## 1. Disability, Recognition, and Redistribution



It is clear that people with disabilities have long been treated as
moral and social inferiors, at the same time that they have suffered
distributive injustices of various kinds (see generally, Barclay
2018). Routinely, people with disabilities have been denied jobs for
which they are highly qualified because they have been considered
incompetent, or because employers have not been comfortable with their
presence in the workplace. Often, people with certain disabilities
have been consigned to segregated institutions and facilities because
they have been regarded as incapable of making decisions or caring for
themselves, or because others in the community did not want to
interact with them.



These forms of relational injustice are associated with very concrete
material inequalities. In 2009, almost 20 years after the passage of
the Americans with Disabilities Act, the employment-population ratio
of people with disabilities in the United States was 19.2%, compared
to 64.5% for persons without a disability (Bureau of Labor Statistics
2010). Based on data from 1996-1999, researchers estimate that
47.4% of working-age adults who experienced poverty for a year or more
had at least one disability (Fremstad 2009).



Facts such as these have led some to conclude that 



> 
> 
> in particular, internally diverse ways, people with disabilities have
> been on the end of a kind of pincer movement between Fraser's
> two impediments to parity: "misrecognition" and
> "maldistribution" (Calder 2010: 62).
> 
> 
> 



In these respects, people with disabilities are in a comparable
position to members of other "discrete and insular
minorities" with a history of being subject to both distributive
and relational injustice. But there is a significant difference.
Simply put, there is no reason to think that it need be particularly
*expensive* to eliminate disrespect and misrecognition towards
racial, ethnic, and sexual minorities. But insofar as accommodation
and reconstruction of the built environment are necessary to eliminate
disrespect and misrecognition towards people with disabilities,
relational justice for people with disabilities may require diverting
significant resources from other causes. In that sense, achieving
justice for people with disabilities requires us to directly address
the relationship between relational justice and distributive justice
to a degree that achieving justice for members of other groups
generally does not. 



To be sure, the costs associated with accommodation and reconstruction
of the built environment need not be understood as
*compensation* for the alleged deficits of people with
disabilities. Indeed, they would have to be acknowledged even if
disabilities were seen as intrinsically neutral physical or mental
characteristics that merely differ from those of a majority of the
population. In any society whose physical structures and social
practices are designed for average or typical members, people with
disabilities will be disadvantaged just because of their minority
status. A similar point has been made by feminist scholars, who have
pointed out the structural discrimination of workplaces and public
settings designed exclusively for men. The expenses of additional
restrooms, stalls, or pumping stations do not compensate women for
their deficiencies. They simply accommodate differences ignored in a
society that saw a woman's place as in the home (Wendell 1996;
Wasserman 1998: 178-179).



Still, the rectification of such structural discrimination may raise
more difficult issues for people with disabilities than for women,
because there is greater uncertainty and potential for disagreement
about the extent of the changes that are required to treat people with
disabilities as social and political equals. Indeed, the range and
variety of physical and mental differences within a society raise
issues of distributive justice that have no obvious analogue for other
stigmatized groups. A "gender-neutral" environment can be
readily conceived, and achieved at modest cost. In contrast,
disability scholars and activists have not specified what it would
mean to achieve an "ability-neutral" environment--one
that was no more advantageous to people with some physical and mental
characteristics than others. And some argued that the ideas of an
"ability-neutral" environment is either conceptually
incoherent or prohibitively expensive (Barclay 2011, 2018). Moreover,
it seems likely that questions about the extent to which justice
requires reconstructing or modifying the built environment would arise
with respect to people with disabilities even in a society with no
history of invidious attitudes or practices toward such persons. By
contrast, it seems less likely that such questions would arise in a
society with no history of sexism, for example.



Justice for people with disabilities, then, appears to raise questions
about the relationship between distributive justice and relational
justice that justice for other stigmatized groups does not. Yet the
need for redistribution hardly reduces the importance of recognition
in achieving justice. Indeed, the complex, disputed relationship
between the two makes disability a significant challenge for theories
of justice.


## 2. Models of Disability and Their Implications for Justice



"Disability" is typically defined in terms of two
elements: (i) a physical or mental characteristic labeled or perceived
as an impairment or dysfunction, and (ii) a significant personal or
social limitation associated with that characteristic. The
relationship between these two elements--and the role of the
environment in mediating them--is a core issue in the
conceptualization of, and social response to, disability. The
*medical model* treats disability as an individual physical or
mental characteristic with significant personal and social
consequences. In particular, it sees the limitations faced by people
with disabilities as resulting primarily or solely from their
impairments. By contrast, the various *social models* see
disability as a relationship between individuals and their social
environments: physical and mental characteristics are limiting only or
primarily in virtue of social practices that lead to the exclusion of
people with those characteristics. This exclusion is manifested not
only in deliberate segregation, but in built environments and social
practices that restrict the participation of people regarded as having
disabilities (see SEP entry on
 disability: 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 and
limitation. Almost all writers on disability acknowledge some role for
both the impairment and the environment in causing limitations; the
disagreement largely concerns the assessment of their comparative
contribution, and their interaction. Most scholars who embrace some
version of the social model acknowledge that
impairments--generally but not universally understood as
deviations from species-relative statistical norms--can be
sources of discomfort and limitation even in the absence of
disadvantaging social practices (e.g., Shakespeare 2006, Thomas 2004).
These scholars would argue, however, that such adverse effects are far
less damaging than social exclusion, are greatly magnified by hostile
environments, and could be significantly reduced by more inclusive
environments. The medical model is less often explicitly defended than
unreflectively adopted--by health care professionals,
bioethicists, and philosophers who ignore or underestimate the
contribution of social and other environmental factors to the
limitations faced by people with disabilities. Even among these
groups, however, there is a growing awareness of the environmental
contribution 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 medical
model of disability would not deny that disability raises issues of
justice. Indeed, that model might give support to the view that the
disadvantages perceived as inherent to disability raise some of the
most urgent claims of justice (Barclay 2011, 2018). But such a model
does not recognize any *principled* rationale for preferring
reconstruction of the social and built environment over compensation
or correction as a means for correcting disability-related
disadvantage, a point made by Wolff (2009a, 2009b), among others. In
contrast, the social model strongly supports such a rationale, since
it construes many aspects of disability-related disadvantage as
*essentially* connected to various forms of literal and
figurative exclusion. Relatedly, the social model construes
reconstruction as a public good: more accessible structures and more
inclusive practices can be enjoyed by a wide variety of people with
and without disabilities (Scotch and Schriner 1997). But such
reconstruction also helps to achieve a fairer distribution of tangible
and intangible goods, particularly social and economic
opportunities.



Some critics accuse social model theorists of assuming that any
disadvantage caused by the social environment is *ipso facto*
unjust (Samaha 2007). This assumption would reflect an oversimplified
view of the relationship between causing disadvantage and creating
injustice. The fact that social structures or practices cause
disadvantage does not imply that there is a duty of justice to correct
or compensate for the disadvantage. That will depend on the costs of
alleviating it, and--under any plausible theory of
justice--some comparison with the advantages and disadvantages
that would result from alternative social arrangements. Thus, for
example, choosing to spend the bulk of a municipal arts budget on a
concert hall rather than an art museum may disadvantage those who
cannot hear. But that disadvantage, although caused by a social
decision, is not necessarily unjust. That will depend, *inter
alia*, on the availability of non-auditory forms of aesthetic
experience and the comparative costs of building the museum instead.
To take another example, placing ramps and elevators in new high-rise
buildings is relatively inexpensive and beneficial to most users,
whereas placing them in nineteenth century walk-ups is difficult and
expensive; holding public meetings or events in buildings with ramps
and elevators has negligible costs, whereas moving an existing
business from a building that lacks them to one that has them may be
very expensive (Samaha 2007; Wasserman 2001).



The difficulty of inferring injustice from socially caused
disadvantage is clear in contexts where greater social provision
secures incremental advantage. In such contexts, the question of how
much is just will not always have an obvious answer. For example, it
would at least marginally benefit wheelchair-users to have additional
restricted parking spaces, but we could hardly infer an injustice from
the fact that an institution provided *N* rather than *N* +
1 such spaces. Intuitively, the allotment should be proportionate to
the number of wheelchair users in the community or at the facility,
but that number may be uncertain, and a range of spaces would likely
satisfy any proportionality
 requirement.[1]
 In deciding how many spaces are enough, we would receive no guidance
from the indisputable fact that any disadvantage or advantage in this
context would have social causes.



