Among the topics in philosophy and disability, the relationshipbetween disability and justice has received the lion’s share ofattention. No doubt this is in part because justice, often regarded asthe “first virtue of social institutions” (Rawls 1971: 3),is central to the evaluation of social policies and publicinstitutions. But it is also because disability has played at leasttwo distinct roles in recent discussions of social justice. First,disability has been seen by many as a paradigm example of unchosendisadvantage. Hence, disability has played a central role in internaldiscussions of luck egalitarianism, in particular with respect to the“currency” question—equality of what?—andexternal discussions, in particular with respect to the question ofwhether luck egalitarianism is disrespectful or stigmatizing. Second,people with disabilities, particularly intellectual or cognitivedisabilities, have been seen by many as a “limit case” forcontractarian or contractualist theories of justice. Hence, disabilityhas played a central role in discussions about the eligibilityconditions for being party to the contractual procedures by whichprinciples of justice are chosen and for being subject to theprinciples of justice so chosen.

Disability also presents difficult issues as a social or groupidentity: roughly, a central part of the way an individualunderstands, presents, or values herself. This aspect of disabilityhas been made salient by the civil rights movement that establisheddisability as an important category in antidiscrimination law.Theories that assess justice in terms of the distribution of resourcesor opportunities have sometimes been criticized for failing to takeadequate account of such identities. But the embrace of socialidentity as a component of justice can be equally problematic.

Disability is of special interest for justice because of the way inwhich it juxtaposes two basic and powerful senses ofinjustice. These two senses of injustice are sometimesexpressed in terms of a distinction between the justice ofdistributions and the justice ofrecognition, ormore recently, betweendistributive justice andrelational injustice. Very roughly, we can think of theselabels as denoting a distinction between the injustice of certainoutcomes—in particular, outcomes in which there is aninequality of income, wealth, health, or other aspects of well-beingresulting from morally irrelevant factors—and the injustice ofcertain forms oftreatment—in particular, the treatmentof some peopleas moral, social, or political inferiors onthe basis of morally irrelevant characteristics. Correcting the firstform of injustice is thought to require, fundamentally, a change inthe distribution of resources, broadly construed, that affectwell-being. Correcting the first form of injustice is thought torequire, fundamentally, a change in the structure and character ofinterpersonal relationships, which may in turn require changes tosocial and institutional norms and practices. Needless to say, therelationship and comparative importance of these two forms ofinjustice have been the subject of considerable discussion, and thereis no canonical statement of the distinction (Fourie et al. 2015;Anderson 1999; Fraser 2001, 1996; Honneth 1992).

This entry is organized as follows: Section 1 will discuss disabilityin terms of these two broad types of injustice. Sections 2 and 3 willexamine the implications of different models of disability for thedistinction between redistribution and recognition. Section 4 willthen examine the treatment of disability in contemporary theories ofdistributive justice. It will explain how the environmental and socialcharacter of disability has been largely overlooked by contractarianand egalitarian theories, not so much because of their distributivefocus, but because of their narrow focus on one aspect ofdisability—functional limitation—to the neglect ofexclusionary attitudes and practices. Section 4 will conclude bydiscussing recent efforts to rectify this neglect, describing severalways in which distributive justice theorists have sought to takeaccount of environmental and social barriers and to address claims forrecognition. These efforts include broadening the metric for justdistributions to encompass respectful relationships and socialpractices; arguing that a just distribution on such broader metricscan be attained more effectively and appropriately by modifying thephysical and social environment than by redistributing resources amongindividuals; and adopting outcome standards that do not require strictequality on any metric but rather the reduction or elimination ofdisrespectful inequalities. Section 5 will discuss a major issue inthe recognition of disability: the relationship of disability identityto various approaches to justice, where “identity” isunderstood as a part of an individual’s self-understanding orself-presentation.

• 1. Disability, Recognition, and Redistribution
• 2. Models of Disability and Their Implications for Justice
• 3. Justice, Reconstruction, and Reasonable Accommodation
• 4. Disability in Contemporary Theories of Justice
  • 4.1 Disability and Contemporary Social Contract Theories
  • 4.2 Disability, Outcome-Oriented Theories, and the “Currency” of Justice
  • 4.3 The Appropriate Metric for Distributive Justice
  • 4.4 The Appropriate Standard for Distributive Justice
• 5. Justice, Disability Identities, and Epistemic Injustice
• 6. Conclusion
• Bibliography
• Academic Tools
• Other Internet Resources
• Related Entries

1. Disability, Recognition, and Redistribution

It is clear that people with disabilities have long been treated asmoral and social inferiors, at the same time that they have suffereddistributive injustices of various kinds (see generally, Barclay2018). Routinely, people with disabilities have been denied jobs forwhich they are highly qualified because they have been consideredincompetent, or because employers have not been comfortable with theirpresence in the workplace. Often, people with certain disabilitieshave been consigned to segregated institutions and facilities becausethey have been regarded as incapable of making decisions or caring forthemselves, or because others in the community did not want tointeract with them.

These forms of relational injustice are associated with very concretematerial inequalities. In 2009, almost 20 years after the passage ofthe Americans with Disabilities Act, the employment-population ratioof people with disabilities in the United States was 19.2%, comparedto 64.5% for persons without a disability (Bureau of Labor Statistics2010). Based on data from 1996–1999, researchers estimate that47.4% of working-age adults who experienced poverty for a year or morehad at least one disability (Fremstad 2009).

Facts such as these have led some to conclude that

in particular, internally diverse ways, people with disabilities havebeen on the end of a kind of pincer movement between Fraser’stwo impediments to parity: “misrecognition” and“maldistribution” (Calder 2010: 62).

In these respects, people with disabilities are in a comparableposition to members of other “discrete and insularminorities” with a history of being subject to both distributiveand relational injustice. But there is a significant difference.Simply put, there is no reason to think that it need be particularlyexpensive to eliminate disrespect and misrecognition towardsracial, ethnic, and sexual minorities. But insofar as accommodationand reconstruction of the built environment are necessary to eliminatedisrespect and misrecognition towards people with disabilities,relational justice for people with disabilities may require divertingsignificant resources from other causes. In that sense, achievingjustice for people with disabilities requires us to directly addressthe relationship between relational justice and distributive justiceto a degree that achieving justice for members of other groupsgenerally does not.

To be sure, the costs associated with accommodation and reconstructionof the built environment need not be understood ascompensation for the alleged deficits of people withdisabilities. Indeed, they would have to be acknowledged even ifdisabilities were seen as intrinsically neutral physical or mentalcharacteristics that merely differ from those of a majority of thepopulation. In any society whose physical structures and socialpractices are designed for average or typical members, people withdisabilities will be disadvantaged just because of their minoritystatus. A similar point has been made by feminist scholars, who havepointed out the structural discrimination of workplaces and publicsettings designed exclusively for men. The expenses of additionalrestrooms, stalls, or pumping stations do not compensate women fortheir deficiencies. They simply accommodate differences ignored in asociety that saw a woman’s place as in the home (Wendell 1996;Wasserman 1998: 178–179).

Still, the rectification of such structural discrimination may raisemore difficult issues for people with disabilities than for women,because there is greater uncertainty and potential for disagreementabout the extent of the changes that are required to treat people withdisabilities as social and political equals. Indeed, the range andvariety of physical and mental differences within a society raiseissues of distributive justice that have no obvious analogue for otherstigmatized groups. A “gender-neutral” environment can bereadily conceived, and achieved at modest cost. In contrast,disability scholars and activists have not specified what it wouldmean to achieve an “ability-neutral” environment—onethat was no more advantageous to people with some physical and mentalcharacteristics than others. And some argued that the ideas of an“ability-neutral” environment is either conceptuallyincoherent or prohibitively expensive (Barclay 2011, 2018). Moreover,it seems likely that questions about the extent to which justicerequires reconstructing or modifying the built environment would arisewith respect to people with disabilities even in a society with nohistory of invidious attitudes or practices toward such persons. Bycontrast, it seems less likely that such questions would arise in asociety with no history of sexism, for example.

Justice for people with disabilities, then, appears to raise questionsabout the relationship between distributive justice and relationaljustice that justice for other stigmatized groups does not. Yet theneed for redistribution hardly reduces the importance of recognitionin achieving justice. Indeed, the complex, disputed relationshipbetween the two makes disability a significant challenge for theoriesof justice.

2. Models of Disability and Their Implications for Justice

“Disability” is typically defined in terms of twoelements: (i) a physical or mental characteristic labeled or perceivedas an impairment or dysfunction, and (ii) a significant personal orsocial limitation associated with that characteristic. Therelationship between these two elements—and the role of theenvironment in mediating them—is a core issue in theconceptualization of, and social response to, disability. Themedical model treats disability as an individual physical ormental characteristic with significant personal and socialconsequences. In particular, it sees the limitations faced by peoplewith disabilities as resulting primarily or solely from theirimpairments. By contrast, the varioussocial models seedisability as a relationship between individuals and their socialenvironments: physical and mental characteristics are limiting only orprimarily in virtue of social practices that lead to the exclusion ofpeople with those characteristics. This exclusion is manifested notonly in deliberate segregation, but in built environments and socialpractices that restrict the participation of people regarded as havingdisabilities (see SEP entry ondisability: definitions, models, experience).

In their extreme forms, which treat the impairment or environment(respectively) as the sole cause of personal and social limitation,the medical and social models have few, if any, defenders. Rather,they mark the limits of possible relationships between impairment andlimitation. Almost all writers on disability acknowledge some role forboth the impairment and the environment in causing limitations; thedisagreement largely concerns the assessment of their comparativecontribution, and their interaction. Most scholars who embrace someversion of the social model acknowledge thatimpairments—generally but not universally understood asdeviations from species-relative statistical norms—can besources of discomfort and limitation even in the absence ofdisadvantaging social practices (e.g., Shakespeare 2006, Thomas 2004).These scholars would argue, however, that such adverse effects are farless damaging than social exclusion, are greatly magnified by hostileenvironments, and could be significantly reduced by more inclusiveenvironments. The medical model is less often explicitly defended thanunreflectively adopted—by health care professionals,bioethicists, and philosophers who ignore or underestimate thecontribution of social and other environmental factors to thelimitations faced by people with disabilities. Even among thesegroups, however, there is a growing awareness of the environmentalcontribution to disability and a partial embrace of the social model(Cureton and Brownlee 2009).

