This paper considers the importance of the body for self-esteem, communication, and emotional expression and experience, through the reflections of those who live with various neurological impairments of movement and sensation; sensory deafferentation, spinal cord injury and Möbius Syndrome. People with severe sensory loss, who require conscious attention and visual feedback for movement, describe the imperative to use the same strategies to reacquire gesture, to appear normal and have embodied expression. Those paralysed after spinal cord injury struggle to have others (...) see them as people rather than as people in wheelchairs and have been active in the disability movement, distinguishing between their medical impairment and the social induced disability others project onto them. Lastly those with Möbius reveal the importance of the face for emotional expression and communication and indeed for emotional experience itself. All these examples explore the crucial role of the body as agent for social and personal expression and self-esteem. (shrink)

In response to criticism of the impairment argument for the immorality of abortion, Bruce Blackshaw and Perry Hendricks appeal to Don Marquis’s future-like-ours (FLO) account of the wrongness of killing to explain why knowingly causing fetal impairments is wrong. I argue that wedding the success of the impairment argument to FLO undermines all claims that the impairment argument for the immorality of abortion is novel. Moreover, I argue that relying on FLO when there are alternative explanations for (...) the wrongness of causing FAS begs the question. I conclude, therefore, that the impairment argument remains unsuccessful. (shrink)

We have argued here that to attribute criminal responsibility to psychopathic individuals is to ignore substantial and growing evidence that psychopathic individuals are significantly impaired in moral understanding. They do not appear to know why moral transgressions are wrong in the full sense required by the law. As morally blameless offenders, punishment as a basis for detention cannot be justified. Moreover, as there are currently no successful treatment programs for psychopathy, nor can detention be justified on grounds of treatment. Instead, (...) we argue detention on the grounds of self- defence, due to the severe and continuing threat posed by the psychopathic criminal. (shrink)

I provide an updated version of The Impairment Argument against abortion and respond to numerous objections that can be (and have been) raised to it.

According to Hendricks Impairment Argument (IA), abortion is immoral because it impairs the fetus. Here, I argue it is not sufficient to show merely that abortion impairs, Hendricks must show that it harms the fetus. If the fetus is not numerically identical to the person it will become, then it isn't harmed by an abortion. But if the fetus is numerically identical to the person it will become, it is harmed by the deprivation of a future of value. However, (...) taking this route ultimately undermines the novelty of the impairment argument. (shrink)

While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial (as a psychological method of coping) has typically not been addressed in these studies. We propose that this failure has limited our understanding of how ISA and denial differentially affect efforts to rehabilitate persons with TBI. In this selective review paper, we summarize early findings in the field and integrate those findings with more (...) recent observations (i.e., 1999–2019). We believe that this synthesis of information and expert clinical opinion will inform future research on ISA and denial as well as approaches to rehabilitation for persons with TBI. (shrink)

In order for the so-called strengthened impairment argument to succeed, it must posit some reason R that causing fetal alcohol syndrome is immoral, one that also holds in cases of abortion. In formulating SIA, Blackshaw and Hendricks borrow from Don Marquis to claim that the reason R that causing FAS is immoral lies in the fact that it deprives an organism of a future like ours. I argue here that SIA fails to show that it is immoral to cause (...) FAS and abort fetuses that will not be born because it deprives them of an FLO. This is because fetuses that will not be born have no chance of having an FLO in the first place, so causing FAS for and aborting them cannot deprive them of one. I then consider three responses to my argument. I conclude that each fails. SIA does not accomplish its task of showing why it is immoral to impair fetuses that will not be born. Perhaps it can accomplish the task of showing why it is immoral to impair fetuses that will be born, but not without sacrificing at least some of its alleged significance. (shrink)

Blackshaw and Hendricks have recently developed and defended the impairment argument against abortion, arguing that the immorality of giving a child fetal alcohol syndrome (FAS) provides us with reason to believe that abortion is immoral. In this paper, we forward two criticisms of the impairment argument. First, we highlight that, as it currently stands, the argument is very weak and accomplishes very little. Second, we argue that Blackshaw and Hendricks are fundamentally mistaken about what makes giving a child (...) FAS immoral. Once we acknowledge this, it is clear that our intuitions about giving a child FAS provide no support for the supposed immorality of abortion. (shrink)