Conversely, the fact that social arrangements do not cause or
contribute to a disadvantage does not insulate it from claims of
justice; the failure to alleviate that disadvantage may be unjust on
plausible accounts of justice. Thus, although many
"natural" disasters like Hurricanes Katrina owe much
of their destructive impact to social arrangements, it is plausible
that the state's duty to support the victims of hurricanes and
tsunamis is not contingent on its responsibility for causing or
exacerbating them (Wasserman
 2001).[2]
 Indeed, as we discuss below, various forms of luck egalitarianism do
not distinguish between disadvantages caused versus merely not
corrected by society's institutions, provided that the relevant
disadvantages are equally severe and equally unchosen by those
disadvantaged.



Nevertheless, the causal claims made by social-model theorists are
relevant to justice in several ways. First, as suggested above, for
most theories of justice, the mere fact that the social environment
can be modified in ways that alleviate the disadvantages associated
with impairment places demands for their alleviation within the scope
of justice--as claims that a theory of justice must consider and
weigh. Second, the fact that those disadvantages are caused by social
arrangements is relevant for those theories that regard society as
having a stronger duty not to create or aggravate disadvantages than
it has to prevent or correct them (Wasserman 2001, Schemmel 2012).
Finally, alleviating the disadvantages attributable to prejudice or
stigma will enjoy priority on any theory of justice that treats
disadvantage resulting from prejudice or stigma as a greater injustice
than innocently-created
 disadvantage.[3]




Beyond a shared concern with the social causation of disability,
different versions of the social model emphasize different features of
the exclusionary structures and practices (see SEP entry on
 disability: definitions, models, experience).
 The *minority group model* regards people with impairments as
a stigmatized minority group. It holds that the main reason people
with disabilities encounter special hardships is that they face
discrimination akin to that faced by racial or ethnic minorities (Hahn
1987, Oliver 1990). The *human variation model* holds that many
of the challenges faced by disabled people do not result from
deliberate exclusion, but from a mismatch between their
characteristics and the physical and social environment (Scotch and
Schriner 1997). These two versions of the social model differ mainly
in emphasis. The discrimination stressed by the minority group model
generally leads to, and is expressed in, the societal failure to
accommodate people with stigmatized differences. Yet the failure to
fully accommodate people with various differences, from extreme height
to intellectual impairment, does not necessarily arise from stigma.
But often, disparities in access that were initially caused by
resource or technological limits are maintained by stigma. For
example, an employer's initial purchase of communications
technology inaccessible to blind or deaf employees may be explained by
the fact that accessible technology had not been developed at the time
of purchase. But those historic facts would not justify the
employer's refusal to include modestly priced accessibility
features when purchasing upgrades a decade later, for example.



Both versions of the social model require the removal of barriers and
practices serving to exclude people with disabilities, and the
reconstruction of the environment to more fully include them. Under a
minority-group model, these measures are dictated primarily by a
demand for recognition and respect, and for the correction of past
expressions of disrespect found in the knowing exclusion of people
with disabilities from many aspects of social, political, and economic
life. The human variation model puts less weight on the expressive or
symbolic significance of past exclusion. Rather than construing people
with disabilities as a "discrete and insular minority"
created by practices of more or less deliberate exclusion, the human
variation model construes people with disabilities as simply people
who differ in degree from the majority of statistically normal
population with respect to one or more physical or mental
characteristics. The purpose of reconstruction is not so much to end
specific exclusionary practices as to create a more inclusive physical
and social environment. Given this difference in emphasis, it is
natural to understand the human variation model as appealing
principally to norms of distributive fairness, ensuring equal or
adequate access to the physical and social environment, in contrast to
the minority group model, which appeals more explicitly to norms of
respect and recognition. 



The demand for greater inclusiveness is less categorical than the
demand to eliminate discrimination. Although any environment can be
made more inclusive, none can be fully inclusive for everyone (Barclay
2010, 2018). This is not necessarily because, as Barclay, following
Shakespeare (2006), claims, the inclusionary features required for one
impairment often conflict with those required by another. Such
conflicts may be minor, temporary, and remediable. The problem is more
general: 1) for many characteristics, from height to mathematical
aptitude, one "size" does not fit all; 2) providing
different sizes increases fit for a wider range of variation, but at
increasing cost (albeit less than often assumed); and 3) it is
frequently impractical, and may arguably be unjust, to ensure that
everyone is equally well-or ill-fitted; it may, for example, be too
expensive to ensure that left-handed or extremely tall individuals
suffer *no* inconvenience in being statistical minorities. Full
inclusion, like universal design, is an ideal--one that cannot be
fully achieved, and that must be compromised in the partial
satisfaction of other legitimate claims.



Even if it would be impossible or unreasonable to achieve full
inclusion through wholesale changes in the physical or social
environment, modest changes could significantly increase inclusion at
little cost. Some examples come from a study of environment
modification for autistic individuals (Owren 2013). Some people with
autism face significant barriers to taking part in routine social
activities: they find such familiar stimuli as applause, light
touching, and deodorant as highly aversive; they must be explicitly
instructed about social expectations because they cannot
"read" most facial expressions or social clues. The
study's author recognizes that the "neurotypical
majority" cannot be expected to give up applause, light
touching, or even deodorant, let alone nuance in communication:



> 
> 
> What would be lost? Large parts of what may be some of the most
> treasured areas of communication: the art of innuendo, the double
> meaning at the heart of much comedy, irony, the implied meaning at the
> heart of so much poetry,... flirtation and "feeling each
> other out" before committing to something that cannot be
> retracted. (2013: 23-24)
> 
> 
> 



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



> 
> 
> Many neurotypicals might profit from being more explicit and from
> others being more explicit, as can be illustrated by the extensive
> focus in couples therapy on getting partners to state their needs and
> expectations more explicitly, not relying on other to pick up on
> "vaguely described, implied, or unspoken behavioral
> expectations". (2013: 92) 
> 
> 
> 



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



> 
> 
> One strategy might be to incorporate into Universal design the
> practice of providing access to low stimulation areas in mainstream
> settings. Another might be to create more public acceptance of
> autistic behaviors like
>  stimming,[4]
>  which seem to help many autistic people reduce the impact of aversive
> sensory stimuli.... (2013: 111)
> 
> 
> 



Such strategies clearly involve tradeoffs, but those tradeoffs would
involve small economic and social costs for a majority to achieve
large gains in inclusion for a minority. The claim that it is
impossible to achieve, or even understand, full inclusion for people
with autism does not deny that there is significant injustice in their
current state of social isolation.



The challenges for social models of disability for justice may seem
greatest for intellectual and psychiatric impairments, as well as for
complex physical impairments such as fibromyalgia, multiple chemical
sensitivity, and other conditions that radically and unpredictably
affect energy, stamina, and functioning (Wendell 1989, 1996; Davis
2005). First, these conditions strikingly display both aspects of
impairment, as markers for stigma and as sources of functional
limitation (see SEP entry,
 disability: definitions, models, experience).
 Cognitive and psychiatric impairments evoke some of the strongest
prejudice and all present some of the most difficult functional
limitations, e.g., on the capacities to engage in practical reasoning,
to recognize the intentions and attitudes of other people, or to
participate in shared activities.Second, some theorists contend that
these conditions pose more of a practical challenge for the social
model than even the most severe physical disabilities, in part because
the measures required for greater inclusion are not as concrete or
tangible, and may demand greater imagination to envision and
 implement.[5]




Although significant practical work has been done in educational and
workplace inclusion, philosophers have been daunted by the challenge
of social reconstruction for cognitive disabilities. Thus Jonathan
Wolff, who generally favors such reconstruction--which he calls
"status enhancement"--as the most respectful
intervention, asks 



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



Many rights and privileges are thought to require a certain level of
cognitive 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 general
sociability.



How much should a society modify these requirements or restructure
these activities to include people with various intellectual,
psychiatric, and complex physical disabilities? A total relaxation of
such requirements would impose large, even "unduly
burdensome" costs. However, many modifications to promote the
inclusion of people with significant cognitive impairments would also
benefit people with typical cognitive function: simplified task
explanations, warning labels, news copy, and jury instructions. Many
accommodations employers are already making to increase flexibility
and reduce stress, from individually-tailored schedules to
telecommuting, would ease the entry of people with these disabilities
into the workplace. There is a growing body of practical and policy
work that applies social models of disability to people with
intellectual, 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 about
whether individuals with the most severe intellectual impairments
qualify as subjects of justice. But even if individuals with the most
substantial intellectual impairments are regarded as subjects of
justice, what justice demands for them, and of them, may be uncertain
or disputed. Nussbaum (2009) contends that the equal citizenship of
those individuals requires that they be enabled to exercise such
political rights as voting and jury service through appropriate
surrogates. Wasserman and McMahan (2012) question whether those rights
could be meaningfully exercised by surrogates for individuals with the
most severe intellectual disabilities.