To the extent that it is held by anyone in unalloyed form, the medicalmodel of disability would not deny that disability raises issues ofjustice. Indeed, that model might give support to the view that thedisadvantages perceived as inherent to disability raise some of themost urgent claims of justice (Barclay 2011, 2018). But such a modeldoes not recognize anyprincipled rationale for preferringreconstruction of the social and built environment over compensationor correction as a means for correcting disability-relateddisadvantage, a point made by Wolff (2009a, 2009b), among others. Incontrast, the social model strongly supports such a rationale, sinceit construes many aspects of disability-related disadvantage asessentially connected to various forms of literal andfigurative exclusion. Relatedly, the social model construesreconstruction as a public good: more accessible structures and moreinclusive practices can be enjoyed by a wide variety of people withand without disabilities (Scotch and Schriner 1997). But suchreconstruction also helps to achieve a fairer distribution of tangibleand intangible goods, particularly social and economicopportunities.

Some critics accuse social model theorists of assuming that anydisadvantage caused by the social environment isipso factounjust (Samaha 2007). This assumption would reflect an oversimplifiedview of the relationship between causing disadvantage and creatinginjustice. The fact that social structures or practices causedisadvantage does not imply that there is a duty of justice to corrector compensate for the disadvantage. That will depend on the costs ofalleviating it, and—under any plausible theory ofjustice—some comparison with the advantages and disadvantagesthat would result from alternative social arrangements. Thus, forexample, choosing to spend the bulk of a municipal arts budget on aconcert hall rather than an art museum may disadvantage those whocannot hear. But that disadvantage, although caused by a socialdecision, is not necessarily unjust. That will depend,interalia, on the availability of non-auditory forms of aestheticexperience and the comparative costs of building the museum instead.To take another example, placing ramps and elevators in new high-risebuildings is relatively inexpensive and beneficial to most users,whereas placing them in nineteenth century walk-ups is difficult andexpensive; holding public meetings or events in buildings with rampsand elevators has negligible costs, whereas moving an existingbusiness from a building that lacks them to one that has them may bevery expensive (Samaha 2007; Wasserman 2001).

The difficulty of inferring injustice from socially causeddisadvantage is clear in contexts where greater social provisionsecures incremental advantage. In such contexts, the question of howmuch is just will not always have an obvious answer. For example, itwould at least marginally benefit wheelchair-users to have additionalrestricted parking spaces, but we could hardly infer an injustice fromthe fact that an institution providedN rather thanN +1 such spaces. Intuitively, the allotment should be proportionate tothe number of wheelchair users in the community or at the facility,but that number may be uncertain, and a range of spaces would likelysatisfy any proportionality requirement.^[1] In deciding how many spaces are enough, we would receive no guidancefrom the indisputable fact that any disadvantage or advantage in thiscontext would have social causes.

Conversely, the fact that social arrangements do not cause orcontribute to a disadvantage does not insulate it from claims ofjustice; the failure to alleviate that disadvantage may be unjust onplausible accounts of justice. Thus, although many“natural” disasters like Hurricanes Katrina owe muchof their destructive impact to social arrangements, it is plausiblethat the state’s duty to support the victims of hurricanes andtsunamis is not contingent on its responsibility for causing orexacerbating them (Wasserman 2001).^[2] Indeed, as we discuss below, various forms of luck egalitarianism donot distinguish between disadvantages caused versus merely notcorrected by society’s institutions, provided that the relevantdisadvantages are equally severe and equally unchosen by thosedisadvantaged.

Nevertheless, the causal claims made by social-model theorists arerelevant to justice in several ways. First, as suggested above, formost theories of justice, the mere fact that the social environmentcan be modified in ways that alleviate the disadvantages associatedwith impairment places demands for their alleviation within the scopeof justice—as claims that a theory of justice must consider andweigh. Second, the fact that those disadvantages are caused by socialarrangements is relevant for those theories that regard society ashaving a stronger duty not to create or aggravate disadvantages thanit has to prevent or correct them (Wasserman 2001, Schemmel 2012).Finally, alleviating the disadvantages attributable to prejudice orstigma will enjoy priority on any theory of justice that treatsdisadvantage resulting from prejudice or stigma as a greater injusticethan innocently-created disadvantage.^[3]

Beyond a shared concern with the social causation of disability,different versions of the social model emphasize different features ofthe exclusionary structures and practices (see SEP entry ondisability: definitions, models, experience). Theminority group model regards people with impairments asa stigmatized minority group. It holds that the main reason peoplewith disabilities encounter special hardships is that they facediscrimination akin to that faced by racial or ethnic minorities (Hahn1987, Oliver 1990). Thehuman variation model holds that manyof the challenges faced by disabled people do not result fromdeliberate exclusion, but from a mismatch between theircharacteristics and the physical and social environment (Scotch andSchriner 1997). These two versions of the social model differ mainlyin emphasis. The discrimination stressed by the minority group modelgenerally leads to, and is expressed in, the societal failure toaccommodate people with stigmatized differences. Yet the failure tofully accommodate people with various differences, from extreme heightto intellectual impairment, does not necessarily arise from stigma.But often, disparities in access that were initially caused byresource or technological limits are maintained by stigma. Forexample, an employer’s initial purchase of communicationstechnology inaccessible to blind or deaf employees may be explained bythe fact that accessible technology had not been developed at the timeof purchase. But those historic facts would not justify theemployer’s refusal to include modestly priced accessibilityfeatures when purchasing upgrades a decade later, for example.

Both versions of the social model require the removal of barriers andpractices serving to exclude people with disabilities, and thereconstruction of the environment to more fully include them. Under aminority-group model, these measures are dictated primarily by ademand for recognition and respect, and for the correction of pastexpressions of disrespect found in the knowing exclusion of peoplewith disabilities from many aspects of social, political, and economiclife. The human variation model puts less weight on the expressive orsymbolic significance of past exclusion. Rather than construing peoplewith disabilities as a “discrete and insular minority”created by practices of more or less deliberate exclusion, the humanvariation model construes people with disabilities as simply peoplewho differ in degree from the majority of statistically normalpopulation with respect to one or more physical or mentalcharacteristics. The purpose of reconstruction is not so much to endspecific exclusionary practices as to create a more inclusive physicaland social environment. Given this difference in emphasis, it isnatural to understand the human variation model as appealingprincipally to norms of distributive fairness, ensuring equal oradequate access to the physical and social environment, in contrast tothe minority group model, which appeals more explicitly to norms ofrespect and recognition.

The demand for greater inclusiveness is less categorical than thedemand to eliminate discrimination. Although any environment can bemade more inclusive, none can be fully inclusive for everyone (Barclay2010, 2018). This is not necessarily because, as Barclay, followingShakespeare (2006), claims, the inclusionary features required for oneimpairment often conflict with those required by another. Suchconflicts may be minor, temporary, and remediable. The problem is moregeneral: 1) for many characteristics, from height to mathematicalaptitude, one “size” does not fit all; 2) providingdifferent sizes increases fit for a wider range of variation, but atincreasing cost (albeit less than often assumed); and 3) it isfrequently impractical, and may arguably be unjust, to ensure thateveryone is equally well-or ill-fitted; it may, for example, be tooexpensive to ensure that left-handed or extremely tall individualssufferno inconvenience in being statistical minorities. Fullinclusion, like universal design, is an ideal—one that cannot befully achieved, and that must be compromised in the partialsatisfaction of other legitimate claims.

Even if it would be impossible or unreasonable to achieve fullinclusion through wholesale changes in the physical or socialenvironment, modest changes could significantly increase inclusion atlittle cost. Some examples come from a study of environmentmodification for autistic individuals (Owren 2013). Some people withautism face significant barriers to taking part in routine socialactivities: they find such familiar stimuli as applause, lighttouching, and deodorant as highly aversive; they must be explicitlyinstructed about social expectations because they cannot“read” most facial expressions or social clues. Thestudy’s author recognizes that the “neurotypicalmajority” cannot be expected to give up applause, lighttouching, or even deodorant, let alone nuance in communication:

What would be lost? Large parts of what may be some of the mosttreasured areas of communication: the art of innuendo, the doublemeaning at the heart of much comedy, irony, the implied meaning at theheart of so much poetry,… flirtation and “feeling eachother out” before committing to something that cannot beretracted. (2013: 23-24)

At the same time, the author points out that the majority could oftengain from more modest accommodations.

Many neurotypicals might profit from being more explicit and fromothers being more explicit, as can be illustrated by the extensivefocus in couples therapy on getting partners to state their needs andexpectations more explicitly, not relying on other to pick up on“vaguely described, implied, or unspoken behavioralexpectations”. (2013: 92)

The author suggests (2013: 111) that it may be feasible to develop“best practices”: “strategies for enhancingaccessibility and reducing sensory issues in a larger scale”without unduly burdening the majority:

One strategy might be to incorporate into Universal design thepractice of providing access to low stimulation areas in mainstreamsettings. Another might be to create more public acceptance ofautistic behaviors like stimming,^[4] which seem to help many autistic people reduce the impact of aversivesensory stimuli.… (2013: 111)

Such strategies clearly involve tradeoffs, but those tradeoffs wouldinvolve small economic and social costs for a majority to achievelarge gains in inclusion for a minority. The claim that it isimpossible to achieve, or even understand, full inclusion for peoplewith autism does not deny that there is significant injustice in theircurrent state of social isolation.

The challenges for social models of disability for justice may seemgreatest for intellectual and psychiatric impairments, as well as forcomplex physical impairments such as fibromyalgia, multiple chemicalsensitivity, and other conditions that radically and unpredictablyaffect energy, stamina, and functioning (Wendell 1989, 1996; Davis2005). First, these conditions strikingly display both aspects ofimpairment, as markers for stigma and as sources of functionallimitation (see SEP entry,disability: definitions, models, experience). Cognitive and psychiatric impairments evoke some of the strongestprejudice and all present some of the most difficult functionallimitations, e.g., on the capacities to engage in practical reasoning,to recognize the intentions and attitudes of other people, or toparticipate in shared activities.Second, some theorists contend thatthese conditions pose more of a practical challenge for the socialmodel than even the most severe physical disabilities, in part becausethe measures required for greater inclusion are not as concrete ortangible, and may demand greater imagination to envision and implement.^[5]

Although significant practical work has been done in educational andworkplace inclusion, philosophers have been daunted by the challengeof social reconstruction for cognitive disabilities. Thus JonathanWolff, who generally favors such reconstruction—which he calls“status enhancement”—as the most respectfulintervention, asks

What would it mean to change the world so that people with cognitivedisabilities and other people were equally able to find a worthwhileplace in the world? Can we even imagine what this would be? (2009a:407)

Many rights and privileges are thought to require a certain level ofcognitive capacity, e.g., the right to vote or contract (Wikler 1979).Similarly, most jobs are structured to require regular hours,uninterrupted activity, undivided attention, and generalsociability.

