Autism – The Ethical Issues
Tim Cadman, PhD
Introduction
Aim: to introduce the ethical, social and philosophical issues
Overview:
 Ethical issues
 Theoretical background
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Practical questions
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Medical vs Social conceptions of autism
Human flourishing
Choosing non-autistic children
Behavioural interventions
Resource allocation
Conclusions
What are the ethical issues?
Practical:
 Development of technology to choose non-autistic
children (antenatal screening, selective implantation,
termination)
 Acceptability of certain behavioural interventions
 Decisions about the allocation of resources
What are the ethical issues?
Theoretical background
 Conceptualisation of autism (disorder vs distinct cognitive
style)
 Human flourishing and the quality of life of autistics
Theoretical issues 1: Medical vs Social
Conception of Autism
Medical model of disability
 Still dominant model in some quarters
 To be disabled is to be impaired in a way which inherently
limits one’s functioning
 Disability is a ‘problem’ which lies with the affected
person
 It is a ‘harmed condition’
Theoretical issues 1: Medical vs Social
Conception of Autism
Social model of disability
 Acknowledgement of differences from the norm
 Impairment ≠ disability
 Impairments disabling only because of circumstances of
society (e.g. Achondroplasia)
 “Disability is something imposed on top of our
impairments by the way we are unnecessarily isolated and
excluded from full participation in society. Disabled
people are therefore an oppressed group in society”
(UPIAS)
Theoretical issues 1: Medical vs Social
Conception of Autism
Medical
 Autism as a disorder (“ASD”)
 Autism as inherently impairing
 Treatment and cure
Social
 Autism as a distinct cognitive style
 Difficulties caused by attitudes and structures of society
 Autism analogous to ethnicity or sexuality
Theoretical issues 1: Medical vs Social
Conception of Autism
Conclusion
 Neither view is satisfactory
 More nuanced position required for autism: cluster of
different properties
 Social explanation persuasive for some difficulties, but not
all.
 However, useful for debate to draw this distinction
Theoretical issues 2: Human flourishing
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What does it mean for a life to go well for the person living it?
Objective
 Certain things are good or bad for a person regardless of their
attitudes to those things
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E.g. safety and security, friendship, sexual relationships,
freedom to pursue one’s interests, knowledge, work,
leisure.
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Overly paternalistic?
Subjective
 Experiential account
 Desire-satisfaction account
Theoretical issues 2: Human flourishing
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Theory of well-being affects judgements about quality of
life of autistic people.
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Example 1: Intellectual disability
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Objective and subjective accounts conflict
Example 2: Friendship
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Objective and subjective accounts may conflict
However, many people with autism have unsatisfied desires for
friendship – accounts can coincide
Practical issues 1: Choosing non-autistic
children
Arguments in opposition to technology
 Strong opposition from sections of autistic community
 Arguments from social model: mislocates problem
 Narrow conception of flourishing
 Discrimination: implication that autistic lives have less
value
Practical issues 1: Choosing non-autistic
children
Arguments in favour of technology
 Reproductive autonomy
 Genuine concern about quality of life
 Procreative beneficence
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Balancing autonomy with concerns about social harm
Practical issues 2: Behavioural
Interventions
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Are certain behavioural interventions harmful?
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E.g. interventions designed to reduce hand-flapping or
encourage eye contact.
These could cause anxiety and distress
Particular worry as children aren’t able to consent to these
Social model argues that there is nothing wrong with
these behaviours
Interventions should focus on improving well-being
Attitudes in society need to be tackled.
Practical issues 3: Allocation of Resources
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Where should resources be targeted?
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Research into causes and early identification
Providing support and enacting social change
Issue of intergenerational justice
Decision making process needs to be democratic
Include views of those with autism, philosophers and
ethicists, carers, policy makers, scientists and the public
Conclusions
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Complex theoretical and practical issues
Important to note diversity of opinion within autistic
community
Agreement may never be reached
Key is to involve range of opinion in debate