Some philosophical intimation of a social model approach to cognitive
disability can be found in Dan Wikler's 1979 essay,
"Paternalism and the Mildly Retarded". Wikler held that
the category of cognitive disability was socially constructed by the
competence thresholds set for important social activities, such as
signing a contract or voting in an election. But although society
chooses, in this sense, who will be cognitively impaired, it does not
have unlimited flexibility, since there can be significant social
costs in altering those thresholds. The issue, Wikler concluded, was
ultimately one of justice; of fairly distributing the burdens of
setting thresholds that will be too high for some or too low for
others. Yet Wikler questioned whether justice would require, or even
permit, the kind of modifications necessary for significantly greater
participation. Writing two decades later, Wolff cited Wikler in
stating, 



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



This pessimism has prevailed in the years since Wikler wrote, and
there has been little philosophical attention to practical
possibilities for the inclusion of people with cognitive impairments.
Although there have been interesting discussions of this issue in the
context 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; Silvers
and Francis 2009; Wong 2007, 2009.) Thus, for cognitive disabilities,
Wolff emphasizes "targeted resource enhancement" rather
than status enhancement, arguing for an entitlement scheme that gives
people with cognitive disabilities maximum possible control over an
individual budget for personal assistance and social support (2009a:
407-413). He does regard some forms of status enhancement,
notably antidiscrimination measures, "as essential", but
he accepts Wikler's conclusion that broader changes in social
practice carry "intolerable costs" (2009a: 413).



In their influential book *From Chance to Choice*, Buchanan et
al. (2000) repeat the assertion that there would be excessive social
costs in reconstructing society to permit the full participation of
people with significant cognitive impairments. They compare the
reconstruction of society for greater inclusion with a family decision
to play only the card games that a young child can understand. They
contend that just as adults will tire of a constant game of Go Fish,
the society will be "dumbed down" if it refashions itself
to fully include people with cognitive impairments.



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



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



It is not clear that such refashioning would impose the
"intolerable costs" feared by Wolff. Social inclusion does
not require, for example, that individuals with significant cognitive
impairments be able to make binding contracts in every domain of law
and business; it requires that competence standards be graduated to
reflect the complexity of specific tasks so that those individuals are
not categorically excluded -a suggestion made more than two
decades ago by the authors of the card-game metaphor (Buchanan and
Brock 1990). Social model theorists know full well that
impairments--physical as well as cognitive--differ from skin
color in that they are sometimes relevant to what people can do, as
are such other attributes as education and income. But that feature of
impairment hardly precludes social reconstruction. Indeed, the most
effective rebuttal to the card-game metaphor may be found in the
practical work that already has been done in educational and workplace
inclusion (e.g., Biklen 1992; Block 2006; Hehir 2002; McGuire et al.
2006). At the same time, it bears emphasis that the social model of
disability was originally conceptualized in terms of physical
disabilities. And there may be significant limitations on the extent
to which it applies to cognitive disabilities. More generally,
although it may be useful to speak of "the" social model
of "disability", the diversity of impairments that fall
under the extension of "disability" suggests that the
aptness of the social model in any given context will vary depending
on the nature of the impairments at issue.


## 3. Justice, Reconstruction, and Reasonable Accommodation



As suggested in
 SS1,
 the disabling impact of social arrangements may be relevant to the
type and scope of interventions that justice requires. In stressing
the impact and the malleability of the environment, social-model
theorists have shifted the focus from claims for correction and
compensation 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 nor
functionally limiting, that society would, on any plausible theory of
justice, be obliged to construct its public spaces, buildings, and
vehicles to accommodate them. They would be treated unjustly if the
construction of the physical environment took no account of them,
especially if the failure to do so caused them significant
disadvantage. Of course, the extent to which their height differences
needed to be taken into account would depend on the distribution of
height in the society, as well as on its level of resources and
competing needs. No plausible theory of justice would require that the
built environment be equally accommodating to all heights, if such a
thing were possible, but all would condemn some environments as
unjustly restrictive. What even this simple case suggests is that the
demand for a more inclusive environment need not be seen in terms of
compensating individuals, tall or impaired, for their internal
deficits, but of accommodating as wide as possible a range of human
variation.



Even if environmental reconstruction should not be seen as
compensating for deficits, a question remains about the extent to
which it should be seen as a matter of redistribution or recognition.
This question is raised by the legal requirement of "reasonable
accommodation". Under the ADA and ADAAA,
"accommodations" include ramps, elevators, texts in
multiple formats, sign-language interpreters, flexible work schedules,
and job coaches or assistance. The failure to make reasonable
accommodation for disabled employees or users of public facilities
constitutes, with some notable exceptions, discrimination (ADA 1990).
There is no reference to that concept in the laws banning
discrimination on the basis of race, sex, or age; the term was
introduced in cases addressing claims of religious discrimination
(see, e.g., Karlan and Rutherglen 1996). Like practitioners of
minority religions, but unlike women, people of color, or older
people, people with disabilities must be "reasonably
accommodated".



For the human variation model, reasonable accommodation requires
changes in the physical and social environment, from installing ramps
to modifying work schedules and altering the location of meetings and
classes. Often, such changes require little more than flexibility and
imagination. But some of these changes can be expensive; at some
point, the cost may make further change unreasonable. On this
approach, the legislative understanding of such accommodation as a
matter of distributive justice is reflected in the qualifying use of
"reasonable" and the exemption of accommodations that
would impose an "undue" burden or hardship on the entity
required to make accommodations (Wasserman 1998).


 But it is also possible to see reasonable accommodation as a
requirement of equality for people with disabilities without recourse
to a theory of distributive justice (e.g., Crossley 2004; Karlan and
Rutherglen 1996). Accommodating religious practices may be expensive
in various ways, but no one regards doing so either as compensating
religions for their deficits. Indeed, such a rationale would appear to
violate the state's constitutionally-mandated neutrality among
religions. Rather, because the state is required to treat religions
and their adherents with equal respect and concern (Dworkin 2003), it
disfavors rules and practices that interfere with religious
observance. Somewhat similarly, a state that regards people with
disabilities with equal respect and concern will disfavor arrangements
that interfere with their participation. With respect to both groups,
substantive equality may require unequal provisions. In the case of
disability as well as religion, how much additional provision is
required is indeterminate, not for lack of a complete theory of
justice to specify the amount or proportion, but because the demands
of equal respect are indeterminate.



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



The debate over the accommodations available for a minority group may
often reflect a complex mix of claims concerning redistribution and
recognition. For example, people in wheelchairs are sometimes provided
restaurant access only through the service entrance. The restaurant
owners often claim that such access is quite reasonable, since the
service entrances already have ramps--a distributive
consideration. Disability advocates claim that however convenient it
may be for the owners, such access treats wheelchair users as
second-class customers--a claim of misrecognition. In this case,
it may seem that the recognition claims clearly trump the conflicting
distributional claims. But this will not always be the case.



Again, resolving such conflicts may involve the same kind of judgment
employed in debates over accommodating minority religious practices.
It may be that some jobs cannot be made available to people whose
Sabbath falls on Friday or Saturday, because (in light of demographic
considerations) the essential functions of those jobs require working
on those days. But although the "essential function"
standard appears objective and determinate, it is often subject to
distributive considerations, e.g., about staffing requirements and
business volume. A refusal to sustain the slightest loss of revenue to
accommodate any minority religion might be a distributive injustice; a
willingness to sustain greater losses to accommodate Jewish and
Adventist employees than Muslim ones might involve misrecognition as
well--the failure to treat Islamic practice as having the same
value as other religious practices. Similarly, the violation of the
ADA involved in refusing to display the same flexibility for disabled
as for pregnant employees arguably constitutes both distributive
injustice and misrecognition.



The uncertainty about the distributive character of reasonable
accommodation suggests that in the case of disability, it may often be
difficult to sharply distinguish claims for redistribution and
 recognition.[6]
 Recognition may require redistribution, and redistribution should aim
at securing recognition. Asch (1989) has gone even further, arguing
that recognition must precede redistribution; that if people with
disabilities were recognized as equals, capable of significant
contributions to others, society would be more willing to adopt
appropriate measures for redistribution and reconstruction.


## 4. Disability in Contemporary Theories of Justice



The resurgence of philosophical interest in justice is often dated to
the publication of John Rawls' *A Theory of Justice* in
1971. Although that was only two years before the passage of the
Rehabilitation 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 as
a social phenomenon. For the 25 years after *A Theory of
Justice*, many justice theorists tacitly accepted the medical
model (e.g., Dworkin 1981a,b; Daniels 1985). They treated disability
as a physical or mental limitation of the individual, the principal
cause of disability-related disadvantage. Disability thus posed a
problem for justice theories based on mutual advantage, hypothetical
agreement, or material or social equality. People with disabilities
did not appear to offer reciprocal advantages; they complicated the
task of reaching a hypothetical agreement on the basic structure of
society; and they made the goal of equality seem impossibly
demanding.