How much should a society modify these requirements or restructurethese activities to include people with various intellectual,psychiatric, and complex physical disabilities? A total relaxation ofsuch requirements would impose large, even “undulyburdensome” costs. However, many modifications to promote theinclusion of people with significant cognitive impairments would alsobenefit people with typical cognitive function: simplified taskexplanations, warning labels, news copy, and jury instructions. Manyaccommodations employers are already making to increase flexibilityand reduce stress, from individually-tailored schedules totelecommuting, would ease the entry of people with these disabilitiesinto the workplace. There is a growing body of practical and policywork that applies social models of disability to people withintellectual, psychiatric, and complex physical impairments (e.g.,Biklen 1992; Block 2006; Connor et al. 2008; Hehir 2002).

As discussed later in this Entry, there is sharp disagreement aboutwhether individuals with the most severe intellectual impairmentsqualify as subjects of justice. But even if individuals with the mostsubstantial intellectual impairments are regarded as subjects ofjustice, what justice demands for them, and of them, may be uncertainor disputed. Nussbaum (2009) contends that the equal citizenship ofthose individuals requires that they be enabled to exercise suchpolitical rights as voting and jury service through appropriatesurrogates. Wasserman and McMahan (2012) question whether those rightscould be meaningfully exercised by surrogates for individuals with themost severe intellectual disabilities.

Some philosophical intimation of a social model approach to cognitivedisability can be found in Dan Wikler’s 1979 essay,“Paternalism and the Mildly Retarded”. Wikler held thatthe category of cognitive disability was socially constructed by thecompetence thresholds set for important social activities, such assigning a contract or voting in an election. But although societychooses, in this sense, who will be cognitively impaired, it does nothave unlimited flexibility, since there can be significant socialcosts in altering those thresholds. The issue, Wikler concluded, wasultimately one of justice; of fairly distributing the burdens ofsetting thresholds that will be too high for some or too low forothers. Yet Wikler questioned whether justice would require, or evenpermit, the kind of modifications necessary for significantly greaterparticipation. Writing two decades later, Wolff cited Wikler instating,

the fact is that what makes much of modern life possible now relies onbinding and enforceable contracts that in turn assume a certain levelof intellectual competence. To change the world so that such a bar islowered would have tremendous costs. (2009a: 407)

This pessimism has prevailed in the years since Wikler wrote, andthere has been little philosophical attention to practicalpossibilities for the inclusion of people with cognitive impairments.Although there have been interesting discussions of this issue in thecontext of education (e.g., Howe 1996; Ladenson 2005; Veatch 1986),the general issue has tended to be dealt with in summary fashion.(Exceptions include Kittay and Carlson 2010; Hartley 2009a; Silversand Francis 2009; Wong 2007, 2009.) Thus, for cognitive disabilities,Wolff emphasizes “targeted resource enhancement” ratherthan status enhancement, arguing for an entitlement scheme that givespeople with cognitive disabilities maximum possible control over anindividual budget for personal assistance and social support (2009a:407–413). He does regard some forms of status enhancement,notably antidiscrimination measures, “as essential”, buthe accepts Wikler’s conclusion that broader changes in socialpractice carry “intolerable costs” (2009a: 413).

In their influential bookFrom Chance to Choice, Buchanan etal. (2000) repeat the assertion that there would be excessive socialcosts in reconstructing society to permit the full participation ofpeople with significant cognitive impairments. They compare thereconstruction of society for greater inclusion with a family decisionto play only the card games that a young child can understand. Theycontend that just as adults will tire of a constant game of Go Fish,the society will be “dumbed down” if it refashions itselfto fully include people with cognitive impairments.

Although the meaning of inclusion is debatable, and different forms ofinclusion will have differing value for different people, thecard-game analogy oversimplifies the challenge. To present inclusionas a zero-sum allocation is to dumb down the incredibly complex taskof rearranging society to respect and nurture all its members. Theanalogy assumes that every activity must be done by everyone, which isfalse.

A more apt analogy to organized social activity might be an assortmentof games that can be played by different combinations of people indifferent ways. Some games could be played by everyone; others couldbe modified to include cognitively impaired people in a way thatpreserved the interest of non-disabled players; some would be beyondthe reach of people with certain cognitive impairments. But even themost cognitively gifted individuals could not participate in allgames—the sheer amount of training and practice required tomaster some of them, and the considerable time and energy many of themrequire, would preclude participation in many or most. Indeed, societymay function better if people have varying aptitudes for, andinterests in, different activities. (A similar criticism of thecard-game analogy is offered by Wong (2007), who recounts how herbrother with Down enriched rather than impoverished family life.) Thefact that a smaller set of activities may be available to people withcognitive impairments need not present a problem, if it does notresult in their social isolation or deny them intellectual challenges(Parens & Asch 2000: 25–26 [quoting Philip Ferguson,personal correspondence]). But ensuring their participation mayrequire society to refashion itself in significant ways.

It is not clear that such refashioning would impose the“intolerable costs” feared by Wolff. Social inclusion doesnot require, for example, that individuals with significant cognitiveimpairments be able to make binding contracts in every domain of lawand business; it requires that competence standards be graduated toreflect the complexity of specific tasks so that those individuals arenot categorically excluded –a suggestion made more than twodecades ago by the authors of the card-game metaphor (Buchanan andBrock 1990). Social model theorists know full well thatimpairments—physical as well as cognitive—differ from skincolor in that they are sometimes relevant to what people can do, asare such other attributes as education and income. But that feature ofimpairment hardly precludes social reconstruction. Indeed, the mosteffective rebuttal to the card-game metaphor may be found in thepractical work that already has been done in educational and workplaceinclusion (e.g., Biklen 1992; Block 2006; Hehir 2002; McGuire et al.2006). At the same time, it bears emphasis that the social model ofdisability was originally conceptualized in terms of physicaldisabilities. And there may be significant limitations on the extentto which it applies to cognitive disabilities. More generally,although it may be useful to speak of “the” social modelof “disability”, the diversity of impairments that fallunder the extension of “disability” suggests that theaptness of the social model in any given context will vary dependingon the nature of the impairments at issue.

3. Justice, Reconstruction, and Reasonable Accommodation

As suggested in§1, the disabling impact of social arrangements may be relevant to thetype and scope of interventions that justice requires. In stressingthe impact and the malleability of the environment, social-modeltheorists have shifted the focus from claims for correction andcompensation to claims for reconstruction.

Consider a society with much greater height variation than our own.Even if very tall or short stature was neither stigmatized norfunctionally limiting, that society would, on any plausible theory ofjustice, be obliged to construct its public spaces, buildings, andvehicles to accommodate them. They would be treated unjustly if theconstruction of the physical environment took no account of them,especially if the failure to do so caused them significantdisadvantage. Of course, the extent to which their height differencesneeded to be taken into account would depend on the distribution ofheight in the society, as well as on its level of resources andcompeting needs. No plausible theory of justice would require that thebuilt environment be equally accommodating to all heights, if such athing were possible, but all would condemn some environments asunjustly restrictive. What even this simple case suggests is that thedemand for a more inclusive environment need not be seen in terms ofcompensating individuals, tall or impaired, for their internaldeficits, but of accommodating as wide as possible a range of humanvariation.

Even if environmental reconstruction should not be seen ascompensating for deficits, a question remains about the extent towhich it should be seen as a matter of redistribution or recognition.This question is raised by the legal requirement of “reasonableaccommodation”. Under the ADA and ADAAA,“accommodations” include ramps, elevators, texts inmultiple formats, sign-language interpreters, flexible work schedules,and job coaches or assistance. The failure to make reasonableaccommodation for disabled employees or users of public facilitiesconstitutes, with some notable exceptions, discrimination (ADA 1990).There is no reference to that concept in the laws banningdiscrimination on the basis of race, sex, or age; the term wasintroduced in cases addressing claims of religious discrimination(see, e.g., Karlan and Rutherglen 1996). Like practitioners ofminority religions, but unlike women, people of color, or olderpeople, people with disabilities must be “reasonablyaccommodated”.

For the human variation model, reasonable accommodation requireschanges in the physical and social environment, from installing rampsto modifying work schedules and altering the location of meetings andclasses. Often, such changes require little more than flexibility andimagination. But some of these changes can be expensive; at somepoint, the cost may make further change unreasonable. On thisapproach, the legislative understanding of such accommodation as amatter of distributive justice is reflected in the qualifying use of“reasonable” and the exemption of accommodations thatwould impose an “undue” burden or hardship on the entityrequired to make accommodations (Wasserman 1998).

But it is also possible to see reasonable accommodation as arequirement of equality for people with disabilities without recourseto a theory of distributive justice (e.g., Crossley 2004; Karlan andRutherglen 1996). Accommodating religious practices may be expensivein various ways, but no one regards doing so either as compensatingreligions for their deficits. Indeed, such a rationale would appear toviolate the state’s constitutionally-mandated neutrality amongreligions. Rather, because the state is required to treat religionsand their adherents with equal respect and concern (Dworkin 2003), itdisfavors rules and practices that interfere with religiousobservance. Somewhat similarly, a state that regards people withdisabilities with equal respect and concern will disfavor arrangementsthat interfere with their participation. With respect to both groups,substantive equality may require unequal provisions. In the case ofdisability as well as religion, how much additional provision isrequired is indeterminate, not for lack of a complete theory ofjustice to specify the amount or proportion, but because the demandsof equal respect are indeterminate.

Consider, for example, the question of how much it is reasonable for asmall business to spend on an elevator or ground-floor space to beable to employ a talented IT technician with emphysema. To answer thatquestion, we might do better to decide what respect for that persondemands, based in part on current social practice and convention,rather than to consult a comprehensive but abstract theory ofdistributive justice. In any case, it may be unreasonable to expect adeterminate answer; it may be appropriate to rely on a fair procedureto select among a range of plausible outcomes. But by the same token,the utter lack of accommodation in many workplaces and publicfacilities is clearly unjust on any plausible theory of justice.