Most democratic countries either limit or deny altogether voting rights for people with cognitive impairments or mental health conditions. Against this weight of legal and practical exclusion, disability advocacy and developments in international human rights law increasingly push in the direction of full voting rights for people with cognitive impairments. Particularly influential has been the adoption by the UN of the Convention on the Rights of Persons with Disabilities in 2007. Article 29 declares that states must ‘ensure that persons with (...) disabilities can effectively and fully participate in political and public life on an equal basis with others, directly or through freely chosen representatives, including the right and opportunity for persons with disabilities to vote and be elected’. This article also argues for the right of all people to vote, including people with cognitive impairments, by adopting a uniquely strategic approach. Firstly, some of the strategic limitations of existing arguments in favour of extending the franchise are highlighted. Most such arguments are flawed because they run the risk of inviting disparaging philosophical commentary which compares disabled people to animals, or because they are based on implausible empirical claims, or because they inadvertently tie the case for voting rights for the disabled to other cases unlikely to ever enjoy widespread acceptance. This article, instead, justifies extending voting rights to all people with cognitive impairments based on a simple cost-benefit analysis that avoids all of these problems. (shrink)

Quattrocki and Friston (2014) argued that abnormalities in interoception—the process of representing one’s internal physiological states—could lie at the heart of autism, because of the critical role interoception plays in the ontogeny of social-affective processes. This proposal drew criticism from proponents of the alexithymia hypothesis, who argue that social-affective and underlying interoceptive impairments are not a feature of autism per se, but of alexithymia (a condition characterized by difficulties describing and identifying one’s own emotions), which commonly co-occurs with autism. Despite (...) the importance of this debate for our understanding of autism spectrum disorder (ASD), and of the role of interoceptive impairments in psychopathology, more generally, direct empirical evidence is scarce and inconsistent. Experiment 1 examined in a sample of 137 neurotypical (NT) individuals the association among autistic traits, alexithymia, and interoceptive accuracy (IA) on a standard heartbeat-tracking measure of IA. In Experiment 2, IA was assessed in 46 adults with ASD (27 of whom had clinically significant alexithymia) and 48 NT adults. Experiment 1 confirmed strong associations between autistic traits and alexithymia, but yielded no evidence to suggest that either was associated with interoceptive difficulties. Similarly, Experiment 2 provided no evidence for interoceptive impairments in autistic adults, irrespective of any co-occurring alexithymia. Bayesian analyses consistently supported the null hypothesis. The observations pose a significant challenge to notions that interoceptive impairments constitute a core feature of either ASD or alexithymia, at least as far as the direct perception of interoceptive signals is concerned. (shrink)

To define the determinants of impaired facial emotion recognition (FER) in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS), we examined 76 patients with unilateral MTLE-HS, 36 prior to antero-mesial temporal lobectomy (AMTL) and 40 after AMTL, and 28 healthy control subjects with a FER test consisting of 60 items (20 each for anger, fear, and happiness). Mean percentages of the accurate responses were calculated for different subgroups: right vs. left MTLE-HS, early (age at onset <6 years) (...) vs. late-onset, and before vs. after AMTL. After controlling for years of education, duration of epilepsy and number of antiepileptic drugs (AEDs) taken, on multivariate analysis, fear recognition was profoundly impaired in early-onset right MTLE-HS patients compared to other MTLE patients and control subjects. Happiness recognition was significantly better in post-AMTL MTLE-HS patients compared to pre-AMTL patients while anger and fear recognition did not differ. We conclude that patients with right MTLE-HS with age at seizure onset <6 years are maximally predisposed to impaired fear recognition. In them, right AMTL does not further worsen FER abilities. Longitudinal studies comparing FER in the same patients before and after AMTL will be required to refine and confirm our cross-sectional observations. (shrink)

In his recent article Perry Hendricks presents what he calls the impairment argument to show that abortion is immoral. To do so, he argues that to give a fetus fetal alcohol syndrome is immoral. Because killing the fetus impairs it more than giving it fetal alcohol syndrome, Hendricks concludes that killing the fetus must also be immoral. Here, I claim that killing a fetus does not impair it in the way that giving it fetal alcohol syndrome does. By examining (...) the reason why giving a fetus this condition is wrong, I conclude that the same reasoning, on common pro‐choice accounts, does not apply to killing the fetus. Accordingly, Hendricks's argument does not succeed in showing abortion is immoral. (shrink)

This review essay addresses the question, "What, properly speaking, is a pragmatic impairment?" Drawing on work from two recent books, it presents three possible answers, and evaluates them.

