can are encouraged to help those who cannot

RobertNozick

Libertarian

Anarcho-capitalist

Rational his-torical devel-opment, no rights violated

Minimal (night watchman) state protects rights to life, liberty, and property

GeraldCohen

Luck egalitarian Analytical Marxist

Eliminate involuntary disadvantage,brute bad luck

Equal rights and wellbeing for all who do not voluntarily risk them

Main characteristics of views 2/3

Primary ideologies

Basis of justification

Normativeposition

Ronald Dworkin

Responsibility-sensitive egalitarian

Eliminate involuntary advantage that causes envy

Welfare state provides for those with disabilities and insufficient talents

Carol Gilligan

FeministEthics of care

Relationships outweigh justice and well-being

Caregivers should be valued in both public and private spheres

MichaelSandel

Communi-tarianConservative

Reasonable acceptance of good traditions

Solidarity and the given in social life should be protected from individualism

Main characteristics of views 3/3

Primary ideologies

Basis of justification

Normativeposition

John Harsanyi

Game theorist

Preference utilitarian

Requirements of rationality in uncertainty and risk

The autonomously chosen preferences of individuals ought to be satisfied

Amartya Sen

Revisionist liberal conse-quentialist

Social choice, accounting for adaptive preferences

Promote people’s capabilities to live lives they have reason to value

MarthaNuss-baum

FeministCapability theorist

Aristotelian take resulting in ten central capabilities

Promote (especially women’s) capabilities to live lives they have reason to value

Theories

Luck egalitarian

Welfare liberal

Libertarian

Commu-nitarian

Preference utilitarian

Capability approach

Relational

Polarisations 1/3

Luck egalitarian

Welfare liberal

Libertarian

Commu-nitarian

Preference utilitarian

Capability approachRelational

WEAK STATE

STRONG STATE

Polarisations 2/3

Luck egalitarian

Welfare liberal

Libertarian

Commu-nitarian

Preference utilitarian

Capability approachRelational

RELATIONS HAVE UTILITY VALUE

RELATIONS HAVE INTRINSIC VALUE

Polarisations 3/3

Luck egalitarian

Welfare liberal

Libertarian

Commu-nitarian

Preference utilitarian

Capability approachRelational

GIVEN TRADITION CAN OPPRESS

GIVEN TRADITION IS GOOD & RULES

Our question

How do theories of justice

respond to disability,

home and abroad?

What is a disability – Case 1

• A suffers from dust allergy, but is expected to work in an office with a wall-to-wall carpet that is irregularly cleaned.

• A has a physical impairment (allergy) that, due to contributing social factors (tradition of wall-to-wall carpets and dismissal of allergic reactions) and due to lack of compensatory social factors (to be considered momentarily), seriously and enduringly impedes A’s everyday functioning at the workplace (constant sniffing and sneezing).

• By definition, A has a disability.

Responses to disability – Case 1

• Firing A. (Economic, but not seen as reasonable.)

• Allergen immunotherapy. (A may resist this, costly.)

• Removal of the carpet. (Against the culture, costly.)

• Regular cleaning. (Costly.)

• In all the costly solutions, the employer would allocate extra resources to address A’s situation, at the expense of other employees, shareholders, and other stakeholders – a question of justice.

What is a disability – Case 2 1/2

• River blindness is the second most common cause of infection-related blindness globally.

• 37 million people worldwide are infected with the parasite that causes it.

• 300,000 of them have been permanently blinded.

• Other symptoms also lower quality of life and impede the performance of daily activities.

• In Africa 85 million people live in endemic areas; another 120 million are in danger of contracting the disease.

What is a disability – Case 2 2/2

• River blindness is a physical impairment that, due to contributing social factors (poverty, poor sanitation, and the stigmatisation of people who are infected) and due to lack of compensatory social factors (public inability or unwillingness to check black fly populations and to instigate prevention and treatment programmes), seriously and enduringly impedes people’s everyday functioning.

• B works in a small local business office in Nigeria and has just been infected ( = disability).

Responses to disability – Case 2

• Firing B on economic grounds as a threat to the firm’s viability.

• Providing ivermectin medication twice a year (halts the development of the disease and relieves the symptoms).

• Support and workplace adjustments that would make continuation of work possible regardless of the stage of the disease, including but not limited to actual blindness.

Faces of globalisation 1/2

• One aspect of globalisation is the import of the values of the affluent West to other cultures and other circumstances.

• A Westerner’s first reaction to firing B as a solution would quite probably be negative.

• Attitudes towards medication can also be ambivalent (side effects, autonomy, medicalisation).

• So extensive support and workplace adjustments? But what is their affordability?

Faces of globalisation 2/2

• Another aspect of globalisation is international aid to regions where people are poor and public support systems scanty.

• River blindness has been fought by WHO and other programmes since 1974: larvicides to control black fly populations in fast-flowing rivers and ivermectin medication.

• Merck has made Mectizan (Merck’s ivermectin trade name) available free of charge for aid organisations and programmes since 1988.

Our question focused

How do theories of justice respond to international attempts to eliminate and alleviate river blindness?

Possible general answers

• Governments and global organisations ought to instigate and support programmes like this.

• Governments and international actors are permitted to participate in such programmes, at their own discretion.

• Governments have an obligation NOT to get involved with programmes like this.