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



Before describing these developments, it is useful to distinguish two
types of distributive theories. Modern social contract theories,
notably Rawls' (1971), seek to determine the fair terms of
social cooperation to which individuals (generally with limited
knowledge of their own situations) would agree; they argue that
certain distributive principles would be among those terms
(Rawls' "difference principle" may be the most
familiar). Rawlsian theories are procedural in one sense: they regard
any distribution as just if and only if it is consistent with the
distributive principles that would be chosen by those individuals.
Disability-oriented criticism of these theories has focused on their
assumptions about the individuals who are eligible to make a
hypothetical contract or participate in the cooperative scheme it
establishes. Critics have argued for the eligibility of people with
disabilities or their representatives to participate in the
contract-making processes and resulting cooperative scheme more than
about the validity of the principles or rules yielded by that process
(Richardson 2006; Silvers and Francis 2005; Stark 2007). The second
type of theory is primarily interested in outcomes; in the kind of end
state a just society should strive for: either equality on some
outcome metric or the reduction of certain kinds of inequality. Here,
disability-informed criticism has favored outcome metrics that take
account of the social contribution to disability-related disadvantage,
and standards for just distributions that are oriented toward
disrespectful inequalities (Anderson 1999; Nussbaum 2006a; Wolff
2009b).


### 4.1 Disability and Contemporary Social Contract Theories



Within social contract theories, a distinction is often drawn between
contractarian/Hobbesian and contractualist/Lockean accounts (see SEP
entry on
 contractarianism).
 One way to characterize this distinction is in terms of the
parties' motivation and interaction. In the former, they are
narrowly self-interested and hard-bargaining; in the latter, their
self-interest is tempered or balanced by their commitment to
justifying themselves to others, and they proceed by deliberating
rather than by bargaining. This distinction is often formulated in
terms of a distinction between (merely) rational agents, and
"reasonable" agents.



A Rawlsian approach might seem more congenial than a Hobbesian
approach to people with disabilities. It derives the basic structure
of society from a hypothetical choice situation, the Original
Position, in which a veil of ignorance precludes reliance on the
contractors' actual limitations--limitations that a
Hobbesian contractor might ruthlessly (albeit rationally, if not
reasonably) exploit (cf.
 note 10).
 Although the parties themselves are motivated exclusively by
considerations of self-interest, which Rawls understands in terms of
the fulfillment of two higher-order interests (see SEP Entry on
 the original position),
 the informational constraints of the Original Position compel the
parties to motivate *as if* they are reasonable, at least in
the sense that it compels them to be impartial between the claims of
all who will be subject to the principles they choose.



But even if Rawlsian contractors do not know their specific
limitations, they do know that they, or the individuals they
represent, are not permanently disabled. Rawls stipulated that the
idealized society whose "basic structure" was the subject
of 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 severe
and permanent physical and mental disabilities (Rawls 1993:
18-20). He did not defend that assumption, nor provide for the
representation of those people in the process by which the basic
structure of society is to be determined. Instead, he consigned their
fate to the later, legislative phase. Rawls also restricted
participation in the Original Position to those with two "moral
powers": the capacity to form and revise one's own
conception of the good; and the capacity for a sense of justice, the
capacity to act on and apply fair terms of cooperation
(*ibid*.). It is doubtful that these powers can be attributed
to people with the most severe intellectual and psychiatric
impairments, although some philosophers and disability scholars have
argued that a just society should treat all human beings as having the
potential to develop such functioning (Wong 2007, 2009).



Disability scholars have been particularly critical of these
eligibility conditions for the Original Position. If the deliberators
in the Original Position do not believe that they could be
representing, or could turn out to actually be, people with
"severe and permanent" disabilities when the veil is
lifted, they will have no prudential reason to choose a basic
structure for their society that will provide for the inclusion of
those people. Indeed, insofar as such measures would impose costs on
people with non-disabilities, the parties will have prudential reasons
*not* to support such measures, since doing so would undermine
the interests of people whom they know they could represent (the
able-bodied on whom the costs are imposed) for the sake of those whom
they explicitly know they don't represent (the disabled for whom
the costs are imposed).



Several philosophers sympathetic to the Rawlsian framework have
suggested modifications that would give people with disabilities a
greater and more direct role in the social contracting process. Some
have argued that the "full cooperation" requirement, and
the kind of reciprocity it involves, can be liberally interpreted so
as 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 the
device of the [Original Position] do not essentially depend on any
reciprocity premise" (2006: 427). He examines modified versions
of the Original Position that drop the assumption that no one has
severe and permanent disabilities. He contends that with such
modifications, the Original Position can yield principles more
sensitive to disability concerns about the continuous nature of
abilities, the stigmatization resulting from false dichotomization,
and the exclusion of severely disabled human beings.



In response, Martha Nussbaum (2006b: 490-498) concedes that
Richardson's proposed reconstruction of Rawls would largely
avoid the exclusionary features of the OP to which disability scholars
have objected. But she argues that this reconstruction is a more
radical departure from Rawls than Richardson acknowledges. She
suggests that the theory loses its contractual character if it
dispenses, per Richardson, with the reciprocity requirement and the
assumption that the contractors have roughly equal physical and mental
powers.



Rawls' "moral powers" condition has posed further
problems. Harry Brighouse (2001) observes that modifying the
cooperation requirement still excludes those whose cognitive
impairments preclude their possession of the two moral powers. Sophia
Wong (2009, 2007) argues that those powers can be acquired by people
with 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 can
collaborate with others to construct individualized, authentic
conceptions of the good. Silvers and Francis (2005) and Christie
Hartley (2009a) also maintain that people with severe intellectual
impairments can be represented adequately in a contracting process
that consists in trust-building more than hard bargaining, even if
they cannot participate in it personally.



Others have argued that exclusion from the Original Position need not
adversely affect people with disabilities or treat them with
disrespect. Adam Cureton (2008) argues that the exclusion of people
with severe disabilities from the Original Position is just part of
its idealization, and does not diminish the urgency or priority of
their claims. Cynthia Stark (2007) proposes lifting the
full-cooperation requirement to include people with disabilities at
the second stage of Rawlsian deliberation, where the society's
constitution is established and where the hypothetical decision makers
acquire some knowledge about the resources, development level, and
other characteristics of their society.



The plausibility of these responses to Rawls depends to some extent on
which version of the Original Position we consider. Rawls made a
change in his presentation of the Original Position in his
*Restatement* (2001) that is especially pertinent to people
with cognitive disabilities. He emphasized that the participants in
the Original Position are representatives of people in the future
society, not people living in the future society denied knowledge of
their social position. If representatives were made to take into
account the possibility that those they represent might be disabled,
this might help to ensure that the interests of the disabled were
represented. It would only do so, however, if the contractors have the
ability to imagine the very different embodiments of people with a
variety of disabilities, an ability feminist critics of Rawls have
questioned with respect to men representing women (Young 1990;
Benhabib 1992; Okin 1994). The strictly representational role of
participants in the Original Position would also avoid the conflict of
interest faced by cognitively unimpaired individuals representing
themselves *and* cognitively impaired individuals.



More broadly, philosophers have varied widely in their optimism about
the prospects for including people with disabilities in contractarian
or 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 provision
for people with disabilities in the scheme of social cooperation they
adopt. Their acceptance of reciprocity would arise from recognition of
the needs and vulnerabilities they and their loved ones have or will
likely acquire. That recognition places a premium on social provisions
for health. 



> 
> 
> Even for the tough crowd, health is now ripe for inclusion in the list
> of basic goods. And it may be that a robust social commitment to
> health will address questions of justice for the disabled--as
> long as we are careful to include fundamental aspects of psychological
> health (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 a
matter of health as they more narrowly construe it, with an emphasis
on 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 concerns
that motivate his theory. Rawls' assumption that the
participants in the original position are or represent fully
productive members of society neglects the fact of pervasive,
inevitable human dependency. "[T]hose within relationships of
dependency fall outside the conceptual perimeters of Rawls'
egalitarianism" (1999: 79).