The debate over the accommodations available for a minority group mayoften reflect a complex mix of claims concerning redistribution andrecognition. For example, people in wheelchairs are sometimes providedrestaurant access only through the service entrance. The restaurantowners often claim that such access is quite reasonable, since theservice entrances already have ramps—a distributiveconsideration. Disability advocates claim that however convenient itmay be for the owners, such access treats wheelchair users assecond-class customers—a claim of misrecognition. In this case,it may seem that the recognition claims clearly trump the conflictingdistributional claims. But this will not always be the case.

Again, resolving such conflicts may involve the same kind of judgmentemployed in debates over accommodating minority religious practices.It may be that some jobs cannot be made available to people whoseSabbath falls on Friday or Saturday, because (in light of demographicconsiderations) the essential functions of those jobs require workingon those days. But although the “essential function”standard appears objective and determinate, it is often subject todistributive considerations, e.g., about staffing requirements andbusiness volume. A refusal to sustain the slightest loss of revenue toaccommodate any minority religion might be a distributive injustice; awillingness to sustain greater losses to accommodate Jewish andAdventist employees than Muslim ones might involve misrecognition aswell—the failure to treat Islamic practice as having the samevalue as other religious practices. Similarly, the violation of theADA involved in refusing to display the same flexibility for disabledas for pregnant employees arguably constitutes both distributiveinjustice and misrecognition.

The uncertainty about the distributive character of reasonableaccommodation suggests that in the case of disability, it may often bedifficult to sharply distinguish claims for redistribution and recognition.^[6] Recognition may require redistribution, and redistribution should aimat securing recognition. Asch (1989) has gone even further, arguingthat recognition must precede redistribution; that if people withdisabilities were recognized as equals, capable of significantcontributions to others, society would be more willing to adoptappropriate measures for redistribution and reconstruction.

4. Disability in Contemporary Theories of Justice

The resurgence of philosophical interest in justice is often dated tothe publication of John Rawls’A Theory of Justice in1971. Although that was only two years before the passage of theRehabilitation Act of 1973, embodying a social model of disability(see SEP entry,disability: definitions, models, experience), it was well before the academic reconceptualization of disability asa social phenomenon. For the 25 years afterA Theory ofJustice, many justice theorists tacitly accepted the medicalmodel (e.g., Dworkin 1981a,b; Daniels 1985). They treated disabilityas a physical or mental limitation of the individual, the principalcause of disability-related disadvantage. Disability thus posed aproblem for justice theories based on mutual advantage, hypotheticalagreement, or material or social equality. People with disabilitiesdid not appear to offer reciprocal advantages; they complicated thetask of reaching a hypothetical agreement on the basic structure ofsociety; and they made the goal of equality seem impossiblydemanding.

By the late 1990s, some mainstream political philosophers werebecoming acquainted with social models of disability, and somedisability theorists were gaining a hearing among politicalphilosophers. Some philosophers sought to modify distributive theoriesof justice to take account of the social and environmental characterof disability; others cited the failure of those theories to takeappropriate account of disability as one reason to reject exclusivelydistributive approaches.

Before describing these developments, it is useful to distinguish twotypes of distributive theories. Modern social contract theories,notably Rawls’ (1971), seek to determine the fair terms ofsocial cooperation to which individuals (generally with limitedknowledge of their own situations) would agree; they argue thatcertain distributive principles would be among those terms(Rawls’ “difference principle” may be the mostfamiliar). Rawlsian theories are procedural in one sense: they regardany distribution as just if and only if it is consistent with thedistributive principles that would be chosen by those individuals.Disability-oriented criticism of these theories has focused on theirassumptions about the individuals who are eligible to make ahypothetical contract or participate in the cooperative scheme itestablishes. Critics have argued for the eligibility of people withdisabilities or their representatives to participate in thecontract-making processes and resulting cooperative scheme more thanabout the validity of the principles or rules yielded by that process(Richardson 2006; Silvers and Francis 2005; Stark 2007). The secondtype of theory is primarily interested in outcomes; in the kind of endstate a just society should strive for: either equality on someoutcome metric or the reduction of certain kinds of inequality. Here,disability-informed criticism has favored outcome metrics that takeaccount of the social contribution to disability-related disadvantage,and standards for just distributions that are oriented towarddisrespectful inequalities (Anderson 1999; Nussbaum 2006a; Wolff2009b).

4.1 Disability and Contemporary Social Contract Theories

Within social contract theories, a distinction is often drawn betweencontractarian/Hobbesian and contractualist/Lockean accounts (see SEPentry oncontractarianism). One way to characterize this distinction is in terms of theparties’ motivation and interaction. In the former, they arenarrowly self-interested and hard-bargaining; in the latter, theirself-interest is tempered or balanced by their commitment tojustifying themselves to others, and they proceed by deliberatingrather than by bargaining. This distinction is often formulated interms of a distinction between (merely) rational agents, and“reasonable” agents.

A Rawlsian approach might seem more congenial than a Hobbesianapproach to people with disabilities. It derives the basic structureof society from a hypothetical choice situation, the OriginalPosition, in which a veil of ignorance precludes reliance on thecontractors’ actual limitations—limitations that aHobbesian contractor might ruthlessly (albeit rationally, if notreasonably) exploit (cf.note 10). Although the parties themselves are motivated exclusively byconsiderations of self-interest, which Rawls understands in terms ofthe fulfillment of two higher-order interests (see SEP Entry onthe original position), the informational constraints of the Original Position compel theparties to motivateas if they are reasonable, at least inthe sense that it compels them to be impartial between the claims ofall who will be subject to the principles they choose.

But even if Rawlsian contractors do not know their specificlimitations, they do know that they, or the individuals theyrepresent, are not permanently disabled. Rawls stipulated that theidealized society whose “basic structure” was the subjectof hypothetical agreement was restricted to members who would be“fully-cooperating” over the course of their adult lives.Rawls assumed that this restriction would exclude people with severeand permanent physical and mental disabilities (Rawls 1993:18–20). He did not defend that assumption, nor provide for therepresentation of those people in the process by which the basicstructure of society is to be determined. Instead, he consigned theirfate to the later, legislative phase. Rawls also restrictedparticipation in the Original Position to those with two “moralpowers”: the capacity to form and revise one’s ownconception of the good; and the capacity for a sense of justice, thecapacity to act on and apply fair terms of cooperation(ibid.). It is doubtful that these powers can be attributedto people with the most severe intellectual and psychiatricimpairments, although some philosophers and disability scholars haveargued that a just society should treat all human beings as having thepotential to develop such functioning (Wong 2007, 2009).

Disability scholars have been particularly critical of theseeligibility conditions for the Original Position. If the deliberatorsin the Original Position do not believe that they could berepresenting, or could turn out to actually be, people with“severe and permanent” disabilities when the veil islifted, they will have no prudential reason to choose a basicstructure for their society that will provide for the inclusion ofthose people. Indeed, insofar as such measures would impose costs onpeople with non-disabilities, the parties will have prudential reasonsnot to support such measures, since doing so would underminethe interests of people whom they know they could represent (theable-bodied on whom the costs are imposed) for the sake of those whomthey explicitly know they don’t represent (the disabled for whomthe costs are imposed).

Several philosophers sympathetic to the Rawlsian framework havesuggested modifications that would give people with disabilities agreater and more direct role in the social contracting process. Somehave argued that the “full cooperation” requirement, andthe kind of reciprocity it involves, can be liberally interpreted soas not to exclude most people with significant physical disabilities(Hartley 2009b; Stark 2009). Henry Richardson has gone even further,maintaining that “Rawls’ arguments making use of thedevice of the [Original Position] do not essentially depend on anyreciprocity premise” (2006: 427). He examines modified versionsof the Original Position that drop the assumption that no one hassevere and permanent disabilities. He contends that with suchmodifications, the Original Position can yield principles moresensitive to disability concerns about the continuous nature ofabilities, the stigmatization resulting from false dichotomization,and the exclusion of severely disabled human beings.

In response, Martha Nussbaum (2006b: 490–498) concedes thatRichardson’s proposed reconstruction of Rawls would largelyavoid the exclusionary features of the OP to which disability scholarshave objected. But she argues that this reconstruction is a moreradical departure from Rawls than Richardson acknowledges. Shesuggests that the theory loses its contractual character if itdispenses, per Richardson, with the reciprocity requirement and theassumption that the contractors have roughly equal physical and mentalpowers.

Rawls’ “moral powers” condition has posed furtherproblems. Harry Brighouse (2001) observes that modifying thecooperation requirement still excludes those whose cognitiveimpairments preclude their possession of the two moral powers. SophiaWong (2009, 2007) argues that those powers can be acquired by peoplewith severe intellectual impairments, with adequate social support.Leslie Francis (2009) and Anita Silvers (Silvers and Francis 2009)contend that many individuals with severe cognitive impairments cancollaborate with others to construct individualized, authenticconceptions of the good. Silvers and Francis (2005) and ChristieHartley (2009a) also maintain that people with severe intellectualimpairments can be represented adequately in a contracting processthat consists in trust-building more than hard bargaining, even ifthey cannot participate in it personally.

Others have argued that exclusion from the Original Position need notadversely affect people with disabilities or treat them withdisrespect. Adam Cureton (2008) argues that the exclusion of peoplewith severe disabilities from the Original Position is just part ofits idealization, and does not diminish the urgency or priority oftheir claims. Cynthia Stark (2007) proposes lifting thefull-cooperation requirement to include people with disabilities atthe second stage of Rawlsian deliberation, where the society’sconstitution is established and where the hypothetical decision makersacquire some knowledge about the resources, development level, andother characteristics of their society.

The plausibility of these responses to Rawls depends to some extent onwhich version of the Original Position we consider. Rawls made achange in his presentation of the Original Position in hisRestatement (2001) that is especially pertinent to peoplewith cognitive disabilities. He emphasized that the participants inthe Original Position are representatives of people in the futuresociety, not people living in the future society denied knowledge oftheir social position. If representatives were made to take intoaccount the possibility that those they represent might be disabled,this might help to ensure that the interests of the disabled wererepresented. It would only do so, however, if the contractors have theability to imagine the very different embodiments of people with avariety of disabilities, an ability feminist critics of Rawls havequestioned with respect to men representing women (Young 1990;Benhabib 1992; Okin 1994). The strictly representational role ofparticipants in the Original Position would also avoid the conflict ofinterest faced by cognitively unimpaired individuals representingthemselvesand cognitively impaired individuals.