A common justification for abortion rights is that the death of the fetus does not violate any of the fetus’s time-relative interests. The time-relative interest account (TRIA) of harm and wrongdoing tells us that a necessary condition for harming someone is that his or her time-relative interests are frustrated. Regarding the justification for abortion, this account falls prey to impairment arguments. Impairment arguments entertain cases of prenatal injury, such as the mother using illicit drugs that disable the child. (...) The intuition is that the child who is born with such disabilities is harmed by the mother’s drug use. But it is unclear what time-relative interest is violated in cases of prenatal harm. Typical responses to impairment arguments point out that the abortion case is different because the child does not exist to experience such harms; but in prenatal injury + survival cases, the child does live to experience those harms. Thus, the TRIA justification for abortion is not impugned by impairment counter-examples. This article argues that this response to impairment arguments is viciously circular. The response must say that so long as you kill the child, no harm is done. But this assumes that killing itself is morally inconsequential and is not itself a case of harm. The response to impairment arguments, then, assumes the permissibility of abortion. (shrink)

According to Hendricks Impairment Argument (IA), abortion is immoral because it impairs the fetus. Here I argue it is not sufficient to show merely that abortion impairs, Hendricks must show that it harms the fetus. If the fetus is not numerically identical to the person it will become, then it isn’t harmed by an abortion. But if the fetus is numerically identical to the person it will become, it is harmed by the deprivation of a future of value. However, (...) taking this route ultimately undermines the novelty of the impairment argument. (shrink)

Perry Hendricks has recently presented the impairment argument for the immorality of abortion, to which I responded and he has now replied. The argument is based on the premise that impairing a fetus with fetal alcohol syndrome is immoral, and on the principle that if impairing an organism is immoral, impairing it to a higher degree is also—the impairment principle. If abortion impairs a fetus to a higher degree, then this principle entails abortion is immoral. In my reply, (...) I argued that abortion does not impair an organism in the way fetal alcohol syndrome does, and showed that interest theorists can avoid the argument. Hendricks has responded to my criticisms by demonstrating how abortion does impair an organism. In this reply, I acknowledge Hendricks’ point, but proceed to criticise the application of the impairment principle to abortion, showing that it is invalid if we accept his explanation for why inflicting fetal alcohol syndrome is immoral. I also argue that counter-examples show the impairment principle itself to be dubitable, concluding that the impairment argument remains unpersuasive. (shrink)

The ethics of involving persons with cognitive impairments and/or mental illness in research continues to gain academic and public attention. Concerns about the ability of such persons to provide ethically and legally valid consent and about the appropriateness of their research involvement in certain categories of studies have resulted in publication of guidelines, position papers, standards, and court decisions. These analyses address not only when and from whom informed consent may be obtained but also under what conditions it is ethically (...) permissible to involve persons in research who are too decisionally impaired to provide their own consent.It is an advance in research ethics that there is heightened appreciation of the need for greater protections for, and possibly research participation limitations on, persons unable to give their own consent. In our zeal to protect potentially vulnerable subjects, however, we must craft new protections carefully. Prudence is required in shaping and implementing any new protections. (shrink)

The drawbacks of using the concepts of models in discussing the problems of disabled people are discussed. It is suggested that the terms “impairment”, “disability”, and “handicap” can unify the different models and enhance the position of people with disabilities in society.

Schizophrenia is a severe mental illness affecting sense of identity. Autobiographical memory deficits observed in schizophrenia could contribute to this altered sense of identity. The ability to give a meaning to personally significant events is also critical for identity construction and self-coherence. Twenty-four patients with schizophrenia and 24 control participants were asked to recall five self-defining memories. We assessed meaning making in participants’ narratives and afterwards asked them explicitly to give a meaning to their memories . We found that both (...) spontaneous and cued meaning making were impaired in patients with schizophrenia. This impairment was correlated with executive dysfunctions and level of negative symptoms. Our results suggest that patients’ difficulties in drawing lessons about past experiences could contribute to explain the lack of coherence observed in their life trajectories and their impaired social adjustment abilities. Implications for psychotherapy are also discussed. (shrink)

