Many models of cognitive ability and disability rely on the idea of cognition as abstract reasoning processes implemented in the brain. Research in cognitive science, however, emphasizes the way that our cognitive skills are embodied in our more basic capacities for sensing and moving, and the way that tools in the external environment can extend the cognitive abilities of our brains. This chapter addresses the implications of research in embodied cognition and extended cognition for how we (...) think about cognitive impairment and rehabilitation, how cognitive reserve mitigates neural impairment, and the distinction between medical and social models of disability. (shrink)

Cognitively disabled individuals have been marginalized by our larger culture; they’ve also been marginalized in philosophical discussions. This paper seeks to begin correcting this situation by examining how assumptions which shape our social interactions and expectations disadvantage individuals with a range of cognitive disabilities. After considering Rubella syndrome and autism in detail, I argue that we have a moral obligation to change how we approach social interactions with cognitively disabled individuals.

This chapter provides a roadmap of ongoing conversations about cognitive disability and moral status. Its aim is to highlight the political stakes of these conversations for advocates for the cognitively disabled while at the same time bringing out how a fundamental point of divergence within the conversations has to do with what count as appropriate methods of ethics. The main divide is between thinkers who take ethical neutrality to be a regulative ideal for doing empirical justice to the lives (...) of people with cognitive disabilities and those who reject this methodological precept as unduly restrictive. What results is a debate between, on the one hand, fans of various familiar forms of moral individualism and Kantian approaches in ethics and, on the other, a range of disability scholars and activists who implicitly or explicitly make use of philosophically more radical methods. (shrink)

This paper considers the range of possible policy options that are available if we wish to attempt to treat people with cognitive disabilities as equal members of society. It is suggested that the goal of policy should be allow each disabled person to establish a worthwhile place in the world and sets out four policy options: cash compensation, personal enhancement, status enhancement and targeted resource enhancement. The paper argues for the social policy of targeted resource enhancement for individuals (...) with cognitive disabilities, in the form of providing cash with some limits on its use. Taking the example from the UK of ‘self-directed support’ it is argued that such policies can be cost-effective and advance the autonomy of people with cognitive disabilities, especially when compared with current policies of centrally provided services. (shrink)

This chapter contains sections titled: The Case for Restricting the Civil Liberties of the Cognitively Disabled Two Conceptions of Competence Further Topics Editor's Note.

In this paper, I argue that, contrary to what some critics suggest, political liberalism is not exclusionary with regards to the rights and interests of individuals with cognitive disabilities. I begin by defending four publicly justifiable reasons that are collectively sufficient for the inclusion of members of this group. Briefly, these are the epistemic uncertainty that inevitably exists about individuals’ actual capacities, the political liberal duty to treat parents fairly, the social framework that is required for the fulfilment (...) of parental duties, and the necessity of cultivating certain emotions that are strongly associated with reasonableness. These reasons show why a more inclusive reading of political liberalism is plausible, and how this can be achieved without abandoning or revising the theory’s commitment to public reason, the political conception of the person, and the role of social cooperation. I then turn to the question of what a more inclusive political liberalism would look like. More specifically, I argue that, although it would not require the participation of individuals with cognitive disabilities in the practice of legitimation, it would require their full inclusion in the realm of justice as equal rights-bearers. (shrink)

Through a series of essays contributed by clinicians, medical historians, and prominent moral philosophers, Cognitive Disability and Its Challenge to Moral ...

I argue that capabilities approaches are useful in formulating a political theory that takes seriously the needs of persons with severe cognitive disabilities (PSCD). I establish three adequacy criteria for theories of justice that take seriously the needs of PSCD: A) understanding PSCD as oppressed, B) positing a single standard of what is owed to PSCD abled individuals, and C) concern with flourishing as well as political liberty. I claim that conceiving valued capabilities as the end of social (...) distribution may help a political theory to meet these criteria.I posit three further adequacy criteria: D) refusing to see PSCD as less than human, E) valuing moral powers other than practical reason, and F) securing space for care and dependency relationships. I show that how well Elizabeth Anderson and Martha Nussbaum’s capabilities approaches meet these criteria depends on their divergent conceptions of what capabilities are for. I sketch another capabilities approach that might better meet the three latter criteria (inspired by Lawrence Becker and Eva Kittay’s work), that conceives capabilities as for agency and relationship. (shrink)

This essay explores various philosophical approaches to cognitive disability within feminist philosophy. In doing so, it addresses three broad questions: What positive contributions can feminist philosophy make to the philosophy of cognitive disability? How have feminist philosophers critiqued the presence and absence of cognitive disability in philosophy? And what challenges does cognitive disability pose to feminist philosophy itself? The essay begins with definitions and models of disability and then turns to feminist work on cognitive disability (...) in moral and political philosophy, bioethics, and epistemology. It concludes with some methodological considerations. (shrink)

This essay explores problems of consistency among commonsense beliefs about the comparative moral status of animals, fetuses, and human beings congenitally endowed with cognitive capacities and potential no higher than those of higher animals. The possibility of genetic cognitive enhancement exacerbates some of these problems, but also offers new resources for understanding the basis of our moral status as inviolable.

