Disability

DISABILITY AND JUSTICE

Amartya Sen

1

I feel very privileged to be here in this conference on disability and inclusion - a subject of immense importance. I am also very grateful for the kind remarks of Jim Wolfensohn. There are very few people in the world I admire as much as Jim, and it is wonderful for me to interact with him in this meeting. I also join you all in offering my warmest good wishes to the "birthday boy"!

People with physical or mental disability are not only among the most deprived human beings in the world, they are also, frequently enough, the most neglected. Even though this is a conference on practical matters, concerned with the great urgency - and also with the ways and means - of righting the wrongs that are done to the disabled people, my primary focus will be on theory, in particular the treatment of disability in theories of justice. It is important to see why the treatment of disability and the understanding of the demands of justice to the disabled should be so central to ethics in general and theories of justice in particular. It is also, I would argue, useful to understand why the main schools of thought in theories of justice have tended to neglect this central issue, and how that neglect, in its turn, has tended to bias practical policies in the direction of inaction, and has even contributed to suppressing the sense of inadequacy that can reasonably accompany the failure to take a responsible view of the social obligation to the disabled. Part of this talk will, thus, take the form of a "whodunnit" - albeit a rather philosophical whodunnit.

There can be, at one level, nothing as obvious as the predicament of the disabled and the manifest need to do something about it. When, twenty-five hundred years ago, young Gautama - later known as Buddha - left his princely home, in the foothills of the Himalayas, in search of enlightenment, he was moved, in particular, by the sight of mortality (a dead body being taken to the cremation), morbidity (he saw a person severely afflicted by illness), and disability (he watched a person disabled by old age). Gautama Buddha's concern about the deprivations and adversities of human life has served as a powerful image of caring humanity throughout the ages, and it remains deeply evocative today.

There is something immediate and poignant in the recognition of disability that calls for reflection and response. The deliberation that this leads to can be, with reason, expected to reinforce the immediacy and force of the call to action. Fairness to people in divergent circumstances is central to the subject matter of justice, and any adequate theory of justice must tell us how such fairness is to be achieved. Indeed, it is not hard to argue that any theory of justice must address this issue, in order to qualify as an acceptable doctrine, and must identify what is owed by society to the people who happen to be significantly handicapped. There can, of course, be debates on precisely how the predicament of the disabled is to be overcome or ameliorated, and what institutions, rules and conventions would be right in dealing with this grave challenge. But overlooking or ignoring the plight of the disabled is not an option that an acceptable theory of justice can have.

And yet, to a great extent, this is precisely what the theories of justice that have commanded loyalty over the centuries have tended to do, and this has profoundly affected the practical understanding of the nature of a good society and the demands of public order and social fairness. We must examine how this has happened, and why the impoverished perspectives that avoid addressing the claims of the disabled have come to occupy such central positions in political philosophy and welfare economics.

2

Any theory of social ethics, and particularly any theory of justice, has to choose what we may call an "informational basis," that is, it has to decide what features of the world we have to concentrate on in judging the success and failure of a society, and in assessing justice and injustice. In this context, it is particularly important to have a view on how an individual's advantage is to be assessed. Consider, for example, three prominent theories of social evaluation and justice.

First, utilitarianism - championed by Jeremy Bentham and others - concentrates on individual happiness or pleasure (or some other interpretation of individual "utility") as the best way of assessing whether a person is advantaged or disadvantaged.

A second approach, which can be found in many practical exercises in economics (and has had its run in theories of welfare economics), assesses a person's advantage in terms of his or her income and wealth. This is an opulence-based approach, just as utilitarianism is a utility-based approach, and its informational focus is on such data as aggregate incomes, on one hand, and income distribution, on the other.

A third theory is that presented by the greatest political philosopher of our time, John Rawls. This demands that attention be paid to liberty and its priority, but going beyond that Rawlsian theory of justice insists that in assessing distributional equity, the advantage of each person be judged in terms of the "primary goods" that each person respectively has. Primary goods constitute a general category of resources - or general-purpose means - that would help anyone to promote his or her ends. Rawls exemplifies primary goods by pointing to the need to include "rights, liberties and opportunities, income and wealth, and the social bases of self-respect."

It can be easily shown that none of these dominant theories of ethics and justice can really pay serious attention to the issue of fairness to the disabled. I start with examining the second approach, the opulence-based theory, which is the approach economists often use in focusing on income distribution, and which tends to dominate public discussion of distributional concerns in the media and in public discussion in general. The basic problem with this approach was noted with much clarity 2300 years ago by Aristotle, in his book Nicomachean Ethics. Aristotle put the point thus: "wealth is evidently not the good we are seeking; for it is merely useful and for the sake of something else."

Wealth or income is not something we value for its own sake. A person with severe disability need not really be judged to be more advantaged than an able-bodied person even if he or she has a higher level of income or wealth than the thoroughly fit person. We have to examine the overall capability that any person has to lead the kind of life she has reason to want to lead, and this requires that attention be paid to her personal characteristics (including her disabilities, if any) as well as to her income and other resources, since both can influence her actual capabilities. To ground a theory of justice on the informational foundation of opulence and income distribution would be a confusion of ends and means: income and opulence are things that we seek "for the sake of something else" (as Aristotle put it).

It is extremely important to distinguish between two types of handicap that tend to go with disability, which may be respectively called "earning handicap" and "conversion handicap." A disabled person may find it harder to get a job or to retain it, and may receive lower compensation for work. This earning handicap will be reflected in the opulence-based theory, since a disabled person may well be seriously disadvantaged in terms of income and wealth. But that is only a part of the problem. To do the same things as an able-bodied person, a person with physical disability may need more income than the able-bodied person. To move easily or at all, a person who happens to be, say, crippled by an accident or by illness may need assistance, or a prosthesis, or both. The conversion handicap refers to the disadvantage that a disabled person has in converting money into good living. It is not sufficient to be concerned only with earning handicap, since disabled persons tend to suffer also from conversion handicaps.

The issue is quite central to understanding the limitations of an income-based view of poverty. Poverty can be seen as an inadequacy of the basic capabilities that a person has. This links with lowness of incomes, certainly, but not just with that. With the same level of income a disabled person may be able to do far fewer things, and may be seriously deprived in terms of the capabilities that he or she has reason to value. For the same reason for which disability makes it harder to earn an income, disability also makes it harder to convert income into the freedom to live well.

Let me illustrate the influence of conversion handicap with some results from poverty rates in the United Kingdom obtained by Wiebke Kuklys, in an illuminating thesis recently completed at Cambridge University. Taking a poverty cut-off line at 60% of the national median income, Kuklys finds that 17.9 percent of individuals lived in families with below-poverty line income. If attention is now shifted to individuals in families with a disabled member, the percentage of such individuals living on below-poverty line income is 23.1. This gap of about 5 percentage point would largely reflect the income handicap associated with disability and the care of the disabled. If now conversion handicap is introduced, and note is taken of the need for more income to ameliorate the disadvantages of disability, the proportion of individuals in families with disabled members jumps up to 47.4 percent - a gap of nearly 20 percentage point over

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