Disability as a test of justice
in a globalising world
Matti Häyry
Simo Vehmas
Professor of Philosophy
Aalto University
Professor 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
Nozick
Sandel
Harsanyi
Rawls
Gilligan
Cohen
Dworkin
Sen
Nussbaum
Main characteristics of views 1/3
Primary
ideologies
Basis of
justification
Normative
position
John
Rawls
Welfare liberal
Liberal
egalitarian
Rational
choice behind
the veil of
ignorance
Equal opportunities,
those who can are
encouraged to help
those who cannot
Robert
Nozick
Libertarian
Anarchocapitalist
Rational historical development, no
rights violated
Minimal (night
watchman) state
protects rights to life,
liberty, and property
Gerald
Cohen
Eliminate
Luck egalitarian
involuntary
Analytical
disadvantage,
Marxist
brute bad luck
Equal rights and
wellbeing for all who
do not voluntarily
risk them
Main characteristics of views 2/3
Primary
ideologies
Ronald
Dworkin
Basis of
justification
Eliminate
Responsibility
involuntary
-sensitive
advantage that
egalitarian
causes envy
Carol
Gilligan
Feminist
Ethics of care
Relationships
outweigh
justice and
well-being
Michael
Sandel
Communitarian
Conservative
Reasonable
acceptance
of good
traditions
Normative
position
Welfare state
provides for those
with disabilities and
insufficient talents
Caregivers should be
valued in both public
and private spheres
Solidarity and the
given in social life
should be protected
from individualism
Main characteristics of views 3/3
Primary
ideologies
John
Harsanyi
Amartya
Sen
Martha
Nussbaum
Game
theorist
Preference
utilitarian
Basis of
justification
Normative
position
Requirements
of rationality in
uncertainty
and risk
The autonomously
chosen preferences
of individuals ought
to be satisfied
Social choice,
Revisionist
accounting for
liberal conseadaptive
quentialist
preferences
Feminist
Capability
theorist
Aristotelian
take resulting
in ten central
capabilities
Promote people’s
capabilities to live
lives they have
reason to value
Promote (especially
women’s) capabilities
to live lives they have
reason to value
Theories
Libertarian
Communitarian
Preference
utilitarian
Welfare
liberal
Relational
Luck
egalitarian
Capability
approach
Polarisations 1/3
WEAK
STATE
Libertarian
Communitarian
Preference
utilitarian
Welfare
liberal
Relational
Luck
egalitarian
STRONG
STATE
Capability
approach
Polarisations 2/3
RELATIONS HAVE
UTILITY VALUE
Libertarian
Communitarian
Preference
utilitarian
Welfare
liberal
Relational
Luck
egalitarian
RELATIONS HAVE
INTRINSIC VALUE
Capability
approach
Polarisations 3/3
GIVEN TRADITION
IS GOOD & RULES
Libertarian
Communitarian
Preference
utilitarian
Welfare
liberal
Relational
Luck
egalitarian
Capability
approach
GIVEN TRADITION
CAN OPPRESS
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-towall 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 libertarianism 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 literature
Cohen, 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.