Another debate within contractarian theories that has particular
relevance to disability concerns the scope of justice itself: Is
justice concerned only with the distribution of social goods, or also
with the rectification of "natural inequalities" (Pogge
1989: 44-47). Pogge (1995) argues that in the Original Position,
it would be irrational for parties to ignore the contribution of
natural advantages to the well-being (understood in terms of the
fulfillment of the two "higher-order interests") of
prospective citizens, since from that standpoint, it is just as bad to
be disadvantaged by uncompensated disabilities as it is to be
disadvantaged (to the same degree) by a small share of social primary
goods. But Pogge claims that attempting to eliminate those
inequalities would go beyond the scope of justice. Some philosophers
argue, however, that many natural inequalities are within the scope of
justice, and that health care to mitigate them is a requirement of
justice (Daniels 1985; Buchanan et al. 2000).



Other philosophers and disability scholars would deny that the
inequalities associated with impairments can be regarded as
"natural" (Amundson 1992; Wasserman 2001). In questioning
the very notion of "natural inequalities", they join a
broader philosophical debate about whether it is possible to draw a
coherent distinction between natural and artificial or social
inequalities (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 out
that many or most inequalities in abilities are artificial: as with of
obsolete skills, those inequalities may be largely attributable to the
physical 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 approach
than Rawls. They are directly concerned with the kinds of outcomes a
just society should pursue. These theories differ in the outcome
metrics they adopt--the "currency" of distributive
justice (Cohen 1989). Some adopt a resource metric (Dworkin 1981b);
still others, a metric based on opportunities for welfare (Arneson
1989) or access to advantage (Cohen 1989). Finally, capability
theories assess outcomes not only by the goods or resources that
people have, but also by what people are able to do with what they
have (Nussbaum 1990; Sen 1980). Such outcome-oriented theories may be
more or less demanding, depending on whether they require equality or
merely priority for the worst-off, and on whether they support
equality of a sort that may not require the significant redistribution
of goods or resources.



The most prominent family of outcome-oriented approaches has been
called "luck egalitarianism" (see, for example, Arneson
2000; Dworkin 2003; Lippert-Rasmussen 2015). According to the dominant
characterization of that position, its central claim is that it is
unjust when there are unfair inequalities in the distribution of
"brute luck"--an advantage or disadvantage with
respect to the relevant metric that is not attributable to an
individual's fault, choice, or assumption of risk. "Option
luck", in contrast, refers to an advantage or disadvantage an
individual acquires through the foreseeable consequences of his or her
actions. The stronger versions of luck egalitarianism (e.g., Dworkin
81b) deny that any inequality resulting from option luck generates
claims of justice. On those versions, only some disabilities generate
justice claims--those that resulted from brute bad luck (e.g.,
congenital impairments)--whereas others, which may involve the
same or greater disadvantage, do not, simply because they resulted
from a free choice (e.g., reckless pastimes or an unhealthy
lifestyle).



Some philosophers have taken these implications as a *reductio ad
absurdum* of luck egalitarianism (Anderson 1999), and they would
no doubt be rejected by many writers on health care, who have
questioned the moral and policy relevance of individual responsibility
(Cavallero 2011; Feiring 2008; Galvin 2002; Wikler 1987). The greater
concern for disability scholars may be with the conflation of
disadvantages resulting from unchosen impairments with disadvantages
resulting from unchosen social conditions under the one heading of
"bad brute luck". Luck egalitarianism does not, *as
such*, provide any principled rationale for distinguishing between
equally severe setbacks to the well-being of people with disabilities
that result from the "bad luck" of being born in a society
with disability discrimination and the "bad luck" of being
born with an intrinsically disadvantageous set of physical
abilities. Both are equally unchosen from the individual's
standpoint, and it is individual responsibility, rather than some
combination of individual and collective responsibility, that
determines whether a given disadvantage generates a valid justice
complaint. This is not to deny that luck egalitarianism can be
*supplemented* to account for the intuition that the "bad
luck" of being born in a disabling environment (Fine and Asch
1988) 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 on
two 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 distributive
standard they impose--strict equality, priority for the worse
off, or merely some minimum for everyone (sufficientarianism). We will
consider these two features in order, although they are sometimes
intertwined.



Rawls and other social contract theorists adopted a broad outcome
metric for assessing the comparative advantage of the individual in a
society: "social primary goods", which include
opportunities, basic liberties, income, and the social bases of
self-respect. This breadth is intended to achieve neutrality between
competing substantive conceptions of the good, since the social
primary goods are construed as "all-purpose means" that
are valuable to have irrespective of the content of one's
particular conception of the good. For many disability scholars, the
difficulty in this approach does not concern its neutrality, but its
failure to take account of the environment in which those goods must
be utilized, which may profoundly affect their value to those
receiving them. Two persons might be alike in their share of social
primary goods, and have similar projects, aims, commitments, and
values, but nonetheless differ in the value they can derive from those
goods, if one person is disabled and the other is not. As we shall see
below, the capabilities approach takes into account this objection,
when the difference between the uses to which each person can put her
primary goods is construed as the result of differences in
"internal resources", or the rate at which the individual
can convert resources to "functionings".



A failure to take adequate account of the environment may also be
found in directly-egalitarian resource-based approaches. Dworkin
(1981a,b), for example, appears to take the social environment for
granted in proposing a hypothetical division of resources into
individual bundles. Giving people with impairments equal material
shares in a society like our own would hardly satisfy the demands of
equality in a physical and social environment designed exclusively for
people with standard endowments. Dworkin is aware of the problem, but
his solution is to adjust individual shares to include insurance
payouts against poor environmental fit, rather than to redesign the
environment to reduce inequalities in fit. To that degree, Dworkin
appears to tacitly assume a medical model of disability, according to
which limitations resulting from impairments are solely attributable
to the impairment itself, and, if not correctable, compensable only by
the redistribution of resources to people with such impairments. Such
compensation may ensure survival, but it does little to enhance or
equalize participation, and may in fact hinder participation if
Anderson (1999) is right that compensating for disabilities expresses
disrespect. Moreover, the size of the insurance payout for a given
disability is determined by the amount by which able-bodied people
would be willing to insure themselves against the prospect of
incurring that disability. Insofar as the judgments of able-bodied
people don't always track the intuitively relevant facts about
disability-related disadvantage, such an approach threatens to
"bake in" flawed assumptions about the experience of
disability into its account of just entitlements for people with
disabilities (Bodenheimer 1997a,b).



Several alternatives for assessing outcomes for purposes of political
and social equality seem more responsive to the disabling role of the
social environment. The most familiar and influential of these
alternatives is the capabilities approach, developed in different ways
by Martha Nussbaum (2006a) and Amartya Sen (1980). Their accounts are concerned
not only with the resources an individual has but also with what she
can do with them; with her "capability" of engaging in a
number of valuable "functionings", such as forming
intimate relationships and having rich sensory and aesthetic
experiences.



Nussbaum's earlier formulations of the capabilities placed
considerable emphasis on species-typical functioning. For example, she
initially treated "the exercise of the five senses" as a
necessary constituent of human flourishing. More recent formulations
are more congenial to social models of disability, in part because of
Nussbaum's encounter with disability scholarship. She now makes
room for the social contribution to "natural" deficits
(see Wasserman 1998; Terzi 2009), recognizing that most capabilities
bear only a contingent, environmentally-mediated relationship to
people's "natural endowment". She abstracts from
differences between people with impaired and normal limb function to
find 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 the
individual more mobile. Similarly, a person lacking sight or hearing
can achieve aesthetic satisfaction by other means; a person with
intellectual impairments can participate in activities structured to
include individuals of varying cognitive skills. An individual with
emphysema could increase his capacity for affiliation and control over
the material environment (two capabilities from Nussbaum's
2006a list) not only by
measures to increase his lung capacity but also by measures to
increase his access to social and business venues through better
transit and architectural design.



Nussbaum's broader framing enables her to recognize the
prospects for flourishing of people with severe impairments. The
plausibility of the capabilities approach for disability critics of
distributive accounts lies in the way the capabilities are
individuated. A basis for individuation might be found in a
comprehensive account of human nature and human flourishing, such as
the Aristotelian account that informs Nussbaum's work. As Becker
notes, however, such a comprehensive account would have limited appeal
in justifying a distributive scheme in a pluralistic society (2005:
35). Despite its promise, considerably more work is needed to clarify
her approach. Another feature of Nussbaum's theory that some
disability theorists find congenial is her incorporation of
recognition and respect into her set of basic capabilities. Thus, the
capability for "affiliation" encompasses not only
intimacy, but self-respect and dignity; the capability for
"control over the environment" includes both the material
and political environments.