Tom Shakespeare’s important new book includes, among other topics, a persuasive critique of the social model of disability. A key component in his case against that model consists in an argument against the impairment/disability distinction as this is understood within the social model. The present paper focuses on the case Shakespeare makes against that distinction. Three arguments mounted by Shakespeare are summarised and responded to. It is argued that the responses adequately rebut Shakespeare’s case on this specific issue. Moreover, (...) as the engagement with Shakespeare’s argument illustrates, his claim to employ a critical realist perspective appears to be in considerable tension with the case he offers against the impairment/disability distinction. (shrink)

Although psychologist impairment has received attention from researchers, there is a paucity of empirical data aimed at determining the point at which such impairment necessitates action. The purpose of this study was to provide such empirical data. Members of Division 42 ( n = 285) responded to vignettes describing a psychologist whose symptoms of either depression or substance abuse varied across five levels of severity. Results identified specific levels of impairment at which psychologists were deemed too impaired (...) to practice psychotherapy, as well as significant differences between ratings of increasingly severe impairment. Practical and ethical implications of these results are discussed. (shrink)

Perry Hendricks’ original impairment argument for the immorality of abortion is based on the impairment principle (TIP): if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. Since abortion impairs a fetus to a higher degree than fetal alcohol syndrome (FAS) and giving a fetus FAS is immoral, it follows that abortion is immoral. Critics have argued that the ceteris paribus is not met for FAS and abortion, (...) and so we proposed the Modified Impairment Principle (MIP) to avoid these difficulties. Dustin Crummett has responded, arguing that MIP is open to various counterexamples which show it to be false. He also shows that MIP can generate moral dilemmas. Here, we propose a modification to MIP that resolves the issues Crummett raises. Additionally, Alex Gillham has criticized our appropriation of Don Marquis’ ‘future like ours’ reasoning about the wrongness of impairment. We show that his objections have minimal implications for our argument. (shrink)

The ‘impairment argument’ against abortion developed by Perry Hendricks aims to derive the wrongness of abortion from the wrongness of causing foetal alcohol syndrome. Hendricks endorses an ‘impairment principle’, which states that, if it is wrong to inflict an impairment of a certain degree on an organism, then, ceteris paribus, it is also wrong to inflict a more severe impairment on that organism. Causing FAS is wrong in virtue of the impairment it inflicts. But abortion (...) inflicts an even more severe impairment, and so, ceteris paribus, is also wrong. Notably, Hendricks thinks that this argument does not require the claim that the foetus is a person. Here, I respond to Hendricks by arguing that the ceteris paribus clause of the impairment principle is not met in ordinary cases of pregnancy. Carrying an unwanted pregnancy to term is much more burdensome than is refraining from excessive drinking for nine months. This provides a pro tanto justification for obtaining an abortion that does not apply to causing FAS. If the foetus is not a person, it seems fairly clear to me that this justification is strong enough to render abortion permissible. Hendricks is therefore incorrect in claiming that the impairment argument can go without claims concerning foetal personhood. If the foetus is a person, then whether burdensomeness justifies abortion depends on certain questions relating to Thomson’s famous violinist argument. I will not attempt to answer those. But anyone who is otherwise sympathetic to Thomson’s argument should not be moved by the impairment argument. (shrink)

Work injury compensation and pensions are often determined according to medical disability rating scales attributing a percentage to each impaired body part or function. Incorporated into central medical–administrative networks of committees and examinations, these produce disability as a calculable space. This article examines the specific case of the Israeli National Insurance regulations regarding work injuries of 1956 and analyzes the shifted order they set. Looking at this system in the specific historical context of transition from the British Mandate workmen’s compensation (...) system to the “disability percentages” system, provides insight into the process of structuring and stabilizing durable numerical forms and the production of centralized government. Drawing on conceptualizations regarding the sociotechnical role of classification systems, I contend that through encoding and calculating classifications of disability, heterogeneity is eliminated and an ordering based on physiology is “black boxed,” illustrating the importance of technoscientific formations in structuring the “medical model of disability.”. (shrink)