Individuals with ‘severe’ cognitive disabilities are primarily discussed in philosophy and bioethics to determine their moral status. In this paper it is argued that theories of moral status have limited relevance to the unjust ways in which people with cognitive disabilities are routinely treated in the actual world, which largely concerns their relegation to an inferior social status. I discuss three possible relationships between moral and social status, demonstrating that determinate answers about the moral status of (...) individuals with ‘severe’ cognitive disabilities are neither necessary nor sufficient for defending the imperative that they be treated as our social equals. (shrink)

The question of how to treat people with cognitive disabilities (PCDs) poses an important problem for Rawlsian theories of justice because it is unclear whether PCDs are included within the scope of moral personhood. Rawls’s Standard Solution focuses on nondisabled adults as the fundamental case, while later addressing PCDs as marginal cases. I claim that the Standard Solution has two weaknesses. First, it relies on a dichotomy between nondisabled and disabled that is tenuous and difficult to defend. Second, (...) it makes the theory circular in a vicious way.I argue that Rawls’s theory can be revised so that it solves the problem of how to treat PCDs while avoiding the two weaknesses of the Standard Solution. There are three constraints on any successfully revised Rawlsian theory: 1) it must be resourcist rather than welfarist; 2) it must provide some principled basis for limiting our obligations to PCDs; and 3) it must address the whole range of PCDs, including the most severely disabled individuals. (shrink)

People with cognitive disabilities are equal citizens, and law ought to show respect for them as full equals. To do so, law must provide such people with equal entitlements to medical care, housing, and other economic needs. But law must also go further, providing people with disabilities truly equal access to education, even when that is costly and involves considerable change in current methods of instruction. The central theme of this essay is what is required in order (...) to give such people political and civil rights on a basis of genuine equality. (shrink)

This Introduction to the collection of essays surveys the philosophical literature to date with respect to five central questions: justice, care, agency, metaphilosophical issues regarding the language and representation of cognitive disability, and personhood. These themes are discussed in relation to three specific conditions: intellectual and developmental disabilities, Alzheimer's disease, and autism, though the issues raised are relevant to a broad range of cognitive disabilities. The Introduction offers a brief historical overview of the treatment cognitive (...) disability has received from philosophers, and explains the specific challenges that cognitive disability poses to philosophy. In briefly summarizing the essays in the collection, it highlights the distinctive contributions the collection makes to ethics, political philosophy, bioethics, and the philosophy of disability. We hope that the richness of the topics explored by these essays will be a spur to further investigation. (shrink)

Many social practices treat citizens with cognitive disabilities differently from their nondisabled peers. Does John Rawls's theory of justice imply that we have different duties of justice to citizens whenever they are labeled with cognitive disabilities? Some theorists have claimed that the needs of the cognitively disabled do not raise issues of justice for Rawls. I claim that it is premature to reject Rawlsian contractualism. Rawlsians should regard all citizens as moral persons provided they have the (...) potential for developing the two moral powers. I claim that every citizen requires specific Enabling Conditions to develop and exercise the two moral powers. Structuring basic social institutions to deny some citizens the Enabling Conditions is unjust because it blocks their developmental pathways toward becoming fully cooperating members of society. Hence, we have a duty of justice to provide citizens labeled with cognitive disabilities with the Enabling Conditions they require until they become fully cooperating members of society. (shrink)

Liberalism welcomes diversity in substantive ideas of the good but not in the process whereby these ideas are formed. Ideas of the good acquire weight on the presumption that each is a person's own, formed independently. But people differ in their capacities to conceptualize. Some, appropriately characterized as cerebral, are proficient in and profoundly involved with conceptualizing. Others, labeled cognitively disabled, range from individuals with mild limitations to those so unable to express themselves that we cannot be sure whether their (...) behavior is mediated by concepts at all. Constricted cognitive capacities have been thought to prevent participation in the prescribed process for forming personalized ideas of the good. So liberal theory, when formulating principles and practices of justice, often disregards cognitively disabled peoples' perspectives. We put aside metaphysically driven notions about personhood and show how interpersonal processes of “prosthetic” thinking (different from surrogacy) can satisfy liberalism's standards, positioning cognitively disabled individuals as fully participating subjects of justice. (shrink)