Less ambitiously than Nussbaum, Jonathan Wolff (2009b) classifies
equality-enhancing measures for people with disabilities by the extent
to which they address recognition as well as redistribution. Thus, the
individual limitations of people with disabilities can be addressed
with either cash compensation or "personal enhancement",
medical, surgical, or rehabilitative measures to correct those
limitations. "Targeted resource enhancement" offers an
intermediate option, which tries to improve the fit of the individual
and the environment with a range of restricted resources such as
personal assistance and assistive technology. Finally, "status
enhancement" alters the built environment and social practices
to reduce the impact of individual differences in abilities on social
equality. Wolff generally favors status enhancement as the most
respectful intervention, because it shapes the environment to the
needs of all members of society. It is also the most stable
intervention, because it protects the social equality against sudden
changes in individuals' levels of functioning.



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



Yet doubts remain about the extent to which concerns about
recognition, respect, and social equality can be captured in any
outcome metric of individual well-being, however broad. Thus,
Christian Schemmel (2012) argues that the treatment of people as
equals must be understood in terms of respectful relationships among
individuals and institutions, and that the presence of such
relationships cannot plausibly be regarded in what Pogge (2004a,b)
calls "recipient-oriented" terms, as components of
individual well-being. The moral significance of respectful treatment
is neither exhausted by, nor derivative of, its contribution to
individual well-being. As Schemmel argues (2012: 19), people may need
some forms of affiliation to flourish but do not necessarily require
social and political equality for their own well-being. The
plausibility of these claims depends to some extent on how narrow or
broad a conception of well-being one adopts. A conception that
encompasses virtually all that a person has reason to care about will
more easily accommodate social equality and respectful
relationships.


### 4.4 The Appropriate Standard for Distributive Justice



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



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



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



Underlying this approach is the more fundamental distinction between
relational and distributive theories of justice. Although this
distinction can be drawn in different ways (see, e.g.,
Lippert-Rasmussen 2015, Fourie et al. 2015), it identifies two
critical dimensions of justice. One concerns how well-off individual
people are, both absolutely and in comparison to each other. The other
concerns the kinds of social relationships people stand in to one
another. As discussed in
 SS4.3,
 it is a difficult question to what extent either dimension of justice
can be reduced to, or expressed in terms of, the other.



Against the claim that relational justice can be understood as an
instance of distributive justice, one may observe that at least with
respect to equality, there seems to be an important
*structural* difference between two people standing in some
relation to *some third thing* (i.e., some good) to the same
degree and two people standing in some relation to *one
another* to the same degree (e.g., the relation of being
respected, recognized, and so on). Insofar as interpersonal equality
has a different structure when construed as relational, it is a
mistake to think that it can be reduced to a species of distributive
equality, for "equal" means something different in each
case. For example, it is one thing for any two people in society to
have equal respect *from others*; it is a different thing for
any two people in society to have equal respect for *one
another.* This distinction is relevant to debates about disability
in particular, because one way to understand the social model is in
terms of the relational view--its core insight is that disability
is not a one-place property of individuals, defined in terms of some
welfare 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 over
the expressive significance of different measures to remediate the
disadvantages associated with disability. Pogge (2002) and Anderson
(1999) have claimed that it is disrespectful to attribute a
person's disadvantage to features of his or her natural
endowment because it treats her as needy, deficient, or inferior. For
this reason, they argue against justifying redistributive measures to
achieve inclusion on the grounds that they correct natural
inequalities in skills, talents, or the ability to convert resources
into welfare. Instead, they contend that such measures can and should
be justified as redressing discrimination, and conversely, that
failures to achieve inclusion should be recognized as unjustly
discriminatory.



Barclay (2010, 2018) challenges the argument that a claim for
redistribution treats the claimant as deficient or inferior. Such
claims need only recognize that some traits are less suited than
others for specific environments--a contingency that does not
imply the intrinsic superiority or inferiority of a given endowment.
She thus questions those (e.g, Daniels 1985; Buchanan et al. 2000) who
claim that certain characteristics or traits are universally valuable,
such that an individual who lacked them would be deficient in any
environment. Although she tends to see the environment as fixed rather
than malleable, Barclay argues that the project of achieving inclusion
is best seen in terms of maximizing individuals' environmental
fit. Achieving that fit may require expending more resources for some
individuals than others in any given environment. The demands made by
very tall or left-handed people for greater accommodation do not
presuppose their inferiority, only their minority status (see
 SS2,
 infra). These comparisons suggest that the demands for accommodation
of people with such statistically atypical features differ merely in
degree, not kind, from those made by people with various
impairments.



Even if compensation for disadvantage need bit be demeaning, however,
specific grounds for compensation may well be. Laws and policies that
compensate people simply because they are disabled, or have a specific
disability, may be objectionable because of the social meaning of
disability-compensation. Compensation that is based on the medical
classification of disability may reinforce the humanity-obscuring
stereotype of "the cripple" as helpless and pitiable. This
grave threat to social equality should make us wary of drawing
distributive implications from the claim that disability is a
"bad difference" rather than a "mere difference
"(see entry, "Disability: Well-Being, Health, and Personal
Relationships"). Even if disability in general, or specific
disabilities, were bad differences, that would hardly imply that
individuals who had (those) disabilities were entitled to compensation
simply by virtue of that fact.


## 5. Justice, Disability Identities, and Epistemic Injustice



There are many categories or groups into which people can place
themselves, and be placed, on the basis of their varying
characteristics. The salience and appeal of these categories depend on
social and historical context as well as individual preferences and
values. Identity and identity politics become important as members of
historically excluded groups challenge their status and work for
inclusion. Many women gained a sense of group identity in opposing
laws that limited voting and other political rights to men; racial
identities have been forged in the fight against segregation. Although
people with disabilities are not always understood as sharing an
identity, their awareness of membership in an oppressed group has been
shaped by exclusionary laws and customs, from "ugly laws"
prohibiting people with physical deformities from appearing in public
to the state-sponsored involuntary sterilization of "mental
defectives". A sense of group identity has been further
encouraged by welfare, social security and other laws that place
people with various disabilities in a single category, even if they
define that category in different ways.



The importance of disability as a social category was increased by the
movement to establish civil rights for people with disabilities. As in
the case of other stigmatized groups, the characteristics used as a
ground for exclusion became a basis for mobilization and a source of
pride. The social model of disability, which informed the movement for
disability rights, emphasized what people with various impairments
have in common--their stigmatization and exclusion--and
thereby promoted the emergence of disability as a powerful social
identity.



Critics like Fraser argue that the importance of social identity
cannot be adequately captured in any metric of individual advantage.
An effective social response to stigmatized identities requires both
recognition and transformation--changes in cultural framing and
social perception that are poorly served by redistribution. An
emphasis on redistribution is often self-defeating, exacerbating
stigma and reinforcing the impression of the stigmatized group as
deficient (Fraser 1995, 1997; see Olsen 2001). Yet as we will discuss, some
ways of transforming social identity have significant dangers as
well.



For proponents of recognition, one issue is whether justice requires
not only respect for individual members of society, but also respect
for their group or cultural identities. Must a just society recognize
"group-specific cultural identity" or merely "the
status of group members as full partners in social interaction"
(Fraser 2001: 23, 24)? Are these separate requirements, or does
respect for an individual entail respect for her social or cultural
identities? These questions have been addressed primarily with respect
to religious, ethnic, racial, and sexual minorities. Very little work
has been done on the question of what a disability identity would look
like and what sorts of recognition claims it would implicate.



A somewhat parallel issue has been raised in distributive
justice--must society allocate resources, broadly construed, to
support the group and cultural identities of its members? That support
could be based on the claim that such identities are a constituent,
perhaps an irreducible one, of the well-being of the individual
members of society. This claim has been suggested by justice theorists
who argue for the importance of culture as a "context of
choice" for individuals (e.g., Kymlicka 1989, Sparrow 2005). An
individual deprived of a culture through which he has experienced and
interpreted the world will find it far more difficult to flourish. As
we will discuss, however, it is doubtful that disability in general,
or particular impairments, play such a comprehensive role in the lives
of many--let alone all--people with
 disabilities.[8]



We begin by describing the different characteristics of an
individual's "identity". One sense of this term is
that of numerical identity over time: what makes some person at time
t1 the same person as the person at time t2? (see SEP entry on
 identity over time).
 This is, in the first instance, a metaphysical question and not our
interest here. A different sense of "identity" refers to
those characteristics that make one the particular person one is, as
judged both by oneself and by others. This includes narrative,
biographical, and practical identities. It is less about criteria for
sameness over time and more about the constitutive or defining
features of one's self- (or social) conception. This is the
sense of "identity" we will be concerned with.