The lifetime prevalence of major depressive disorder in adolescents is reported to be as high as 20%; thus, MDD constitutes a significant social and public health burden. MDD is often associated with nonsuicidal self-injury behavior, but the contributing factors including cognitive function have not been investigated in detail. To this end, the present study evaluated cognitive impairment and psychosocial factors in associated with MDD with NSSI behavior. Eighteen and 21 drug-naïve patients with first-episode MDD with or without NSSI and (...) 24 healthy control subjects were enrolled in the study. The Hamilton Anxiety Scale, Hamilton Depression Scale, Adolescent Self-injury Questionnaire, Beck Scale for Suicide Ideation–Chinese Version, Shame Scale for Middle School Students, Sensation Seeking Scale and Childhood Trauma Questionnaire were used to assess depression-related behaviors, and event-related potentials were recorded as a measure of cognitive function. The latency of the N1, N2, P3a, P3b, and P50 components of ERPs at the Cz electrode point; P50 amplitude and P50 inhibition showed significant differences between the 3 groups. CTQ scores also differed across three groups, and the NSSI– and NSSI+ groups showed significant differences in scores on the Shame Scale for Middle School Students. Thus, cognitive function was impaired in adolescents with MDD with NSSI behavior, which was mainly manifested as memory decline, attention and executive function deficits, and low anti-interference ability. We also found that childhood abuse, lack of social support, and a sense of shame contributed to NSSI behavior. These findings provide insight into the risk factors for MDD with NSSI behavior, which can help mental health workers more effectively diagnose and treat these patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Where Does It Go From Here?John Bond (bio) and Lynne Corner (bio)Keywordsbiomedicalization, dementia, mild cognitive impairment, subjectivityThe joy of formal interdisciplinary discussion of this kind is the way that ideas presented through the gaze of social scientists stimulate such exciting thoughts and responses from other disciplines such as philosophy and psychology. We would like to thank Sabat and Thornton for their supportive and provocative reactions (...) to our paper. In the spirit of their responses, it is not our intention to respond to their thoughts directly; rather, we take the opportunity to theorize sociologically about this new category of psychiatry that has come to be known simply as mild cognitive impairment (MCI). In reviewing the responses of Sabat and Thornton, three thoughts emerged. First, together we have covered ontologic, epistemologic, methodologic, and theoretical questions about MCI, but none of us has posed basic political questions, such as: Why has MCI emerged as a new psychiatric label at this particular time? Second, this discussion brings together social scientists with a psychologist and a philosopher, but important constituents are missing. Consequently we are missing "insider" views on the importance of MCI to clinical practice. Third, this discussion highlights for us even more acutely the central question: Is MCI a real entity? In the following, we reflect on the first of these because our response also addresses the third. We first revisit the "evidence" about the importance of MCI for clinical practice.The notion of MCI as the transitional state between normal aging and Alzheimer's disease and other dementias has existed in a number of guises for many years, with benign senescent forgetfulness (Kral 1962) being the forerunner of a number of other terms, including questionable dementia, incipient dementia, isolated memory impairment, mild neurocognitive decline, age-associated memory impairment, age-associated cognitive decline, and cognitive-impairment-not-demented (Geda et al. 2004). Given that psychiatric labels implying the existence of MCI have been part of the practice landscape for over forty years, it is perhaps not surprising that its reinvention in the form of MCI has not, it appears, raised much attention outside specialist centers in North America and Europe. The reaction from grassroots clinical practice has been similar in intensity to their subdued reaction to the antipsychiatry movement in the 1960s. But for specialist clinics like the Mayo Clinic in Rochester, Minnesota, it has been an expanding [End Page 29] industry with numerous published papers, international conference presentations, and research funding opportunities.MCI can be distinguished from similar diagnostic categories that preceded its appearance in 1991. A key diagnostic criteria is the requirement for a subjective memory complaint by the person subsequently diagnosed as having MCI. Other diagnostic criteria include normal general cognitive function, normal activities of daily living, and memory being impaired for age, but not being demented (Petersen et al. 1999; Petersen and Morris 2003). To our knowledge, the idea of subjectivity being an important diagnostic criterion, as opposed to a means of identifying signs and symptoms, is a first in medical science. We know of no other medical category or diagnosis where subjectivity plays such a significant role, other than perhaps severe health phobias. Broadly speaking, two kinds of clinical evidence for MCI exist: first, that originating from studies (some quite small) applying the diagnostic criteria in specialist clinic populations; and, second, that found in large population studies. The main distinction between these two sets of evidence is that one is based on selected clinic populations and the other on unselected community populations. Most studies conclude that people whose memory is impaired for their age, as measured by similar cognitive tests such as the Mini-Mental State Examination, show decline in cognition that often leads to Alzheimer's disease and other kinds of dementia in the future. This finding is not remarkable given that it has long been known that age is a predictor of cognitive impairment. However, the population studies suggest a lower conversion rate than those for specialist clinics (Ritchie, Artero, and Touchon 2001).Petersen (2005) provides a robust defense as to why MCI might be a useful category in research and also indicates the potential benefits of treating MCI... (shrink)

