A small disability

On the mere difference view of disability, one isn’t worse off for being disabled as such, though one is worse off due to ableist arrangements in society. A standard observation is that the mere difference view doesn’t work for really big disabilities.

In this post, I want to argue that it doesn’t work for some really tiny disabilities. For instance, about 3-5% of the population without any other brain damage exhibits “musical anhedonia”, an inability to find pleasure in music. I haven’t been diagnosed, but I seem to have something like this condition. With the occasional exception, music is something I either screen out or a minor annoyance. Occasionally I find myself with an emotional response, but I also don’t like having my emotions pulled on by something I don’t understand. When I play a video game, one of the first things I do is turn off all music. If I could easily run TV through a filter that removed music, I would (at least if watching alone). (Maybe movies as well, though I might feel bad about disturbing the artistic integrity of the director.)

On the basis of testimony, however, I know that music can embody immense aesthetic goods which cannot be found in any other medium. I am missing out on these goods. My missing out on them is not a function of ableist assumptions. After all, if the world were structured in accordance with musical anhedonia, there would be no music in it, and I would still miss out on the aesthetic goods of music—it’s just that everybody else would miss out on them as well, which is no benefit to me. I suppose in a world like that more effort would be put into other art forms. The money spent on music in movies might be spent on better editing, say. In church, perhaps, better poetic recitations would be created in place of hymns. However, more poetry and better editing wouldn’t compensate for the loss of music, since having music in addition to other art forms makes for a much greater diversity of art.

Furthermore, presumably, parallel to music anhedonia there are other anhedonias. If to compensate for musical anhedonia we replace music with poetic recitations, then those who have poetic anhedonia (I don’t know if that is a real or a hypothetical condition; I would be surprised, though, if no one suffered from it; I myself don’t appreciate sound-based poetry much, though I do appreciate meaning-based poetry, like Biblical Hebrew poetry or Solzhenitsyn’s “prose poems”) but don’t have musical anhedonia are worse off.

In general, the lack of an ability to appreciate a major artistic modality is surely a loss in one’s life. It need not be a major loss: one can compensate by enjoying other modalities. But it is a loss.

In the case of a more major disability, there can be personal compensations from the intrinsic challenges arising from the disability. But really tiny disabilities need not generate much in the way of such meaningful compensations.

Here’s another argument that musical anhedonia isn’t a mere difference. Suppose that Alice is a normal human being who would be fully able to get pleasure from music. But Alice belongs to a group unjustly discriminated against, and a part of this discrimination is that whenever Alice is in earshot, all music is turned off. As a result, Alice has never enjoyed music. It is clear that Alice was harmed by this. And the bulk of the harm was that she did not have the aesthetic experience of enjoying music—which is precisely the harm that the person with music anhedonia has.

Objection 1: Granted, musical anhedonia is not a mere difference. But it is also not a disability because it does not significantly impact life.

Response 1.1: But music is one of the great cultural accomplishments of the human species.

Response 1.2: Moreover, transpose my argument to a hypothetical society where it is difficult to get by without enjoying music, a society where, for instance, most social interactions involve explicit sharing in the pleasure of music. In that society, musical anhedonia may make one an outcast. It would be a disability. But it would still make one lose out on one of the great forms of art, and hence would still be a really bad thing, rather than a mere difference.

Objection 2: There is a philosophical and a spiritual benefit to me from my musical anhedonia, and it’s not minor. The spiritual benefit is that I look forward to being able to really enjoy music in heaven in a way in which I probably wouldn’t if I already enjoyed it significantly. The philosophical benefit is that music provides me with a nice model of an aesthetic modality that is beyond one’s grasp. Normally, “things beyond one’s grasp” are hard to talk about! But in the case of music, I can lean on the testimony of others, and thus talk about this art form that is beyond my grasp. And this, in turn, provides me with a reason to think that there are likely other goods beyond our current ken, perhaps even goods that we will enjoy in heaven (back to the spiritual). Furthermore, music provides me with a conclusive argument against emotivist theories of beauty. For I think music is beautiful, but I do not have the relevant aesthetic emotional reaction to it. My belief that music is beautiful is largely based on testimony.