The sense of individual identity most directly relevant to respect and
recognition is arguably that of practical identity. Following
Korsgaard (1996, 2009), we can understand a practical identity to be a
description under which a person values herself, where valuing oneself
involves treating oneself as a source of reasons. For example, someone
who identifies as a mother in this sense values herself under the
description "mother" and for that reason treats the fact
that she is a mother as a source of (normative practical) reasons.
Moreover, to "drop" this identification is not like
dropping a desire or short-term goal. It involves changing one's
sense of who one is as a person and what gives one's life
value.



On this view, a person's practical identities should be
normatively significant for other people as well. For one thing, many
of a person's significant *interests* are derived from
her practical identities. Since it is uncontroversial that respect and
concern require giving appropriate weight to the interests of others,
it follows that respect and concern require giving appropriate weight
to other people's practical identities, at least insofar as they
generate (legitimate) interests. In addition, respecting a
person's practical identities plausibly falls under a more
general requirement of respect for personal autonomy. Personal
autonomy is a foundational value of liberal democracies, whose laws
and policies do not require individuals to organize their lives around
any particular identity, but rather give them the latitude to make of
their identities what they will (Appiah 2005; Appiah and Gutmann 1996;
see also the SEP entry on
 identity politics).
 This can be seen as a part of liberalism's broader commitment
to neutrality about conceptions of the good (e.g., Rawls 1993).



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



Being disabled, like being a member of a minority race, subjects one
to particular treatment. But one can experience that treatment without
feeling compelled to regard one's disability or minority status
as part of one's individual identity in the practical sense of
being a description under which one values oneself. Often, having a
disability identity ascribed to one, like having a racial identity
ascribed, consists in part in being the object of, and provides an
excuse for, discriminatory, demeaning or degrading treatment of
various sorts. This is so both for people whose impairments are
immediately observable and for those whose impairments are hidden but
subject to exposure and ridicule by a temporary change in appearance,
e.g., a person with epilepsy who has a seizure in public (Schneider
and Conrad 1985; more generally, Davis 2005). And since this social
identity is often part of one's individual identity, such
treatment is likely to be injurious to the self-respect of the one
with this identity, and in that sense constitute an instance of
misrecognition. Ironically, the fact of being unfairly stereotyped can
itself shape the identities of those who are treated in this way, as
Appiah notes, even if initially they did not identify strongly with
the group in question.



Desirable change with respect to social identities is possible in at
least two ways. First, even if some important aspects of one's
self are not chosen--say, the fact that one has paraplegia or
deafness--how central they are to one's self-conception,
how much they matter to one's interests and plans, is to some
extent within one's voluntary control. On some views, notably
Korsgaard's, reflective endorsement of an identity is a
necessary condition of its being normative for the agent, i.e.,
providing reasons for her. At the same time, the extent to which
one's identifications are voluntary depends on the constraints
of the social environment. One cannot simply decide to make
one's disability a less salient feature of one's
biographical identity, at least, especially if one's disability
is not "hidden". If the identity is ascribed, and
emphasized, by the larger society, it may be difficult to reduce its
importance in one's own practical reasoning. But one still has
some choice about whether to accept or resist that emphasis.



Second, there can be a change in the *valence* of the label, as
there has been with the term "queer": what was once a
negative label, accompanied by unjust treatment of various sorts, can
be transformed into a positive label and championed as a source of
self-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 the
positive promotion of disability as a cultural identity" (Lawson
2001: 203-21). Neither sort of change--in identification or
valence--can be accomplished without struggle, personal as well
as political, but partial success is sometimes achievable.



Even if disability is not and does not have to be a central component
of every disabled person's identity, this does not negate the
significance of disability as an organizing principle of political
action. But when the social and political recognition of disability
becomes the objective of political action, as it is in identity
politics, it gives rise to the "dilemma of difference"
(Minow 1990). Consider special education for children: On the one
hand, labeling a child "disabled" risks stigmatizing and
isolating the child. In this sense, to be "different" is
to be inferior. Alternatively, being labeled "disabled" is
a way for parents to secure attention to the child's particular
ways of learning and functioning. In this sense, to be
"different" is to be entitled to appropriate educational
assistance.



The dilemma may not be insurmountable. The movement for universal
design in education aims to refashion classrooms and teaching
practices to encourage the participation of all students. To the
extent 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 creatively
about ways to solve this dilemma so that the stigma they seek to
eliminate is not in effect reinforced. Success in resolving the
dilemma of difference may reduce the importance of disability identity
for justice. If disability is simply a characteristic to be taken
account of in social arrangements, it could become as significant or
insignificant as height or aptitude.



There are at least two other risks for an identity politics of
disability. One involves the danger of assuming that the members of a
particular marginalized group all share the same culture, be it
African-American culture or disability culture. This assumption is not
required by a mature identity politics, but it may be encouraged by
efforts to mobilize diverse individuals around a single identity. Two
considerations may help to resist this tendency. First, we must
recognize that culture is a complex concept, and that defining it is
no easy task. Second, we must recognize that on any plausible
definition, people with the same disability (let alone different
disabilities) need not share a common culture. There are some examples
of a shared disability culture: Deaf culture is perhaps the best
known. But many people who are deaf, particularly those who do not
sign, do not identify as Deaf or take part in Deaf culture (Tucker
1997[10]
 And even for those who participate, Deaf culture does not appear to
be the kind of "encompassing" or
"comprehensive" culture claimed by Kymlicka, Margalit, and
Raz to provide a "context of choice" for its
 members.[11]



The second, related risk involves privileging one identity over
others. This is especially important for people with multiple or
"intersectional" identities. People who are
African-American and disabled, or female and disabled, or disabled and
LGBT may sometimes feel a conflict between those identities. In one
study, for example, African-American women with mobility impairments
reported that they felt estranged from the disability-rights movement,
partly because its leadership seemed predominantly white, and partly
because some of its principal goals--to maximize
independence--went against their more communal values, which
emphasized family and co-dependence (Feldman and Tegart 2003). More
generally, although there has been comparatively little discussion of
the intersection between disability and race within philosophical work
on disability (though see Stubblefield 2009), more discussion can be
found in disability studies more generally (e.g., Bell 2011). Also,
some have noted that mainstream feminism's focus on independence
and self-sufficiency has tended to exclude women with disabilities,
who are perceived as lacking in these cardinal virtues (Crawford and
Ostrove 2003; Wendell 1996). At the same time, disabled women are
often particularly vulnerable to the injustices that motivate the
feminist movement: they are frequently victims of sexual exploitation
(Crawford and Ostrove 2003), encounter many obstacles to leaving
dissatisfying relationships because of physical, psychological and
financial dependency (Olkin 2003), and have median incomes below the
poverty line and substantially lower than those of their male
counterparts (Crawford and Ostrove 2003; Olkin 1999).



In addition to these potential risks associated with emphasizing
identity politics for persons with disabilities and other stigmatized
minorities, there have been several major challenges in mobilizing
people with disabilities around an affirmative group or cultural
identity. The first, addressed by the disability rights movement, was
getting people with disabilities to recognize that they have something
in common with others who are differently impaired but also suffer
stigma and exclusion because of their impairment. This has been
difficult because people who are born with disabilities or acquire
them in childhood come from widely dispersed socioeconomic, geographic
and racial groups (Scotch 1988) and so are less likely to grow up with
a sense of group identity. Another obstacle has been the
overwhelmingly negative connotation of the label
"disabled". Indeed, the challenge for people with visual,
motor, and psychiatric impairments has been to recognize that they
share a "disabled" identity while denying that this makes
them dependent, child-like, or powerless (Asch 1985; Scotch 1988);
such a self-identity would quite literally *disable*
one's capacity for social participation and political
action.



It is instructive to compare how the medical and social models would
address these challenges. The medical model suggests a disability
identity that is both fragmented and negative. Because the medical
model defines disability in terms of particular physical or mental
impairments, the primary commonalities it recognizes among disabled
people are strictly functional; it views the blind person and the deaf
person as having very different problems. Although it could recognize
the fact that such biomedically distinct conditions had similar social
consequences--stigmatization and exclusion--it would treat
those similar consequences merely as secondary effects of the two
conditions. Even within a single impairment, a medical model
encourages distinctions based on etiology. For example, it would
distinguish blindness due to Leber's congenital amaurosis from
blindness due to retinaopathy of prematurity, focusing on genetic
testing for the former and treatment for the latter, and placing less
emphasis on the shared challenges of living with blindness. Although
this narrow focus may be appropriate for the purposes of clinical
intervention, it obscures the recognition of disability as a social
and political problem, except insofar as it raises perennial questions
about how to distribute scarce health-care resources (Barnartt et al.
2001).