More broadly, philosophers have varied widely in their optimism aboutthe prospects for including people with disabilities in contractarianor contractualist deliberations. On the one hand, Lawrence Becker(2005) suggests that even selfish, hard-bargaining contractarians (his“tough crowd”) would accept an expansive notion of“reciprocity”, one that would ensure adequate provisionfor people with disabilities in the scheme of social cooperation theyadopt. Their acceptance of reciprocity would arise from recognition ofthe needs and vulnerabilities they and their loved ones have or willlikely acquire. That recognition places a premium on social provisionsfor health.

Even for the tough crowd, health is now ripe for inclusion in the listof basic goods. And it may be that a robust social commitment tohealth will address questions of justice for the disabled—aslong as we are careful to include fundamental aspects of psychologicalhealth (i.e., those associated with active rational agency….(2005: 35)

Members of the tough crowd may not be so careful, however. Indeed,some may not even regard “active rational agency” as amatter of health as they more narrowly construe it, with an emphasison physical survival and comfort. In contrast to Becker, Eva Kittay(1999) holds that even the most liberal interpretation of Rawls’scheme will not be sufficiently responsive to the egalitarian concernsthat motivate his theory. Rawls’ assumption that theparticipants in the original position are or represent fullyproductive members of society neglects the fact of pervasive,inevitable human dependency. “[T]hose within relationships ofdependency fall outside the conceptual perimeters of Rawls’egalitarianism” (1999: 79).

Another debate within contractarian theories that has particularrelevance to disability concerns the scope of justice itself: Isjustice concerned only with the distribution of social goods, or alsowith the rectification of “natural inequalities” (Pogge1989: 44–47). Pogge (1995) argues that in the Original Position,it would be irrational for parties to ignore the contribution ofnatural advantages to the well-being (understood in terms of thefulfillment of the two “higher-order interests”) ofprospective citizens, since from that standpoint, it is just as bad tobe disadvantaged by uncompensated disabilities as it is to bedisadvantaged (to the same degree) by a small share of social primarygoods. But Pogge claims that attempting to eliminate thoseinequalities would go beyond the scope of justice. Some philosophersargue, however, that many natural inequalities are within the scope ofjustice, and that health care to mitigate them is a requirement ofjustice (Daniels 1985; Buchanan et al. 2000).

Other philosophers and disability scholars would deny that theinequalities associated with impairments can be regarded as“natural” (Amundson 1992; Wasserman 2001). In questioningthe very notion of “natural inequalities”, they join abroader philosophical debate about whether it is possible to draw acoherent distinction between natural and artificial or socialinequalities (see Lippert-Rasmussen 2004; Nagel 1997; Pogge 2004a,b;Aas and Wasserman, 2016).^[7] Even if such a distinction can be plausibly drawn, it may turn outthat many or most inequalities in abilities are artificial: as with ofobsolete skills, those inequalities may be largely attributable to thephysical and social environment (Bickenbach 1993).

4.2 Disability, Outcome-Oriented Theories, and the “Currency” of Justice

Other distributive theories of justice take a less procedural approachthan Rawls. They are directly concerned with the kinds of outcomes ajust society should pursue. These theories differ in the outcomemetrics they adopt—the “currency” of distributivejustice (Cohen 1989). Some adopt a resource metric (Dworkin 1981b);still others, a metric based on opportunities for welfare (Arneson1989) or access to advantage (Cohen 1989). Finally, capabilitytheories assess outcomes not only by the goods or resources thatpeople have, but also by what people are able to do with what theyhave (Nussbaum 1990; Sen 1980). Such outcome-oriented theories may bemore or less demanding, depending on whether they require equality ormerely priority for the worst-off, and on whether they supportequality of a sort that may not require the significant redistributionof goods or resources.

The most prominent family of outcome-oriented approaches has beencalled “luck egalitarianism” (see, for example, Arneson2000; Dworkin 2003; Lippert-Rasmussen 2015). According to the dominantcharacterization of that position, its central claim is that it isunjust when there are unfair inequalities in the distribution of“brute luck”—an advantage or disadvantage withrespect to the relevant metric that is not attributable to anindividual’s fault, choice, or assumption of risk. “Optionluck”, in contrast, refers to an advantage or disadvantage anindividual acquires through the foreseeable consequences of his or heractions. The stronger versions of luck egalitarianism (e.g., Dworkin81b) deny that any inequality resulting from option luck generatesclaims of justice. On those versions, only some disabilities generatejustice claims—those that resulted from brute bad luck (e.g.,congenital impairments)—whereas others, which may involve thesame or greater disadvantage, do not, simply because they resultedfrom a free choice (e.g., reckless pastimes or an unhealthylifestyle).

Some philosophers have taken these implications as areductio adabsurdum of luck egalitarianism (Anderson 1999), and they wouldno doubt be rejected by many writers on health care, who havequestioned the moral and policy relevance of individual responsibility(Cavallero 2011; Feiring 2008; Galvin 2002; Wikler 1987). The greaterconcern for disability scholars may be with the conflation ofdisadvantages resulting from unchosen impairments with disadvantagesresulting from unchosen social conditions under the one heading of“bad brute luck”. Luck egalitarianism does not,assuch, provide any principled rationale for distinguishing betweenequally severe setbacks to the well-being of people with disabilitiesthat result from the “bad luck” of being born in a societywith disability discrimination and the “bad luck” of beingborn with an intrinsically disadvantageous set of physicalabilities. Both are equally unchosen from the individual’sstandpoint, and it is individual responsibility, rather than somecombination of individual and collective responsibility, thatdetermines whether a given disadvantage generates a valid justicecomplaint. This is not to deny that luck egalitarianism can besupplemented to account for the intuition that the “badluck” of being born in a disabling environment (Fine and Asch1988) differs morally from less socially mediated forms of bad luck,as we will see in our discussion of the capabilities approach.

4.3 The Appropriate Metric for Distributive Justice

The implications of outcome-oriented theories for disability depend ontwo features of those theories. The first is the metric, or“currency” of justice they adopt—welfare, resources,primary goods, or capabilities. The second is the distributivestandard they impose—strict equality, priority for the worseoff, or merely some minimum for everyone (sufficientarianism). We willconsider these two features in order, although they are sometimesintertwined.

Rawls and other social contract theorists adopted a broad outcomemetric for assessing the comparative advantage of the individual in asociety: “social primary goods”, which includeopportunities, basic liberties, income, and the social bases ofself-respect. This breadth is intended to achieve neutrality betweencompeting substantive conceptions of the good, since the socialprimary goods are construed as “all-purpose means” thatare valuable to have irrespective of the content of one’sparticular conception of the good. For many disability scholars, thedifficulty in this approach does not concern its neutrality, but itsfailure to take account of the environment in which those goods mustbe utilized, which may profoundly affect their value to thosereceiving them. Two persons might be alike in their share of socialprimary goods, and have similar projects, aims, commitments, andvalues, but nonetheless differ in the value they can derive from thosegoods, if one person is disabled and the other is not. As we shall seebelow, the capabilities approach takes into account this objection,when the difference between the uses to which each person can put herprimary goods is construed as the result of differences in“internal resources”, or the rate at which the individualcan convert resources to “functionings”.

A failure to take adequate account of the environment may also befound in directly-egalitarian resource-based approaches. Dworkin(1981a,b), for example, appears to take the social environment forgranted in proposing a hypothetical division of resources intoindividual bundles. Giving people with impairments equal materialshares in a society like our own would hardly satisfy the demands ofequality in a physical and social environment designed exclusively forpeople with standard endowments. Dworkin is aware of the problem, buthis solution is to adjust individual shares to include insurancepayouts against poor environmental fit, rather than to redesign theenvironment to reduce inequalities in fit. To that degree, Dworkinappears to tacitly assume a medical model of disability, according towhich limitations resulting from impairments are solely attributableto the impairment itself, and, if not correctable, compensable only bythe redistribution of resources to people with such impairments. Suchcompensation may ensure survival, but it does little to enhance orequalize participation, and may in fact hinder participation ifAnderson (1999) is right that compensating for disabilities expressesdisrespect. Moreover, the size of the insurance payout for a givendisability is determined by the amount by which able-bodied peoplewould be willing to insure themselves against the prospect ofincurring that disability. Insofar as the judgments of able-bodiedpeople don’t always track the intuitively relevant facts aboutdisability-related disadvantage, such an approach threatens to“bake in” flawed assumptions about the experience ofdisability into its account of just entitlements for people withdisabilities (Bodenheimer 1997a,b).

Several alternatives for assessing outcomes for purposes of politicaland social equality seem more responsive to the disabling role of thesocial environment. The most familiar and influential of thesealternatives is the capabilities approach, developed in different waysby Martha Nussbaum (2006a) and Amartya Sen (1980). Their accounts are concernednot only with the resources an individual has but also with what shecan do with them; with her “capability” of engaging in anumber of valuable “functionings”, such as formingintimate relationships and having rich sensory and aestheticexperiences.

Nussbaum’s earlier formulations of the capabilities placedconsiderable emphasis on species-typical functioning. For example, sheinitially treated “the exercise of the five senses” as anecessary constituent of human flourishing. More recent formulationsare more congenial to social models of disability, in part because ofNussbaum’s encounter with disability scholarship. She now makesroom for the social contribution to “natural” deficits(see Wasserman 1998; Terzi 2009), recognizing that most capabilitiesbear only a contingent, environmentally-mediated relationship topeople’s “natural endowment”. She abstracts fromdifferences between people with impaired and normal limb function tofind a common claim to the means of moving about from place to place.Such means may be architectural, vehicular, mechanical, or prosthetic;they may involve making places more accessible or making theindividual more mobile. Similarly, a person lacking sight or hearingcan achieve aesthetic satisfaction by other means; a person withintellectual impairments can participate in activities structured toinclude individuals of varying cognitive skills. An individual withemphysema could increase his capacity for affiliation and control overthe material environment (two capabilities from Nussbaum’s2006a list) not only bymeasures to increase his lung capacity but also by measures toincrease his access to social and business venues through bettertransit and architectural design.