Response 2: These kinds of compensating benefits help the mere difference view. Even if one were able to get tenure on the strength of a book on the philosophy of disease inspired by getting a bad case of Covid, the bad case of Covid would be bad and not a mere difference. The mere difference view is about something more intrinsic to the condition.

Impairment of parts and wholes

Aristotelians tend to find the following argument plausible:

1. Every disability includes the impairment of the proper function of one or more body parts or aspects.

2. If a part or aspect is impaired, the whole is impaired.

3. It is bad for one to be impaired.

4. Hence, every disability includes something that is bad for one.

The argument is compatible with a disability not being on balance bad for one (e.g., because maybe it is instrumentally good, for instance because it might contribute to personal growth in various ways, or make one a member of a particularly valuable community, etc.), but it implies that a disability is always bad for one in some respect. I don’t know that I have seen the argument expressly formulated as above, but I think something like this argument has always been at the back of my mind when thinking about disability.

There is philosophical literature challenging premise (3). But (3) is central to Aristotelian eudaimonism, so challenges to it did not seem very plausible to me.

However, it occurred to me yesterday that premise (2) may well be false. Think about cases of redundancy. Suppose toothies are a species of organisms that, unlike humans, have a variable number of teeth. The minimum number of teeth for the first-order proper functioning of a toothy is 60. With fewer teeth, a toothy can’t chew its food sufficiently well to function properly. However, typical healthy toothies exhibit significant redundancy in their dentation, and have anywhere between 70 and 100 teeth. Toothies that have from 60 and 69 teeth either do not have any redundancy in their dentation (at 60) or have insufficient redundancy (from 61 to 69). We can think of redundancy as a second-order proper function. Furthermore, toothies that have more than 100 teeth have the teeth crowded too much in the jaw, which isn’t good for them.

Toothies constantly grow need teeth and wear out old teeth. The worn-out teeth become flaky and weak, and eventually break and fall out. Now suppose that Alice is a toothy with 85 teeth, one of which is well on its way to wearing out. That tooth is impaired. However, Alice is not impaired by virtue of having an impaired tooth, because any number of teeth between 70 and 100 is sufficient for proper first-order (chewing) and second-order (redundancy) functioning of the organism. When that tooth falls out completely, Alice won’t be impaired, and when the teeth has partial function, as it does now, she isn’t impaired either. This, premise (2) is false.

We might suppose that even if Alice isn’t impaired by having an impaired tooth, she would be better off if that tooth weren’t impaired. But that need not be true. For it need not be true that having more teeth is better for one. Having more teeth makes for more redundancy but it also makes for more crowding in the jaw. When the tooth is wearing out, crowding may be decreased (the tooth may be thinner), even though redundancy is also decreased. So it need not be the case that the tooth impairment is in any way bad for Alice.

Now, it may seem that typical impairments of human bodies or aspects are unlike Alice’s tooth impairment. However, this is not clear. Consider intellectual aptitudes. These include reasoning aptitudes in the domains of the spiritual, moral, emotional, intuitive, interpersonal, spatial, logical, arithmetical, artistic, linguistic, kinaesthetic, etc., etc. But different humans have different social roles. Perhaps what is normal for humans is proper functioning of a sufficient number of these aptitudes, not of all of them, so that each human being can find a good niche in society. Furthermore, the sufficient number of these aptitudes may be one that is sufficient to ensure redundancy. In that case, if someone has more than enough redundancy, a severe impairment of one of the aptitudes need not imply a lack of proper function of the human as a whole. But we might, nonetheless, count someone with such a severe impairment of an intellectual aptitude as disabled. If so, being disabled in that respect need not imply being impaired on whole, or badly off in any respect.

However, in the intellectual aptitude case, shouldn’t we say that having more of the aptitudes is better? It isn’t like teeth, where having too many can be harmful, is it? Well, that isn’t completely clear. After all, it can be harder for a kid with many talents to specialize. But even if we grant that one is better off for having more of the aptitudes, this does not mean that lacking one or more is bad. It can be just less good. If Alice’s having 70 teeth is enough for her toothy nature, but 71 is better, then having only 70 isn’t bad, just less good.

That said, there are doubtless some parts or aspects of a human being such that proper function of the part or aspect is necessary for the proper function of the whole. The most obvious cases are the moral and spiritual: someone whose moral or spiritual aspects are impaired is indeed impaired as a person.