Having encountered landmines in offering a critique of philosophy based on my experience as the mother of a cognitively disabled daughter, I ask, “Should I continue?” I defend the idea that pursuing this project is of a piece with the invisible care labor that is done by people with disabilities and their families. The value of attempting to influence philosophical conceptions of cognitive disability by virtue of this experience is justified by an inextricable relationship between the personal, the (...) political, and the philosophical. If one grants that the “special relationship” between mother and child requires moral recognition, then I need first to make vivid the case that this relationship in the case of a child who lacks some “normal capacities” is indistinguishable from any mother‐child relationship. If this is so, then I believe I can make a case that has as its conclusion that the moral personhood of even the severely cognitively disabled must be granted. Moreover, such recognition, I argue, necessitates the recognition of others who bear no special relationships to the child. (shrink)

In this paper, I offer a solution to the Capacity/Equality Puzzle. The puzzle holds that an account of the franchise may adequately capture at most two of the following: (1) a political equality-based account of the franchise, (2) a capacity-based account of disenfranchising children, and (3) universal adult enfranchisement. To resolve the puzzle, I provide a complex liberal egalitarian justification of a moral requirement to disenfranchise children. I show that disenfranchising children is permitted by both the proper political liberal and (...) the proper political egalitarian understandings of the relationship between cognitive capacity and the franchise. Further, I argue, disenfranchising children is required by a minimalistic, procedural principle of collective competence in political decision-making. At the same time, I show that political equality requires the enfranchisement of all adults, regardless of cognitive capacities, and that the collective competence principle does not ground adult disenfranchisement. This justifies the progressive legal trend that holds the capacity-based disenfranchisement of adults to be incompatible with liberal democratic principles. (shrink)

This chapter contains sections titled: Adults with MMR Psychopathy and Disability MMR, Moral Responsibility, and Moral Community The First Puzzle: Criminal and Moral Responsibility The Second Puzzle: Degrees of Accountability Conclusion Acknowledgments References.

The social and cultural model of disability has challenged the historically powerful perception of disability as a deficiency. Disability is no longer conceived of solely in terms of an individual lack of capacities but also considered as a structural effect of disabling social institutions and normalizing thinking. The UN Convention on the Rights of Persons with Disabilities (CRPD) from 2006 marks a decisive step towards the recognition of humans with (cognitive) disabilities as legal subjects who are entitled (...) to enjoy all human rights on equal terms with others. A central claim of the CRPD refers to full political participation of persons with (cognitive) disabilities. This paper argues for strengthening the political participation of persons with severe cognitive disabilities. The normative starting point is the claim that they are our equals, both morally and socially. In spelling out this status equality for the realm of the political, I focus on what political equality and inclusivity means concerning franchise. I will argue that the disenfranchisement of persons with cognitive disabilities, as practiced in many countries, cannot be justified. Furthermore, enfranchising persons with cognitive disabilities is deemed a central expression of their recognition as equals. Thus, it marks a crucial moment of emancipatory transformation towards a more inclusive political system. In cases where severely cognitive disabled persons cannot exercise the right to vote themselves, forms of assisted voting and supported decision-making must be available. (shrink)

People with cognitive disabilities and their advocates often express uneasiness about prenatal testing and the selective termination of pregnancies because the fetus has a cognitively disabling condition. There are high rates of abortion in such circumstances, and new forms of noninvasive prenatal testing (NIPT) have been introduced to improve the detection of genetic conditions. This chapter argues that the feeling of disquiet about prenatal testing and selective termination is justified. Philosophers working in the field of bioethics often offer (...) reassurance that such feelings are unjustified. This chapter shows that such reassurances fail and presents an argument that bias against people with cognitive disability plays a role in prenatal decision-making. Feelings of disquiet are justified because it is justified to object to bias that is otherwise directed at oneself. (shrink)

Most democracies disenfranchise persons with cognitive disabilities. Several democratic theorists have, for a range of reasons, recently argued that such restrictions ought to be abolished. I agree with such arguments. Some, however, have also expressed the hope that enfranchising such persons might give politicians more powerful incentives to attend to such persons’ interests. I argue that such hopes are likely to be disappointed. If we wish to ensure that such persons’ interests are taken seriously in the political process, (...) we must consider reforms of other kinds. After considering several alternatives, I argue for a deliberative solution—a Citizens’ Assembly for the Cognitively Disabled, modeled upon the 2004 British Columbia Citizens’ Assembly on electoral reform. (shrink)

Agnieszka Jaworska and Julie Tannenbaum address a central problem confronting efforts to understand moral status: the Problem of Nonparadigm Humans. The authors contend that human infants and cognitively disabled human beings whose capacities are comparable to those of dogs nevertheless have higher moral status. In this discussion, I will first reconstruct the authors’ assumptions and argumentative goals. In the article’s two major sections, I will examine the authors’ reasoning in pursuit of those goals and contend that the chain of argumentation (...) contains several weak links. The discussion will close with brief reflections on how the problem might be addressed. (shrink)

Recognizing Justice For Citizens With Cognitive Disabilities engages with the most prominent liberal theories of justice today in revealing the path toward equal justice for citizens with cognitive disabilities.