Nussbaum’s broader framing enables her to recognize theprospects for flourishing of people with severe impairments. Theplausibility of the capabilities approach for disability critics ofdistributive accounts lies in the way the capabilities areindividuated. A basis for individuation might be found in acomprehensive account of human nature and human flourishing, such asthe Aristotelian account that informs Nussbaum’s work. As Beckernotes, however, such a comprehensive account would have limited appealin justifying a distributive scheme in a pluralistic society (2005:35). Despite its promise, considerably more work is needed to clarifyher approach. Another feature of Nussbaum’s theory that somedisability theorists find congenial is her incorporation ofrecognition and respect into her set of basic capabilities. Thus, thecapability for “affiliation” encompasses not onlyintimacy, but self-respect and dignity; the capability for“control over the environment” includes both the materialand political environments.

Less ambitiously than Nussbaum, Jonathan Wolff (2009b) classifiesequality-enhancing measures for people with disabilities by the extentto which they address recognition as well as redistribution. Thus, theindividual limitations of people with disabilities can be addressedwith either cash compensation or “personal enhancement”,medical, surgical, or rehabilitative measures to correct thoselimitations. “Targeted resource enhancement” offers anintermediate option, which tries to improve the fit of the individualand the environment with a range of restricted resources such aspersonal assistance and assistive technology. Finally, “statusenhancement” alters the built environment and social practicesto reduce the impact of individual differences in abilities on socialequality. Wolff generally favors status enhancement as the mostrespectful intervention, because it shapes the environment to theneeds of all members of society. It is also the most stableintervention, because it protects the social equality against suddenchanges in individuals’ levels of functioning.

Although Wolff does not adopt the device of hypothetical decisionmaking to justify a preference for status enhancement, that preferencecould be underwritten by a suitably modified Original Position. AsRichardson (2006) suggests, hypothetical decision makers who know thatthey may represent individuals with severe impairments are more likelyto be concerned with capabilities than with primary goods, since thelatter by themselves may be of limited value to those they represent.Further, those decision makers would recognize that capabilities oftencan be increased more respectfully, as well as more effectively, bystatus enhancements than by other measures.

Yet doubts remain about the extent to which concerns aboutrecognition, respect, and social equality can be captured in anyoutcome metric of individual well-being, however broad. Thus,Christian Schemmel (2012) argues that the treatment of people asequals must be understood in terms of respectful relationships amongindividuals and institutions, and that the presence of suchrelationships cannot plausibly be regarded in what Pogge (2004a,b)calls “recipient-oriented” terms, as components ofindividual well-being. The moral significance of respectful treatmentis neither exhausted by, nor derivative of, its contribution toindividual well-being. As Schemmel argues (2012: 19), people may needsome forms of affiliation to flourish but do not necessarily requiresocial and political equality for their own well-being. Theplausibility of these claims depends to some extent on how narrow orbroad a conception of well-being one adopts. A conception thatencompasses virtually all that a person has reason to care about willmore easily accommodate social equality and respectfulrelationships.

4.4 The Appropriate Standard for Distributive Justice

Two approaches seek to moderate the ambitions of distributive justicein ways that may be more inclusive of people with disabilities. Onetakes the end-state of justice not as equality or priority butsufficiency: it requires that every member of society reach someminimum in the appropriate “currency”. This approach,labeled “sufficientarian” by one critic (Arneson 2006), issuggested but not endorsed by Nussbaum, and it serves to makecapabilities a less demanding metric for distributive justice.(Nussbaum notes that certain capabilities must be distributed equallyif anyone is to have a sufficient level of them, e.g., voting rights.)The requirement that a just society ensure that every citizen reachesa minimum level of each capability may be far less demanding than therequirement of equal capabilities. One way of setting the minimumappeals to the requirements for participation in a democratic society(Gutmann 1987; Anderson 1999).

Although sufficientarian approaches claim to make the demands ofjustice less oppressive, they have been criticized as demanding both toomuch and too little. They demand too much if the minimum for everycapability must be met in the face of recalcitrant impairments orenvironments. They demand too little if attaining the minimum couldstill leave the individual with a miserable life (Arneson 2006;Wasserman 2006; Wolff and de-Shalit 2007). Those approaches have alsobeen criticized for lacking a mechanism for prioritizing capabilities(Wolff and de-Shalit 2007) and for assessing whether the minimum hasbeen reached for any one capability (Riddle 2010). Clearly, the extentto which justice is achievable on such approaches for people withsevere disabilities will depend on where the minimum is set, how itssatisfaction is assessed, and how the capabilities are defined.

A second approach would replace equality on a specific metric ofadvantage with social equality or equality of respect (Anderson 1999;Miller 1999; Norman 1997, 1999). This approach would involve a moreradical departure from luck egalitarianism than a sufficiency account,since it does not lower the standard for a just distribution so muchas propose a non-distributive standard for justice. That standardwould see justice in terms of recognition rather than, or as well as,redistribution. Although this approach may demand strict equality of asort, it is a sort that does not appear to set determinatedistributive requirements. A society of social equals, abounding inmutual respect, can arguably tolerate significant disparities inwelfare, resources, opportunities, or capabilities.

Underlying this approach is the more fundamental distinction betweenrelational and distributive theories of justice. Although thisdistinction can be drawn in different ways (see, e.g.,Lippert-Rasmussen 2015, Fourie et al. 2015), it identifies twocritical dimensions of justice. One concerns how well-off individualpeople are, both absolutely and in comparison to each other. The otherconcerns the kinds of social relationships people stand in to oneanother. As discussed in§4.3, it is a difficult question to what extent either dimension of justicecan be reduced to, or expressed in terms of, the other.

Against the claim that relational justice can be understood as aninstance of distributive justice, one may observe that at least withrespect to equality, there seems to be an importantstructural difference between two people standing in somerelation tosome third thing (i.e., some good) to the samedegree and two people standing in some relation tooneanother to the same degree (e.g., the relation of beingrespected, recognized, and so on). Insofar as interpersonal equalityhas a different structure when construed as relational, it is amistake to think that it can be reduced to a species of distributiveequality, for “equal” means something different in eachcase. For example, it is one thing for any two people in society tohave equal respectfrom others; it is a different thing forany two people in society to have equal respect foroneanother. This distinction is relevant to debates about disabilityin particular, because one way to understand the social model is interms of the relational view—its core insight is that disabilityis not a one-place property of individuals, defined in terms of somewelfare deficit, but an n-place relation between individuals (n>2)defined by stigmatizing or excluding attitudes, dispositions,practices, and forms of treatment.

Some of these issues have taken center-stage in a recent debate overthe expressive significance of different measures to remediate thedisadvantages associated with disability. Pogge (2002) and Anderson(1999) have claimed that it is disrespectful to attribute aperson’s disadvantage to features of his or her naturalendowment because it treats her as needy, deficient, or inferior. Forthis reason, they argue against justifying redistributive measures toachieve inclusion on the grounds that they correct naturalinequalities in skills, talents, or the ability to convert resourcesinto welfare. Instead, they contend that such measures can and shouldbe justified as redressing discrimination, and conversely, thatfailures to achieve inclusion should be recognized as unjustlydiscriminatory.

Barclay (2010, 2018) challenges the argument that a claim forredistribution treats the claimant as deficient or inferior. Suchclaims need only recognize that some traits are less suited thanothers for specific environments—a contingency that does notimply the intrinsic superiority or inferiority of a given endowment.She thus questions those (e.g, Daniels 1985; Buchanan et al. 2000) whoclaim that certain characteristics or traits are universally valuable,such that an individual who lacked them would be deficient in anyenvironment. Although she tends to see the environment as fixed ratherthan malleable, Barclay argues that the project of achieving inclusionis best seen in terms of maximizing individuals’ environmentalfit. Achieving that fit may require expending more resources for someindividuals than others in any given environment. The demands made byvery tall or left-handed people for greater accommodation do notpresuppose their inferiority, only their minority status (see§2, infra). These comparisons suggest that the demands for accommodationof people with such statistically atypical features differ merely indegree, not kind, from those made by people with variousimpairments.

Even if compensation for disadvantage need bit be demeaning, however,specific grounds for compensation may well be. Laws and policies thatcompensate people simply because they are disabled, or have a specificdisability, may be objectionable because of the social meaning ofdisability-compensation. Compensation that is based on the medicalclassification of disability may reinforce the humanity-obscuringstereotype of “the cripple” as helpless and pitiable. Thisgrave threat to social equality should make us wary of drawingdistributive implications from the claim that disability is a“bad difference” rather than a “mere difference“(see entry, “Disability: Well-Being, Health, and PersonalRelationships”). Even if disability in general, or specificdisabilities, were bad differences, that would hardly imply thatindividuals who had (those) disabilities were entitled to compensationsimply by virtue of that fact.

5. Justice, Disability Identities, and Epistemic Injustice

There are many categories or groups into which people can placethemselves, and be placed, on the basis of their varyingcharacteristics. The salience and appeal of these categories depend onsocial and historical context as well as individual preferences andvalues. Identity and identity politics become important as members ofhistorically excluded groups challenge their status and work forinclusion. Many women gained a sense of group identity in opposinglaws that limited voting and other political rights to men; racialidentities have been forged in the fight against segregation. Althoughpeople with disabilities are not always understood as sharing anidentity, their awareness of membership in an oppressed group has beenshaped by exclusionary laws and customs, from “ugly laws”prohibiting people with physical deformities from appearing in publicto the state-sponsored involuntary sterilization of “mentaldefectives”. A sense of group identity has been furtherencouraged by welfare, social security and other laws that placepeople with various disabilities in a single category, even if theydefine that category in different ways.

The importance of disability as a social category was increased by themovement to establish civil rights for people with disabilities. As inthe case of other stigmatized groups, the characteristics used as aground for exclusion became a basis for mobilization and a source ofpride. The social model of disability, which informed the movement fordisability rights, emphasized what people with various impairmentshave in common—their stigmatization and exclusion—andthereby promoted the emergence of disability as a powerful socialidentity.

Critics like Fraser argue that the importance of social identitycannot be adequately captured in any metric of individual advantage.An effective social response to stigmatized identities requires bothrecognition and transformation—changes in cultural framing andsocial perception that are poorly served by redistribution. Anemphasis on redistribution is often self-defeating, exacerbatingstigma and reinforcing the impression of the stigmatized group asdeficient (Fraser 1995, 1997; see Olsen 2001). Yet as we will discuss, someways of transforming social identity have significant dangers aswell.