Parkinson's disease has long been perceived as a pure motor disorder, partly due to its initial description by James Parkinson, who suggested that "senses and intellect remain intact", and partly due to the fact that patients with PD did not survive long, before effective treatment became available. As the survival time of patients with Parkinson's disease has substantially increased due to modern treatment, it has become apparent that cognitive deficits and dementia are also frequent features, especially in elderly patients. With (...) the progression of the disease and age, dementia develops in a substantial number of patients and constitutes a major therapeutic challenge. Dementia has thus increasingly been the focus of research and practice in recent years and a large body of knowledge has been accumulated. Despite these developments there has been no single volume dedicated to this topic. This book provides an extensive overview of the current status of knowledge pertaining to cognitive impairment and dementia associated with Parkinson's disease, intended as a reference book for general neurologists, neurology residents and also those with a special interest in movement disorders. In this edited volume experts in the field describe in detail all aspects of cognitive impairment and dementia in Parkinson's disease, including epidemiology, spectrum of clinical features, pathology, neurochemistry and genetics, findings in auxiliary investigations, relation to other neurodegenerative disorders, diagnostic process and management, and rounded up by discussion of future research directions and expectations. The text is complemented and enriched with tables, figures and heavily referenced to encompass all relevant literature. (shrink)

AbstrctSean Aas, Dana Howard, and Leslie Francis raise compelling and interesting objections to the definition of disability I defend in The Minority Body. In this paper, I reply to these objections and elaborate on my criticisms of the disability/impairment distinction.

According to Hendricks Impairment Argument (IA), abortion is immoral because it impairs the fetus. Here, I argue it is not sufficient to show merely that abortion impairs, Hendricks must show that it harms the fetus. If the fetus is not numerically identical to the person it will become, then it isn't harmed by an abortion. But if the fetus is numerically identical to the person it will become, it is harmed by the deprivation of a future of value. However, (...) taking this route ultimately undermines the novelty of the impairment argument. (shrink)

_The Hearing Impaired Child_ introduces the background issues of hearing impairment then discusses specific aspects. These include causes of hearing loss, speech and language, personality and emotional development, and careers. Appendices provide checklists for language acquisition and reading and writing skills, lists of useful addresses, a helpful glossary and references for further reading.

Although psychologist impairment has received attention from researchers, there is a paucity of empirical data aimed at determining the point at which such impairment necessitates action. The purpose of this study was to provide such empirical data. Members of Division 42 (n = 285) responded to vignettes describing a psychologist whose symptoms of either depression or substance abuse varied across five levels of severity. Results identified specific levels of impairment at which psychologists were deemed too impaired to (...) practice psychotherapy, as well as significant differences between ratings of increasingly severe impairment. Practical and ethical implications of these results are discussed. (shrink)

The social model of disability gives us the tools not only to challenge the discrimination and prejudice we face, but also to articulate the personal experience of impairment. Recognition of difference is therefore a key part of the assertion of our common humanity and of an ethics of care that promotes our human rights.

Conscious awareness comprises two distinct states, autonoetic and noetic awareness. Schizophrenia impairs autonoetic, but not noetic, awareness. We investigated the strategic regulation of relevant and irrelevant contents of conscious awareness in schizophrenia using a directed forgetting paradigm. Twenty-one patients with schizophrenia and 21 normal controls were presented with words and told to learn some of them and forget others. In a subsequent test, they were asked to recognize all the words they had seen previously and give remember, know or guess (...) responses according to whether they recognized words on the basis of autonoetic awareness, noetic awareness, or guessing. Overall, patients showed the same degree of a directed forgetting effect as normal subjects. However, whereas the effect was observed both for remember and know responses in normal subjects, it was observed for know, but not for remember, responses in patients. These results indicate that patients with schizophrenia exhibit an impaired strategic regulation of contents of autonetic awareness for relevant and irrelevant information. (shrink)

I argue that, if it is thought desirable to avoid the collapse of disability into generic social disadvantage, it is necessary to draw a distinction between impairment (a bodily configuration) and disability (the way in which the environment prevents someone with an impairment from undertaking certain kinds of activities), as in social models of disability. I show how to draw such a distinction by utilizing a distinction between intrinsic and extrinsic properties. I argue further that, using this distinction, (...) it is possible to define ‘impairment’ in ways that do not appeal to notions of the normal, and to define ‘disability’ in terms of ‘impairment.’. (shrink)