In asking scholars to reflect on the structures and practices of academic knowledge that render alternative knowledge traditions irrelevant and invisible, as well as on the ways these must change for the academy to cease functioning as an instrument of westernization rather than as an authentically global and diverse intellectual commons, the editor of this special issue of the Journal of Academic Ethics is envisaging a world much needed and much resisted. A great deal of the conversation about diversity in (...) higher education emphasizes, rightly, the need for an international and ethnically diverse population of scholars and students. Less attention is paid to the value of cognitive diversity—the diversity of cognition generated by cognitive disabilities. As one aspect of intellectual diversity, cognitive diversity promises novel ways of thinking and new understandings of what knowledge is, who makes it, and how it is made. The unique value of cognitive diversity is its insistence on a radical shift in our conception of who can know and who can produce knowledge. Insisting on the inclusion, as scholars, of persons with minds labelled disabled, an epistemology of disability pushes us to reform the much criticized but still dominant notion of the expert and scholar as able-bodied and hyper-rational. (shrink)

This is a reprint of the paper "Responsibility and Disability," first published in Metaphilosophy in 2009. It articulates some similarities and differences between psychopaths and individuals with mild intellectual disabilities that have important implications for both types of agents' moral and criminal responsibility.

According to one prominent form of moral individualism, how an individual is to be treated is determined, not by considering her group membership, but by considering her own particular characteristics. On this view, so this paper argues, it is not possible to provide an account of why people with profound cognitive disabilities are owed respect. This conclusion is not new, but it has been challenged by writers who are sympathetic to the recommended emphasis. The paper aims to show (...) that the conclusion cannot be avoided, and to look at what is to be learned from an approach that leads us to this point. It suggests that any account of why profoundly disabled people are owed respect will have to supplement discussion of their particular capacities with a normative account of their humanity. (shrink)

Many theories of moral status that are intended to ground pro-choice views on abortion tie full moral status to advanced cognitive capabilities. Extant accounts of this kind are inconsistent with the intuition that the profoundly cognitively disabled have full moral status. This paper improves upon these extant accounts by combining an anti-luck condition with Steinbock’s stratification of moral status into two levels. On the resulting view, a being has full moral status if and only if she has moral status (...) and has had advanced cognitive capacities, has the potential to develop such capacities, or would have had such capacities were it not for luck. I argue that modal accounts of luck provide a non-speciesist basis for attributing the lack of advanced cognitive capacities in humans to luck without doing the same for non-human animals. (shrink)

Cognitive enhancement is an increasingly discussed topic and policy suggestions have been put forward. We present here empirical data of views of parents of children with and without cognitive disabilities. Analysis of the interviews revealed six primary overarching themes: meanings of health and treatment; the role of medicine; harm; the ‘good’ parent; normality and self-perception; and ability. Interestingly none of the parents used the term ethics and only one parent used the term moral twice.

Caregivers should usually accede to parents’ requests for life-sustaining treatment. For such decision-making, the best interests standard is too limited. John Arras’s “relational potential standard,” con-joined to a contemporary care ethics framework, provides a better guide.

What gender are you? And in virtue of what? These are questions of gender categorization. Such questions are increasingly at the core of many contemporary debat.

(OPEN ACCESS) In this article, I explore the implications of three moral grounds for the justification of supported voting – respect as opacity, respect as equal status, and respect as political care. For each ground, I ask whether it justifies surrogate voting for voters unable to either communicate or give effect to their electoral judgments, due to some cognitive or communicative disability. (Henceforth: incommunicability cases.) I argue that respect as opacity does not permit surrogate voting, and equal status does (...) not justify such support – although the latter account can make sense of the value loss involved in the persistent non-participation of individuals with cognitive and communicative disabilities. Finally, I argue that an account of supported voting based on the ethics of political care can accommodate a pro tanto moral permission to provide surrogate voting as a form of support in incommunicability cases, and it can account for the inclusive approach of the UN Convention on the Rights of Persons with Disabilities to supported decision-making. However, I show that in incommunicability cases, what the political community and individual caretakers ultimately owe to adult fellow citizens as equal members of the political community is some adequate form of political care – but not necessarily surrogate voting. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)