For proponents of recognition, one issue is whether justice requiresnot only respect for individual members of society, but also respectfor their group or cultural identities. Must a just society recognize“group-specific cultural identity” or merely “thestatus of group members as full partners in social interaction”(Fraser 2001: 23, 24)? Are these separate requirements, or doesrespect for an individual entail respect for her social or culturalidentities? These questions have been addressed primarily with respectto religious, ethnic, racial, and sexual minorities. Very little workhas been done on the question of what a disability identity would looklike and what sorts of recognition claims it would implicate.

A somewhat parallel issue has been raised in distributivejustice—must society allocate resources, broadly construed, tosupport the group and cultural identities of its members? That supportcould be based on the claim that such identities are a constituent,perhaps an irreducible one, of the well-being of the individualmembers of society. This claim has been suggested by justice theoristswho argue for the importance of culture as a “context ofchoice” for individuals (e.g., Kymlicka 1989, Sparrow 2005). Anindividual deprived of a culture through which he has experienced andinterpreted the world will find it far more difficult to flourish. Aswe will discuss, however, it is doubtful that disability in general,or particular impairments, play such a comprehensive role in the livesof many—let alone all—people with disabilities.^[8]

We begin by describing the different characteristics of anindividual’s “identity”. One sense of this term isthat of numerical identity over time: what makes some person at timet1 the same person as the person at time t2? (see SEP entry onidentity over time). This is, in the first instance, a metaphysical question and not ourinterest here. A different sense of “identity” refers tothose characteristics that make one the particular person one is, asjudged both by oneself and by others. This includes narrative,biographical, and practical identities. It is less about criteria forsameness over time and more about the constitutive or definingfeatures of one’s self- (or social) conception. This is thesense of “identity” we will be concerned with.

The sense of individual identity most directly relevant to respect andrecognition is arguably that of practical identity. FollowingKorsgaard (1996, 2009), we can understand a practical identity to be adescription under which a person values herself, where valuing oneselfinvolves treating oneself as a source of reasons. For example, someonewho identifies as a mother in this sense values herself under thedescription “mother” and for that reason treats the factthat she is a mother as a source of (normative practical) reasons.Moreover, to “drop” this identification is not likedropping a desire or short-term goal. It involves changing one’ssense of who one is as a person and what gives one’s lifevalue.

On this view, a person’s practical identities should benormatively significant for other people as well. For one thing, manyof a person’s significantinterests are derived fromher practical identities. Since it is uncontroversial that respect andconcern require giving appropriate weight to the interests of others,it follows that respect and concern require giving appropriate weightto other people’s practical identities, at least insofar as theygenerate (legitimate) interests. In addition, respecting aperson’s practical identities plausibly falls under a moregeneral requirement of respect for personal autonomy. Personalautonomy is a foundational value of liberal democracies, whose lawsand policies do not require individuals to organize their lives aroundany particular identity, but rather give them the latitude to make oftheir identities what they will (Appiah 2005; Appiah and Gutmann 1996;see also the SEP entry onidentity politics). This can be seen as a part of liberalism’s broader commitmentto neutrality about conceptions of the good (e.g., Rawls 1993).

These issues become especially charged if we move from individual togroup identities, bringing us closer to the question of disabilityidentities. As K. Anthony Appiah points out, though individualidentity is different from group identity, it nevertheless has acollective or social dimension (Appiah 2005: 21). For example,Palestinians living in the West Bank have a distinct collectiveidentity. This is different from, though certainly compatible with,some specific West Bank resident having as part of his individualidentity being a Palestinian.^[9] It is important to bear this distinction between individual andcollective identities in mind, because the latter, to a greater extentthan the former, is imposed or “ascribed” by the largersociety rather than chosen by the individual.

Being disabled, like being a member of a minority race, subjects oneto particular treatment. But one can experience that treatment withoutfeeling compelled to regard one’s disability or minority statusas part of one’s individual identity in the practical sense ofbeing a description under which one values oneself. Often, having adisability identity ascribed to one, like having a racial identityascribed, consists in part in being the object of, and provides anexcuse for, discriminatory, demeaning or degrading treatment ofvarious sorts. This is so both for people whose impairments areimmediately observable and for those whose impairments are hidden butsubject to exposure and ridicule by a temporary change in appearance,e.g., a person with epilepsy who has a seizure in public (Schneiderand Conrad 1985; more generally, Davis 2005). And since this socialidentity is often part of one’s individual identity, suchtreatment is likely to be injurious to the self-respect of the onewith this identity, and in that sense constitute an instance ofmisrecognition. Ironically, the fact of being unfairly stereotyped canitself shape the identities of those who are treated in this way, asAppiah notes, even if initially they did not identify strongly withthe group in question.

Desirable change with respect to social identities is possible in atleast two ways. First, even if some important aspects of one’sself are not chosen—say, the fact that one has paraplegia ordeafness—how central they are to one’s self-conception,how much they matter to one’s interests and plans, is to someextent within one’s voluntary control. On some views, notablyKorsgaard’s, reflective endorsement of an identity is anecessary condition of its being normative for the agent, i.e.,providing reasons for her. At the same time, the extent to whichone’s identifications are voluntary depends on the constraintsof the social environment. One cannot simply decide to makeone’s disability a less salient feature of one’sbiographical identity, at least, especially if one’s disabilityis not “hidden”. If the identity is ascribed, andemphasized, by the larger society, it may be difficult to reduce itsimportance in one’s own practical reasoning. But one still hassome choice about whether to accept or resist that emphasis.

Second, there can be a change in thevalence of the label, asthere has been with the term “queer”: what was once anegative label, accompanied by unjust treatment of various sorts, canbe transformed into a positive label and championed as a source ofself-respect and pride for those who share in the collective identity.John Lawson discusses how special education for disabled children,once seen as a major factor in the creation of a negative,second-class identity, can be transformed into “sites for thepositive promotion of disability as a cultural identity” (Lawson2001: 203–21). Neither sort of change—in identification orvalence—can be accomplished without struggle, personal as wellas political, but partial success is sometimes achievable.

Even if disability is not and does not have to be a central componentof every disabled person’s identity, this does not negate thesignificance of disability as an organizing principle of politicalaction. But when the social and political recognition of disabilitybecomes the objective of political action, as it is in identitypolitics, it gives rise to the “dilemma of difference”(Minow 1990). Consider special education for children: On the onehand, labeling a child “disabled” risks stigmatizing andisolating the child. In this sense, to be “different” isto be inferior. Alternatively, being labeled “disabled” isa way for parents to secure attention to the child’s particularways of learning and functioning. In this sense, to be“different” is to be entitled to appropriate educationalassistance.

The dilemma may not be insurmountable. The movement for universaldesign in education aims to refashion classrooms and teachingpractices to encourage the participation of all students. To theextent that the movement is successful, it will minimize the need for“special education” (Biklen 1992; Gartner and Lipsky 2002;Lipsky and Gartner 1996). Law and public policy must think creativelyabout ways to solve this dilemma so that the stigma they seek toeliminate is not in effect reinforced. Success in resolving thedilemma of difference may reduce the importance of disability identityfor justice. If disability is simply a characteristic to be takenaccount of in social arrangements, it could become as significant orinsignificant as height or aptitude.

There are at least two other risks for an identity politics ofdisability. One involves the danger of assuming that the members of aparticular marginalized group all share the same culture, be itAfrican-American culture or disability culture. This assumption is notrequired by a mature identity politics, but it may be encouraged byefforts to mobilize diverse individuals around a single identity. Twoconsiderations may help to resist this tendency. First, we mustrecognize that culture is a complex concept, and that defining it isno easy task. Second, we must recognize that on any plausibledefinition, people with the same disability (let alone differentdisabilities) need not share a common culture. There are some examplesof a shared disability culture: Deaf culture is perhaps the bestknown. But many people who are deaf, particularly those who do notsign, do not identify as Deaf or take part in Deaf culture (Tucker1997^[10] And even for those who participate, Deaf culture does not appear tobe the kind of “encompassing” or“comprehensive” culture claimed by Kymlicka, Margalit, andRaz to provide a “context of choice” for its members.^[11]

The second, related risk involves privileging one identity overothers. This is especially important for people with multiple or“intersectional” identities. People who areAfrican-American and disabled, or female and disabled, or disabled andLGBT may sometimes feel a conflict between those identities. In onestudy, for example, African-American women with mobility impairmentsreported that they felt estranged from the disability-rights movement,partly because its leadership seemed predominantly white, and partlybecause some of its principal goals—to maximizeindependence—went against their more communal values, whichemphasized family and co-dependence (Feldman and Tegart 2003). Moregenerally, although there has been comparatively little discussion ofthe intersection between disability and race within philosophical workon disability (though see Stubblefield 2009), more discussion can befound in disability studies more generally (e.g., Bell 2011). Also,some have noted that mainstream feminism’s focus on independenceand self-sufficiency has tended to exclude women with disabilities,who are perceived as lacking in these cardinal virtues (Crawford andOstrove 2003; Wendell 1996). At the same time, disabled women areoften particularly vulnerable to the injustices that motivate thefeminist movement: they are frequently victims of sexual exploitation(Crawford and Ostrove 2003), encounter many obstacles to leavingdissatisfying relationships because of physical, psychological andfinancial dependency (Olkin 2003), and have median incomes below thepoverty line and substantially lower than those of their malecounterparts (Crawford and Ostrove 2003; Olkin 1999).

In addition to these potential risks associated with emphasizingidentity politics for persons with disabilities and other stigmatizedminorities, there have been several major challenges in mobilizingpeople with disabilities around an affirmative group or culturalidentity. The first, addressed by the disability rights movement, wasgetting people with disabilities to recognize that they have somethingin common with others who are differently impaired but also sufferstigma and exclusion because of their impairment. This has beendifficult because people who are born with disabilities or acquirethem in childhood come from widely dispersed socioeconomic, geographicand racial groups (Scotch 1988) and so are less likely to grow up witha sense of group identity. Another obstacle has been theoverwhelmingly negative connotation of the label“disabled”. Indeed, the challenge for people with visual,motor, and psychiatric impairments has been to recognize that theyshare a “disabled” identity while denying that this makesthem dependent, child-like, or powerless (Asch 1985; Scotch 1988);such a self-identity would quite literallydisableone’s capacity for social participation and politicalaction.