Patients with apraxia perform poorly when demonstrating how an object is used, particularly when pantomiming the action. However, these patients are able to accurately identify, and to pick up and move objects, demonstrating intact ventral and dorsal stream visuomotor processing. Appropriate object manipulation for skilled use is thought to rely on integration of known and visible object properties associated with ‘ventro-dorsal’ stream neural processes. In apraxia, it has been suggested that stored object knowledge from the ventral stream may be less (...) readily available to incorporate into the action plan, leading to an over-reliance on the objects’ visual affordances in object-directed motor behaviour. The current study examined grasping performance in left hemisphere stroke patients with (N = 3) and without (N = 9) apraxia, and in age-matched healthy control participants (N = 14), where participants repeatedly grasped novel cylindrical objects of varying weight distribution. Across two conditions, object weight distribution was indicated by either a memory-associated cue (object colour) or visual-spatial cue (visible dot over the weighted end). Participants were required to incorporate object-weight associations to effectively grasp and balance each object. Control groups appropriately adjusted their grasp according to each object’s weight distribution across each condition, whereas throughout the task two of the three apraxic patients performed poorly on both the memory-associated and visual-spatial cue conditions. A third apraxic patient seemed to compensate for these difficulties but still performed differently to control groups. Patients with apraxia performed normally on the neutral control condition when grasping the evenly weighted version. The pattern of behaviour in apraxic patients suggests impaired integration of visible and known object properties attributed to the ventro-dorsal stream: in learning to grasp the weighted object accurately, apraxic patients applied neither pure knowledge-based information (the memory-associated condition) nor higher-level information given in the visual-spatial cue condition. Disruption to ventro-dorsal stream predicts that apraxic patients will have difficulty learning to manipulate new objects on the basis of information other than low-level visual cues such as shape and size. (shrink)

With Perry Hendricks, I recently outlined a strengthened version of the impairment argument for the immorality of abortion. Alex Gillham has argued that our use of Don Marquis’ deprivation of a ‘future-like ours’ account entails we were merely restating Marquis’ argument for the immorality of abortion. Here, I explain why SIA is more than just a reframing of Marquis.

One challenge in providing an adequate definition of physical disability is unifying the heterogeneous bodily conditions that count as disabilities. We examine recent proposals by Elizabeth Barnes (2016), and Dana Howard and Sean Aas (2018), and show how this debate has reached an impasse. Barnes’ account struggles to deliver principled unification of the category of disability, whilst Howard and Aas’ account risks inappropriately sidelining the body. We argue that this impasse can be broken using a novel concept: marginalised functioning. Marginalised (...) functioning concerns the relationship between a person’s bodily capacities and their social world: specifically, their ability to function in line with the default norms about how people can typically physically function that influence the structuring of social space. We argue that attending to marginalised functioning allows us to develop, not one, but three different models of disability, all of which—whilst having different strengths and weaknesses—unify the category of disability without sidelining the body. (shrink)

Hendricks’ The Impairment Argument (TIA) claims that it is immoral to impair a fetus by causing it to have fetal alcohol syndrome (FAS). Since aborting a fetus impairs it to a greater degree than causing it to have FAS, then abortion is also immoral. In this article, I argue that TIA ought to be rejected. This is because TIA can only succeed if it explains why causing an organism to have FAS impairs it to a morally objectionable degree, entails (...) that abortion impairs an organism to a morally objectionable and greater degree than causing FAS, and satisfies The Impairment Principle’s ceteris paribus clause. In order to do all three things, TIA must presuppose some theory of well-being. Even then, no theory of well-being accomplishes all three tasks that TIA must in order to succeed. However, even if this is false and TIA can meet all three objectives by presupposing some theory of well-being, it would not do very much to advance the debate about the morality of abortion. As I argue, TIA would essentially restate well-established arguments against abortion based on whatever theory of well-being it must presuppose in order to be successful. (shrink)