Acknowledgment: I feel that some of what I say is influenced in various ways by conversations I had with my superb student Hilary Yancey, but where I have failed to absorb her ideas at the time.

Impairment and saving lives

Bob and Carl are drowning and you can save only one of them. Bob is a human being in the prime of life, physically and mentally healthy, highly intelligent, and leading a happy and fulfilling life as a physicist committed to lifelong celibacy. To look at him, Carl is Bob’s identical twin. Carl has the same physical and mental powers as Bob, and leads a very similar happy and fulfilling life as a physicist committed to lifelong celibacy.

But there is one crucial difference that you know about, but Carl does not. Carl is actually a member of a superintelligent humanoid alien species. However, due to an unfortunate untreatable genetic condition, Carl suffers from a severe intellectual impairment, having merely the intelligence of a highly intelligent human. In order that Carl might avoid the stigma of the impairment, his parents had some highly sophisticated surgery done on him to make him fit into human society, and arranged for him to be adopted by a human family and raised as a human. No one except for you on earth will ever know that Carl isn’t human. You know because you happened to see the aliens arranging this (but you haven’t told anyone, because you don’t want people to think you are crazy).

Should you save Bob or Carl from drowning? My intuition is that if the above is all that you know, you have no reason to prefer saving one over the other. If one of them is slightly more likely to be saved by you (e.g., they are slightly closer to you), you should go for that one, but otherwise it’s a toss-up.

But notice that if you save Carl, there will be more natural evil in the world: There will be a severe intellectual impairment, which won’t be present if you choose to save Bob instead. It seems pretty plausible that:

1. If you have a choice between two otherwise permissible courses of action, which result in the same goods, but one of them results in exactly one additional evil, you have a moral reason to choose the course of action that does not result in the evil.

Thus, it seems, you should save Bob.

So there is something paradoxical here. On the one hand, there seems to be no reason to pick Bob over Carl. On the other hand, the plausible general ethical principle (1) suggests you should pick Bob.

How can we get out of this paradox? Here are two options.

First, one could say that impairment is not an evil at all. As long as Carl leads a fulfilling life—even if it is merely fulfilling by human standards and not those of his species—his impairment is no evil. Indeed, we might even take the above story to be a reductio ad absurdum of an Aristotelian picture of species as having norms attached to them with it being a harm to one to fall short of these norms.

Second, one argue that principle (1) does not actually apply to the case. For there is a difference of goods in saving Carl: you are saving a member of a superintelligent species, while in the case of saving Bob, you are saving a mere human. For this to fit with the intuition that it’s a toss-up whether to save Bob or Carl, it has to be the case that what the superintelligence of his species adds to the reasons for saving Carl is balanced by what his abnormally low intelligence subtracts from these reasons.

Of these options, I am more attracted to the second. And the second has an interesting and important consequence: "mere" membership in a natural kind can have significant value. This has important repercussions for the status of the human fetus.

Medical conscience exemptions

After listening to a talk by Christopher Kaczor, and the ensuing discussion, I want to offer a defense of a moderate position on the state not compelling healthcare professionals to violate their conscience, even when their conscience is unreasonably mistaken. I think a stronger position than the moderate position may be true, but I won’t be defending that.

This is the central insight:

1. It is a significant harm to an individual to violate their conscience, even when the conscience is irrationally mistaken.

One reason that (1) is true is the Socratic insight is that it is much better to suffer wrong than to do wrong, together with the Conscience Principle that to act against conscience is always wrong.

My argument will need something a bit more precise than (1). For convenience, I will stipulate that I use “grave” for normative considerations, goods, bads and harms whose importance is at least of the order of magnitude of the value of a human life. The coincidence that “grave” not only means very serious but also place of burial in English—even though the etymologies are quite different—should remind us of this. When you read the following, whenever you read “grave” and cognates, don’t just read “serious”, but also imagine a grave.

Then what I need is this:

2. It is a grave harm to a conscientious individual to gravely violate their conscience, even when that conscience is unreasonably mistaken.

(I suspect this is true even if one drops the “conscientious” and “gravely”, but I am only defending a moderate position.) The reasons for (2) are moral and psychological. The moral reasons are based on the aforementioned Socratic insight about the importance of avoiding wrongdoing. But there are also psychological reasons. A conscientious person identifies with their conscience in such a way that gravely violating this conscience is shattering to the individual’s identity. It is a kind of death. It is no coincidence that the Catholic tradition talks of some sins as “mortal”.