In contrast, the various social models were explicitly formulated to
support a disability identity that could serve as the basis for claims
of respect and recognition. The inclusion of people with a vast array
of different impairments in United States and other national civil
rights laws, and the creation of the United Nations convention on the
rights of persons with disabilities, have helped to forge a shared
disability identity. The emergence of disability studies as a
recognized field of academic inquiry has also contributed. The
minority group model promotes a trans-impairment identity by treating
people with disabilities as a "discrete and insular
minority" making claims on a generally stigmatizing able-bodied
majority. Though the minority group model has proven extremely useful
in passing anti-discrimination laws, it may do so at the expense of
emphasizing the *differences* between people with disabilities
and people without them, rather than highlighting the many ways in
which identity need not be tied to the presence or absence of an
impairment. The human variation model tempers this emphasis, and
resists essentialism about disability identity, by treating the group
itself as socially constructed. It sees the category of "the
disabled" as resting on an artificial dichotomy imposed on a
continuum of variation. The conceptualization of disability as just
one source of difference, and as a difference in kind more than
degree, can undercut a sense of disability as the basis for a unique
and exclusive identity.



The more the redesign of the physical and social environment is guided
by a thoroughgoing human-variation model, the less dominant disability
identity and identity politics may become for people with
disabilities. A society in which disabilities lack the social and
practical significance they currently have may be one in which the
equality of people with disabilities can be fully recognized without
having to treat disability as a salient feature of their
identities.



It may be, though, that the physical, sensory, or psychic experience
of a particular impairment turns out to be central and salient to how
those with the impairment live--even in a society deeply
committed to inclusion, participation, and non-discrimination. Perhaps
communicating primarily gesturally and not vocally, or moving through
the world with wheels and not on legs, or focusing on detail rather than context, makes the lives of people who are deaf, or
paralyzed, or autistic sufficiently distinctive that they feel a
strong affinity and connection with others who have the same
impairment (see SEP entry on
 disability: definitions, models, experience
 for a discussion of this claim.) Disability theorists who adopt
different social model approaches might profitably consider how
different views about group and individual identity apply to people
with disabilities.



The connection between different models of disability and different
ways of understanding disability identity points us in the direction
of an important category of injustice, in addition to the distributive
and relational conceptions already discussed. This is *epistemic
injustice* (Fricker 2007; Barnes, 2016). Epistemic injustice
consists in a person's being wronged in her capacity as an
epistemic subject. *Testimonial injustice* consists in
someone's being wronged in her capacity as a subject of
knowledge, while *hermeneutical injustice* consists in
someone's being wronged in her capacity as a subject of
understanding. More specifically, testimonial injustice consists in
someone's testimony being given less credence than the evidence
warrants due to prejudice on the part of the hearer, while
hermeneutical injustice consists in someone's experiences being
obscured from individual and collective understanding due to wrongful
exclusion from the practices by which those understandings are
generated. Both have clear implications for disability, justice, and
identity.



For example, consider the use of quality-adjusted life years (QALYs)
to assess the prospective benefits of health care interventions. The
standard method of "quality adjustment" involves (i)
assigning a value of 1 to each life-year one can reasonably expect to
save through a given intervention, and (ii) discounting each life-year
that would be lived by a person with a disability by some coefficient
(between 0 and 1) which is thought to reflect the badness of living
with the disability in question. These coefficients are typically
arrived at by asking people how many years of life *with* the
disability people would be willing to exchange for each year of life
*without* the disability. For example, suppose survey data
indicate that people would trade 8 years of life with blindness for 4
years of life with sight. The method of quality-adjustment would
assign a QALY of 0.5 to each year of life lived with blindness. The
upshot is that saving nondisabled life-years provides more "bang
for your buck" in the QALY model, and as such is to be preferred
to saving disabled life-years.



This implication has led some to criticize the method of
quality-adjustment on the grounds that it produces a kind of
"double jeopardy:" people with disabilities are
disadvantaged twice-over, first by having the disability itself,
second by having their health care needs discounted for that very
reason (e.g., Singer et al. 1995; Bognar 2011; John et al. 2017). But
there is another way of thinking about QALYs which takes issue with
both quality-adjustment and an assumption behind the double-jeopardy
criticism. When the "exchange rate" between disabled and
non-disabled life-years is calculated, it is primarily or exclusively
based the judgments of *able-bodied* people. This feature is
criticizable on two distinct grounds. One is that it disrespects the
first-person authority of people with disabilities, who know
first-hand what it's like to have the disability in question
(and, if disabled as adults, know also what it's like
*not* to have the disability). This disrespect for first-person
authority is plausibly an example of testimonial injustice, at least
insofar as it reflects prejudicial or otherwise biased attitudes on
the part of the able-bodied. A second, related criticism is that this
approach exaggerates the difference in quality between able-bodied and
disabled lives, relative to an approach that appropriately
incorporated and weighed the perspectives of people with disabilities.
Able-bodied people often overestimate how bad it would be to have a
given disability, given popular stereotypes which depict life with
disability as tragic, occlusive of life's major goods, and so
on. This is plausibly an example of hermeneutical injustice, insofar
as the poor understanding of disabled people's experiences and
identities results from their exclusion from the public sphere. This
is only one example; much work remains to be done exploring the
implications of epistemic injustice for people with disabilities.


## 6. Conclusion



This entry began by pointing out a feature of disability that
distinguishes it from other characteristics which have often been seen
as grounding legitimate claims of justice, such as race, sex, sexual
and gender identity, and religion. Simply put, achieving full
inclusion for people with disabilities is *expensive* to a
degree that achieving full inclusion for other minorities is not. Any
plausible theory of inclusion implies the necessity of considerable
accommodation and environmental reconstruction. And even if the costs
of such measures have often been exaggerated, it is difficult to see
how the appropriate degree of accommodation and reconstruction would
not require diverting significant amounts of resources from other
worthy goals, including some goals which are supported by
countervailing considerations of justice. One implication of this
feature of disability is that disability requires us to directly
compare, and perhaps trade off, values of relational justice, which
ground the demand for full inclusion as part of a society of equals,
and values of distributive justice, which ground the demand for a fair
distribution of scarce resources. 



Having made this general point, the entry proceeded to discuss
different models of disability, which differ principally in their
understanding of the relationship between impairment and limitation.
Whereas the medical model of disability tends to attribute most of the
limitations associated with disability to functional aspects of the
relevant impairments, the social model of disability emphasizes the
mediating role of the social environment--broadly understood to
include the configuration of physical space, the availability of
various forms of accommodation, social practices and norms,
etc.--in generating disability-related disadvantage. Among other
things, the social model highlights the relational aspects of
disability-related disadvantage, such as stigma, invisibility, and
exclusion, whereas the medical model lends itself to a narrow
distributive interpretation of the claims of justice generated by
disability.



In subsequent sections, the entry focused on the role of disability in
contractualist and other distributive theories of justice. Disability
has often been regarded as a "limit case" for
contractualist theories of justice, and more specifically for the
idealizing assumptions these theories make about the capacities of
those who choose and those who are governed by contractualist
principles of justice. We also saw that disability has played a
central role in discussions of outcome-oriented, distributive theories
of justice, in particular luck egalitarianism. Internally, disability
has played a central role in discussions about the
"currency" of justice, since it has often been seen as a
paradigm example of unchosen disadvantage. Externally, disability has
played a central role in relational criticisms of luck egalitarian
theories of justice. At best, these theories have been seen as failing
to attribute normative significance to morally relevant differences
between identical patterns of distribution which differ in the causal
contribution of the social environment. At worst, these theories have
been criticized for expressing disrespect towards people with
disabilities in virtue of characterizing them as "mere"
unfortunates or objects of pity. Although some of these criticisms may
be overstated, they have been taken to heart by many theorists of
distributive justice, especially proponents of the capabilities
approach. Finally, the entry concluded by pointing to a topic which
has received far less attention in discussions of disability and
justice: namely, the normative significance of disability as a form of
social identity, and the connections between disability and epistemic
injustice.



This entry raises a number of questions which would benefit from
further exploration. Clearly, one general question is how exactly to
understand the distinction between distributive and relational values
of justice. Another, related question is how to assess the comparative
weight or importance of these values. And if, as many find plausible,
some form of pluralism about justice is the correct answer, then we
will need to work out how the relevant trade-offs, weights, and so on
apply to the special case of disability, which simultaneously raises
both distributive and relational concerns. A third question which
calls for further research is the link between disability and
epistemic injustice. We briefly discussed two examples of testimonial
and hermeneutical injustice concerning people with disabilities, but
there are--needless to say--many more. Indeed, disability
may be an especially powerful example of epistemic injustice precisely
because the phenomenological experiences of people with disabilities,
especially those with sensory impairments, differ considerably
from the experiences of the able-bodied majority, raising the hard
question of how well we must understand others in order to treat them
as justice requires.