A variety of mental disorders—including ASD, ADHD, major depression, and anxiety disorder, among others—may directly impact what an agent notices or fails to notice. A recent debate has emphasised the potential significance of such “impairment-derived ignorance,” and argued that failure to account for certain compelling cases would seriously undermine theories which intend to establish the conditions for blameworthy ignorance. In this comment we argue, contra a recent challenge, that Quality of Will (QW) accounts are able to explain the normative (...) significance of impairment-derived ignorance. The plausible, ambivalent results QW accounts yield in difficult cases of impairment-derived ignorance further reveals the explanatory power of such accounts when it comes to blameworthy ignorance. (shrink)

The evolution of a relevant nosological concept reflects changes in the distinction between what is recognized and defined as normal and pathologic. Attention is directed to the rationale and value of detecting subclinical aging-related modifications in cognitive performance. The position that different kinds of dementias may have precedents in etiological-specific kinds of early or mild cognitive impairments (MCI) supports targeting people earlier for study of these subclinical symptoms. Because heterogeneous disorders can be expected to have multiple patterns of cognitive and (...) behavioral changes, useful conceptual nosologies should be flexible. Yet clinical research primarily restricts its focus to a single pathway where MCI leads to Alzheimer's disease (AD), and uses selective recruitment, washout screenings, repeated trialing of similar compounds, and other methods that bank the published evidence in favor of the existing therapies and their modest efficacy. This focus on AD recursively colors MCI, not as a flexible "human kind" in need of more careful research, but like AD, as an essential "natural kind." Early determination of MCI targets a potential pharmaceutical market of a quarter to a half of the population over sixty-five and the individual experiencing cognitive decline in its early stages is aware and sensitive to their surroundings, to a linked sociodegeneration with neurodegeneration. This paper examines how classifying people changes both the classifier and the subject of classification. The potential for conflict of interest is raised regarding what new causal knowledge and techniques for ascertainment are selected. Reading evidence from epidemiology, neurology, and clinical studies through science studies and bioethics lenses, we explore the possibility of a pluralistic model of cognitive impairment nosology where biological/pathologic processes respond and interrelate with a normal healthy state. (shrink)

Most opposition to abortion stands or falls on whether a fetus is the sort of being whose life it is seriously wrong to end. In her influential paper ‘A defense of abortion,’ Judith Jarvis Thomson effectively sidesteps this issue, assuming the fetus is a person with the right to life yet arguing this alone does not give it the right to use the mother’s body. In a recent article, Perry Hendricks takes inspiration from Thomson and assumes the fetus is not (...) a person, arguing that abortion is wrong because causing fetal impairment is wrong and abortion is worse than causing fetal impairment. Here I argue Hendricks’ impairment argument fails. For Hendricks, risking fetal impairment is wrong because it risks harm to a future person, but if we assume the fetus is not a person, abortion doesn’t harm anyone, it merely prevents them from existing. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of (...) health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Drawing on insights from the medieval theologians Duns Scotus and Hervaeus Natalis, I argue that medieval views of the incarnation require that there is a sense in which the divine person depends on his human nature for his human personhood, and thus that the paradigmatic pattern of human personhood is in some way dependent existence. I relate this to a modern distinction between impairment and disability to show that impairment—understood as dependence—is normative for human personhood. I try to (...) show how medieval theories of the resurrection of the body can provide, within this context, plausible accounts of what it might be for human persons to be redeemed. (shrink)

What should patients know about the degree to which their physicians may be impaired—unable, in the words of the American Medical Association, “to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence”? What patients do in fact find out about such matters as alcohol or other drug abuse by, say, the surgeon or the anesthesiologist in charge of their care is another matter altogether; most patients learn about such (...) impairment the hard way. But what should they know beforehand, if at all possible? (shrink)

Social interactions typically involve movements of the body that become synchronized over time and both intentional and spontaneous interactional synchrony have been found to be an essential part of successful human interaction. However, our understanding of the importance of temporal dimensions of social motor synchrony in social dysfunction is limited. Here, we used a pendulum coordination paradigm to assess dynamic, process-oriented measures of social motor synchrony in adolescents with and without autism spectrum disorder (ASD). Our data indicate that adolescents with (...) ASD demonstrate less synchronization in both spontaneous and intentional interpersonal coordination. Coupled oscillator modeling suggests that ASD participants assembled a synchronization dynamic with a weaker coupling strength, which corresponds to a lower sensitivity and decreased attention to the movements of the other person, but do not demonstrate evidence of a delay in information transmission. The implication of these findings for isolating an ASD-specific social synchronization deficit that could serve as an objective, bio-behavioral marker is discussed. (shrink)