Next, here is another reasonable principle:

3. Normally, the state should not require a healthcare professional to provide care when the care is likely to come at a grave cost to the professional.

For instance, the state should not require a healthcare professional to donate her own kidney to save a patient. For a less extreme case that I will consider some variations of, neither should the state require a professional who has a severe bee allergy to pass through a cloud of bees to help a patient when allergy reaction drugs are unavailable and when other professionals lacking such an allergy are available.

In order for (3) to be useful in pracice, we need some way of getting rid of the “Normally” in it.

Notice that (3) is true even when the grave cost to the professional results from the professional’s irrationality. For instance, normally a healthcare professional who has a grave phobia of bees should not be required to pass through the cloud of bees, even if it is known that the professional would not be seriously physically harmed. In other words, that the cost results from irrationality does count as an abnormality in (3).

Under what abnormal conditions, then, may the state require the professional to offer care that comes at grave cost to the professional? This is clearly a necessary condition:

4. The need is grave.

But even if the need is grave, if someone else can offer the care for whom offering the care does not come at a grave cost, they should offer it instead. If the way to save a patient’s life is for one doctor to pass through a cloud of bees, and there is a doctor available who is not allergic to bee stings, then a doctor who is allergic should not be made to do it. Thus, we have this condition:

5. There is no way of meeting the need without someone being required to take on a likely grave cost.

We can combine these two conditions into a neater condition (which may also be a bit weaker than the conjunction of (4) and (5)):

6. If the care is not provided by this professional, a grave harm will likely result to someone.

This suggests some principle like this:

7. Unless failure of this professional to provide this instance of care will likely result in a grave harm, the state should not require a healthcare professional to provide care when the care is likely to come at a grave cost to the professional.

Now we go back to (2), the claim about the grave cost of violating conscience. Let us charitably assume that most medical professionals are conscientious, so that any given medical professional is likely to be conscientious. Then we get something like this:

8. Unless failure of this professional to provide this instance of care will likely result in a grave harm, the state should not require a healthcare professional to provide care that gravely violates their conscience, even when that conscience is unreasonably mistaken.

But this cannot be the whole story. For there are also conditions that render one incapable of doing central parts of one’s job. For instance, someone with a grave phobia of fires should not be allowed to be a fire fighter. And while a fire fighter with that grave phobia should not be made to fight a fire when someone else is available, if they had the phobia at the time of hiring, they should not have been hired in the first place. And if they hid this phobia at the time of hiring, they should be fired.

We have, however, a well-developed societal model for dealing with such conditions: the reasonable accommodations model of disability legislation like the Americans with Disabilities Act. It is reasonable to require an office building to put in a ramp for an employee in a wheelchair who is unable to walk; it would be unreasonable for a bank to have to hire a guard specially to watch a kleptomaniac teller. What is and is not a reasonable accommodation depends on the centrality of an aspect of a job, the costs to the employer, and so on.

So my moderate proposal says that we handle the worry that a particular conscientious objection renders a professional incapable of doing their job by analogy to the reasonable and unreasonable accommodations model, and qualify (8) by allowing in hiring or licensure the requirement that the accommodations for a conscientious restriction on practice would have be reasonable in ways analogous to reasonable disability accommodations. A healthcare professional who has only one hand could, I assume, be reasonably accommodated in a number of specialities, but likely not as a surgeon.

The disability case also should push us towards a less judgmental attitude towards a healthcare professional whose conscientious objections are unreasonably mistaken. That an employee became a paraplegic from unreasonable daredevil recreational activity does not render the employee uneligible for otherwise reasonable accommodations.

What about the worry about the rare cases where a healthcare professional has morally repugnant conscientious views that would require discriminatory care, such as refusing to care for patients of a particular race? Could one argue that if patients of that race are rare in a given area, then allowing a restriction of practice on the basis of race could be a reasonable accommodation? We might imagine an employee who has panic attacks triggered by a particular rare configuration of a client’s personal appearance, and that does seem like a case for reasonable accommodations, after all.