Rawls’s ambiguity

• The difference principle states that (in domestic matters) material inequalities are justified only when they are also beneficial to those who are the worst off.

• Interestingly, though, this does not seem to apply to international issues.

• “Burdened” societies will be helped to get their social and political systems going.

• Otherwise affluent countries are allowed to keep the fruits of their natural endowments.

Remedying Rawls

• Some say that the difference principle should be applied also internationally (and / or that Rawls actually meant to say this).

• It is also possible to argue that the societies burdened by river blindness are “burdened” in Rawls’s sense – so we can or must help.

• The important thing for our analysis right now is simply this: Rawls’s theory is open to considerations of international aid (either by revision or by application).

Traditions and relations

• Theorists who emphasise spontaneously formed special relationhips (e.g. Gilligan and Sandel) are likely to support some foreign aid.

• According to Gilligan, a mother-child-based ethic of care guarantees that “everyone will be responded to and included, that no one will be left alone or hurt”.

• And Sandel advocates solidarity, albeit of the kind of the Israeli operation of rescuing Jews (but not others) from famine-ridden Ethiopia in 1984.

Luck egalitarians

• Cohen and Dworkin say that people are responsible for the consequences of their own genuine choices, but not for the outcomes of unchosen mishaps.

• Can contracting river blindness be blamed on those infected? – No, although stigmatising attitudes are based on this idea.

• What about the governments? – Perhaps, but that does not remove our responsibility for the individuals affected.

• Extension across borders not clear, though.

Outcomes as a guide

• Outcome-based theories promote effective humanitarian assistance everywhere in the world.

• Harsanyi’s theory can justify this by calculating the net preference satisfaction to be gained by helping the least advantaged to stay in good health. (Or not if not effective.)

• Sen and Nussbaum rely on increased capabilities, or genuine opportunities, or positive freedoms, promoted by correctly targeted aid mechanisms. (Or not if not.)

What does this survey show so far?

• All theories looked at can potentially justify internationally funded river blindness elimination programmes.

• They would all do this for different reasons: rationality, relations, fairness, preference satisfaction, or capability promotion.

• The question of cosmopolitanism and nationalism remains contested in all of them (is humanity one moral community or many).

• But the potential to discuss the matter is there.

What do libertarians say? 1/2

• Nozick saw the role of the state as strictly limited.

• Its sole duty – and entitlement – is to protect the rights to life, liberty, wellbeing, and property of its citizens against active violations by other people.

• Even within its own jurisdiction, the state has no prerogative to interfere with spontaneously occurring poverty, health discrepancies, reduced capabilities, or disabilities.

• The only way to do this would be through taxation, which is an illegitimate violation of the citizens’ right to their own property.

What do libertarians say? 2/2

• Since governments cannot collect taxes except for a night watchman state, they cannot participate in any kind of caring or aid, home or abroad.

• Due to lack of applicable resources, they cannot help other countries directly, and neither can they finance international organisations that would.

• Libertarians are keen to point out that voluntary organisations can collect funds for charity.

• And Merck’s Mectizan decision was an example of voluntary and self-chosen action instead of involuntary action prompted by state coercion.

Why do we care about what libertarians say? 1/2

• Why is it important to say that one theory refuses to help people with disabilities in other countries? (We have plenty of those to choose from.)

• Because libertarianism is arguably the creed that economic globalisation most closely adheres to.

• Globalisation does not have a unified ideology, but supranational corporations have placed libertar-ianism front and centre in global decision making.

• If we do not like this, then we should start looking for ways of replacing libertarian presuppositions in world-wide economic practices.

Why do we care about what libertarians say? 2/2

• Those were our conclusion (Libertarians do not assign states an obligation to international aid.) and our first corollary (If we think that this is wrong, let us contest libertarianism.).

• Here is our second corollary:

Although it was really nice of Merck to do what they did, that is not the way forward.

• Voluntary corporate aid means aid that is contingent upon good will (or hidden interests).

• This is the libertarian way, and if we want to set ourselves apart from them, it has to be rejected.

Essential literatureCohen, Gerald, If You’re an Egalitarian, How Come You’re So Rich? Cambridge,

MA: Harvard University Press, 2001.

Dworkin, Ronald, Law’s Empire, Cambridge, MA: Harvard University Press, 1986.

Gilligan, Carol, In a Different Voice: Psychological Theory and Women’s Development. Cambridge, MA: Harvard University Press, 1982.

Harsanyi, John, “Morality and the theory of rational behaviour”, in Amartya Sen and Bernard Williams (eds), Utilitarianism and Beyond, Cambridge: Cambridge University Press, 1982: 39–62.

Nozick, Robert, Anarchy, State, and Utopia. Oxford: Blackwell, 1974.

Nussbaum, Martha, Frontiers of Justice: Disability, Nationality, Species Membership. Cambridge, MA: The Belknap Press of Harvard University Press, 2006.

Rawls, John, A Theory of Justice. Cambridge, MA: The Belknap Press of Harvard University Press, 1971.

Rawls, John, The Law of Peoples. Cambridge, MA: The Belknap Press of Harvard University Press, 2001.

Sandel, Michael, Justice: What Is the Right Thing to Do? London: Penguin Books, 2009.

Sen, Amartya, The Idea of Justice. Cambridge, MA: The Belknap Press of Harvard University Press, 2011.