It is instructive to compare how the medical and social models wouldaddress these challenges. The medical model suggests a disabilityidentity that is both fragmented and negative. Because the medicalmodel defines disability in terms of particular physical or mentalimpairments, the primary commonalities it recognizes among disabledpeople are strictly functional; it views the blind person and the deafperson as having very different problems. Although it could recognizethe fact that such biomedically distinct conditions had similar socialconsequences—stigmatization and exclusion—it would treatthose similar consequences merely as secondary effects of the twoconditions. Even within a single impairment, a medical modelencourages distinctions based on etiology. For example, it woulddistinguish blindness due to Leber’s congenital amaurosis fromblindness due to retinaopathy of prematurity, focusing on genetictesting for the former and treatment for the latter, and placing lessemphasis on the shared challenges of living with blindness. Althoughthis narrow focus may be appropriate for the purposes of clinicalintervention, it obscures the recognition of disability as a socialand political problem, except insofar as it raises perennial questionsabout how to distribute scarce health-care resources (Barnartt et al.2001).

In contrast, the various social models were explicitly formulated tosupport a disability identity that could serve as the basis for claimsof respect and recognition. The inclusion of people with a vast arrayof different impairments in United States and other national civilrights laws, and the creation of the United Nations convention on therights of persons with disabilities, have helped to forge a shareddisability identity. The emergence of disability studies as arecognized field of academic inquiry has also contributed. Theminority group model promotes a trans-impairment identity by treatingpeople with disabilities as a “discrete and insularminority” making claims on a generally stigmatizing able-bodiedmajority. Though the minority group model has proven extremely usefulin passing anti-discrimination laws, it may do so at the expense ofemphasizing thedifferences between people with disabilitiesand people without them, rather than highlighting the many ways inwhich identity need not be tied to the presence or absence of animpairment. The human variation model tempers this emphasis, andresists essentialism about disability identity, by treating the groupitself as socially constructed. It sees the category of “thedisabled” as resting on an artificial dichotomy imposed on acontinuum of variation. The conceptualization of disability as justone source of difference, and as a difference in kind more thandegree, can undercut a sense of disability as the basis for a uniqueand exclusive identity.

The more the redesign of the physical and social environment is guidedby a thoroughgoing human-variation model, the less dominant disabilityidentity and identity politics may become for people withdisabilities. A society in which disabilities lack the social andpractical significance they currently have may be one in which theequality of people with disabilities can be fully recognized withouthaving to treat disability as a salient feature of theiridentities.

It may be, though, that the physical, sensory, or psychic experienceof a particular impairment turns out to be central and salient to howthose with the impairment live—even in a society deeplycommitted to inclusion, participation, and non-discrimination. Perhapscommunicating primarily gesturally and not vocally, or moving throughthe world with wheels and not on legs, or focusing on detail rather than context, makes the lives of people who are deaf, orparalyzed, or autistic sufficiently distinctive that they feel astrong affinity and connection with others who have the sameimpairment (see SEP entry ondisability: definitions, models, experience for a discussion of this claim.) Disability theorists who adoptdifferent social model approaches might profitably consider howdifferent views about group and individual identity apply to peoplewith disabilities.

The connection between different models of disability and differentways of understanding disability identity points us in the directionof an important category of injustice, in addition to the distributiveand relational conceptions already discussed. This isepistemicinjustice (Fricker 2007; Barnes, 2016). Epistemic injusticeconsists in a person’s being wronged in her capacity as anepistemic subject.Testimonial injustice consists insomeone’s being wronged in her capacity as a subject ofknowledge, whilehermeneutical injustice consists insomeone’s being wronged in her capacity as a subject ofunderstanding. More specifically, testimonial injustice consists insomeone’s testimony being given less credence than the evidencewarrants due to prejudice on the part of the hearer, whilehermeneutical injustice consists in someone’s experiences beingobscured from individual and collective understanding due to wrongfulexclusion from the practices by which those understandings aregenerated. Both have clear implications for disability, justice, andidentity.

For example, consider the use of quality-adjusted life years (QALYs)to assess the prospective benefits of health care interventions. Thestandard method of “quality adjustment” involves (i)assigning a value of 1 to each life-year one can reasonably expect tosave through a given intervention, and (ii) discounting each life-yearthat would be lived by a person with a disability by some coefficient(between 0 and 1) which is thought to reflect the badness of livingwith the disability in question. These coefficients are typicallyarrived at by asking people how many years of lifewith thedisability people would be willing to exchange for each year of lifewithout the disability. For example, suppose survey dataindicate that people would trade 8 years of life with blindness for 4years of life with sight. The method of quality-adjustment wouldassign a QALY of 0.5 to each year of life lived with blindness. Theupshot is that saving nondisabled life-years provides more “bangfor your buck” in the QALY model, and as such is to be preferredto saving disabled life-years.

This implication has led some to criticize the method ofquality-adjustment on the grounds that it produces a kind of“double jeopardy:” people with disabilities aredisadvantaged twice-over, first by having the disability itself,second by having their health care needs discounted for that veryreason (e.g., Singer et al. 1995; Bognar 2011; John et al. 2017). Butthere is another way of thinking about QALYs which takes issue withboth quality-adjustment and an assumption behind the double-jeopardycriticism. When the “exchange rate” between disabled andnon-disabled life-years is calculated, it is primarily or exclusivelybased the judgments ofable-bodied people. This feature iscriticizable on two distinct grounds. One is that it disrespects thefirst-person authority of people with disabilities, who knowfirst-hand what it’s like to have the disability in question(and, if disabled as adults, know also what it’s likenot to have the disability). This disrespect for first-personauthority is plausibly an example of testimonial injustice, at leastinsofar as it reflects prejudicial or otherwise biased attitudes onthe part of the able-bodied. A second, related criticism is that thisapproach exaggerates the difference in quality between able-bodied anddisabled lives, relative to an approach that appropriatelyincorporated and weighed the perspectives of people with disabilities.Able-bodied people often overestimate how bad it would be to have agiven disability, given popular stereotypes which depict life withdisability as tragic, occlusive of life’s major goods, and soon. This is plausibly an example of hermeneutical injustice, insofaras the poor understanding of disabled people’s experiences andidentities results from their exclusion from the public sphere. Thisis only one example; much work remains to be done exploring theimplications of epistemic injustice for people with disabilities.

6. Conclusion

This entry began by pointing out a feature of disability thatdistinguishes it from other characteristics which have often been seenas grounding legitimate claims of justice, such as race, sex, sexualand gender identity, and religion. Simply put, achieving fullinclusion for people with disabilities isexpensive to adegree that achieving full inclusion for other minorities is not. Anyplausible theory of inclusion implies the necessity of considerableaccommodation and environmental reconstruction. And even if the costsof such measures have often been exaggerated, it is difficult to seehow the appropriate degree of accommodation and reconstruction wouldnot require diverting significant amounts of resources from otherworthy goals, including some goals which are supported bycountervailing considerations of justice. One implication of thisfeature of disability is that disability requires us to directlycompare, and perhaps trade off, values of relational justice, whichground the demand for full inclusion as part of a society of equals,and values of distributive justice, which ground the demand for a fairdistribution of scarce resources.

Having made this general point, the entry proceeded to discussdifferent models of disability, which differ principally in theirunderstanding of the relationship between impairment and limitation.Whereas the medical model of disability tends to attribute most of thelimitations associated with disability to functional aspects of therelevant impairments, the social model of disability emphasizes themediating role of the social environment—broadly understood toinclude the configuration of physical space, the availability ofvarious forms of accommodation, social practices and norms,etc.—in generating disability-related disadvantage. Among otherthings, the social model highlights the relational aspects ofdisability-related disadvantage, such as stigma, invisibility, andexclusion, whereas the medical model lends itself to a narrowdistributive interpretation of the claims of justice generated bydisability.

In subsequent sections, the entry focused on the role of disability incontractualist and other distributive theories of justice. Disabilityhas often been regarded as a “limit case” forcontractualist theories of justice, and more specifically for theidealizing assumptions these theories make about the capacities ofthose who choose and those who are governed by contractualistprinciples of justice. We also saw that disability has played acentral role in discussions of outcome-oriented, distributive theoriesof justice, in particular luck egalitarianism. Internally, disabilityhas played a central role in discussions about the“currency” of justice, since it has often been seen as aparadigm example of unchosen disadvantage. Externally, disability hasplayed a central role in relational criticisms of luck egalitariantheories of justice. At best, these theories have been seen as failingto attribute normative significance to morally relevant differencesbetween identical patterns of distribution which differ in the causalcontribution of the social environment. At worst, these theories havebeen criticized for expressing disrespect towards people withdisabilities in virtue of characterizing them as “mere”unfortunates or objects of pity. Although some of these criticisms maybe overstated, they have been taken to heart by many theorists ofdistributive justice, especially proponents of the capabilitiesapproach. Finally, the entry concluded by pointing to a topic whichhas received far less attention in discussions of disability andjustice: namely, the normative significance of disability as a form ofsocial identity, and the connections between disability and epistemicinjustice.

This entry raises a number of questions which would benefit fromfurther exploration. Clearly, one general question is how exactly tounderstand the distinction between distributive and relational valuesof justice. Another, related question is how to assess the comparativeweight or importance of these values. And if, as many find plausible,some form of pluralism about justice is the correct answer, then wewill need to work out how the relevant trade-offs, weights, and so onapply to the special case of disability, which simultaneously raisesboth distributive and relational concerns. A third question whichcalls for further research is the link between disability andepistemic injustice. We briefly discussed two examples of testimonialand hermeneutical injustice concerning people with disabilities, butthere are—needless to say—many more. Indeed, disabilitymay be an especially powerful example of epistemic injustice preciselybecause the phenomenological experiences of people with disabilities,especially those with sensory impairments, differ considerablyfrom the experiences of the able-bodied majority, raising the hardquestion of how well we must understand others in order to treat themas justice requires.

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Acknowledgments

We want to thank the participants in the Workshop on Disability:Bioethics, Philosophy, and Public Policy (January 18–19, 2007)for enormous help in framing the issues discussed in this Entry. Inaddition, we have received invaluable editorial assistance from DoritBarlevy, Ari Schick and William Chin.