Here I think there is a different thing to be said. We want our healthcare professionals to have certain relevant moral virtues to a reasonable degree. Moral virtues go beyond obedience to conscience. Someone with a mistaken conscience may not be to blame, for the wrongs they do, but they may nonetheless lack certain virtues. The case of the conscientious racist is one of those. So it is not so much because the conscientious racist would refuse to care for patients of a particular race that they should not be a healthcare professional but it is because they fail to have the right kind of respect for the dignity of all human beings.

One may think that this consideration makes the account not very useful. After all, a pro-life individual is apt to be accused of not caring enough for women. Here I just think we need to be honest and reasonably charitable. Caring about the embryo and fetus has human dignity does not render it less likely that one cares about women. Compare this case: A vegan physician believes that all higher animal life is sacred, and hence refuses to prescribe medication whose production essentially involves serious suffering of higher animals. Even if such a physician’s actions might cause harm to patients who need such (hypothetical?) medication, the belief that all higher animal life is sacred is not evidence that the physician does not care about such patients–indeed, it seems to render it more likely that the physician thinks the patients’ lives to be sacred as well, and hence to be cared for. There may be specialties where accommodation is unreasonable, but the mere fact of the belief is not evidence of lack of relevant virtues.

Impairment and non-human organisms

Consider a horse with three legs, a bird with one wing, an oak tree without bark, and a yeast cell unable to reproduce. There is something that all four have in common with each other, and which they also have in common with the human who has only one leg. And it seems to me to be important for an account of disability to acknowledge that which all these five organisms have in common. If the right account of disability is completely disjoined from anything that happens in non-human organisms—or even from anything that happens in non-social organisms—then there is another concept in the neighborhood that we really should also be studying in addition to disability, maybe “impairment”.

Moreover, it seems clear the thing that the five organisms in my examples have in common is bad as far as it goes, though of course it might be good for the organism on balance (the one-winged bird might be taken into a zoo, and thereby saved from a predator).

Are we all seriously impaired?

When I taught calculus, the average grade on the final exam was around 55%. One could make the case that this means that our grading system is off: that everybody’s grades should be way higher. But I suspect that’s mistaken. The average grasp of calculus in my students probably really wasn’t good enough for one to be able to say with a straight face that they “knew calculus”. Now, I think I was a pretty rotten calculus teacher. But such grades are not at all unusual in calculus classes. And if one didn’t have the pre-selection that colleges have, but simply taught calculus to everybody, the grades would be even lower. Yet much of calculus is pretty straightforward. Differential calculus is just a matter of ploughing through and following simple rules. Integral calculus is definitely harder, and exceling at it requires real creativity, but one can presumably do decently just by internalizing a number of heuristics and using trial and error.

I find myself with the feeling that a normal adult human being should be able to do calculus, understand basic Newtonian physics, write a well-argued essay, deal well with emotions, avoid basic formal and informal fallacies, sing decently, have a good marriage, etc. But I doubt that the average adult human being can learn all these things even with excellent teachers. Certainly the time investment would be prohibitive.

There are two things one can say about this feeling. The first is that the feeling is simply mistaken. We’re all apes. A 55% grade in calculus from an ape is incredible. The kind of logical reasoning that an average person can demonstrate in an essay is super-impressive for an ape. There is little wrong with average people intellectually. Maybe the average human can’t practically learn calculus, but if so that’s no more problematic than the facts that the average human can’t practically learn to climb a 5.14 or run a four-minute mile. These things are benchmarks of human excellence rather than of human normalcy.

That may in fact be the right thing to say. But I want to explore another possibility: the possibility that the feeling is right. If it is right, then all of us fall seriously short of what normal human beings should be able to do. We are all seriously impaired.

How could that be? We are, after all, descendants of apes, and the average human being is, as far as we can tell, an order of magnitude intellectually ahead of the best non-human apes we know. Should the standards be another order of magnitude ahead of that?

I don’t think there is a plausible naturalistic story that would do justice to the feeling that the average human falls that far short of where humans should be at. But the Christian doctrine of the Fall allows for a story to be told here. Perhaps God miraculously intervened just before the first humans were conceived, and ensured that these creatures would be significantly genetically different from their non-human parents: they would have capacities enabling them to do calculus, understand Newtonian physics, write a well-argued essay, deal well with emotions, avoid fallacies, sing decently, have a good marriage, etc. (At least once calculus, physics and writing are invented.) But then the first humans misused their new genetic gifts, and many of them were taken away, so that now only statistically exceptional humans have many of these capacities, and none have them all. And so we have more geneticaly in common with our ape forebears than would have been the case if the first humans acted better. However, in addition to genetics, on this story, there is the human nature, which is a metaphysical component of human beings defining what is and what is not normal for humans. And this human nature specifies that the capacities in question are in fact a part of human normalcy, so that we are all objectively seriously impaired.

Of course, this isn’t the only way to read the Fall. Another way—which one can connect in the text of Genesis with the Tree of Life—is that the first humans had special gifts, but these gifts were due to miracles beyond human nature. This may in fact be the better reading of the story of the Fall, but I want to continue exploring the first reading.

If this is right, then we have an interesting choice-point for philosophy of disability. One option will be to hold that everyone is disabled. If we take this option then for policy reasons (e.g., disability accommodation) we will need a more gerrymandered concept than disability, say disability^*, such that only a minority (or at least not an overwhelming majority) is disabled^*. This concept will no doubt have a lot of social construction going into it, and objective impairment will be at best a necessary condition for disability^*. The second option is to say only a minority (or not an overwhelming majority) is disabled, which requires disability to differ significantly from impairment. Again, I suspect that the concept will have a lot of social construction in it. So, either way, if we accept the story that we are all seriously impaired, for policy reasons we will need a disability-related concept with a lot more social construction in it.

Should we accept the story that we are all seriously impaired? I think there really is an intuition that we should do many things that we can’t, and that intuition is evidence for the story. But far from conclusive. Still, maybe we are all seriously impaired, in multiple intellectual dimensions. We may even be all physically impaired.

Treatment and enhancement

Let's grant that my ability to use my hands is normal. Suppose a world-class violin maker loses the little finger on her non-dominant hand. This slightly impedes her ability to use her hands. But the incredible amount of gross and fine motor skills that a top violin maker needs to have exceed my own merely normal skills to such a degree that she is going to do better in any non-gerrymandered manual activity (wiggling ten fingers is gerrymandered!) than I.

But my own abilities are normal. So if her abilities exceed mine, how can hers fail to be normal? Yet it seems clear that to the extent that reattachment of the finger would be treatment rather than enhancement, even though it takes someone whose abilities are above normal, and raises her even higher above what is normal.

So we should not define the kind of abnormalcy or disability that calls for medical treatment in terms of a below-normal degree of overall function. For overall function is affected by compensation—the violin-maker's manual skills compensate for her genuine loss. Rather, we must look at something like local function, the function of a particular bodily subsystem. And here it is clear that when she lost her finger, she lost the full use of a subsystem. Disability is the loss of the full functioning of a subsystem, not necessarily of the whole.

But now here we have an interesting thing. An operation that destroys the functioning of a bodily subsystem that otherwise would have functioned properly, even if it does not adversely affect—or maybe even enhances—overall functioning of the person, nonetheless is producing a disability. Now a physician should be a healer. Sometimes to heal one must destroy a subsystem—amputating a gangrenous limb is an example. Even in those cases, the destruction is a moral reason for the physician not to do the operation, though a reason that may well be outweighed (as it is in the gangrenous limb case) by the need for healing.

But this is far more problematic when the destruction of a subsystem is not done in order to heal the system as a whole, even if in some way the person as a whole benefits. Suppose Sam has a job that consumes all his waking hours and involves no contact with people, and his normal interest in social relationships makes him less good at his job. Moreover, suppose the sad economic realities are such that he has no hope of another job. He is going to live a life of loneliness and unfulfilled sociality. Should we give him drugs that would destroy his sociality? Such drugs would improve his life, after all. Yes: but they would do so by destroying a subsystem. And their positive effect would not be a form of healing—at most a form of enhancement at adaptation to unfortunate circumstances. So there is strong—I think conclusive—moral reason why a physician should not give Sam the drugs.

And the same line of thought applies in a much more controversial, because more realistic, case: sterilization.

An argument from physical disability against naturalism

1. On average, severely disabled people report not being dissatisfied with life.
2. Thus, probably, on average severely disabled people are rightly not dissatisfied with life.

The defeasible inference is due to the presumption in favor of the correctness of people's judgments about their wellbeing.

But (2) is very surprising on naturalism. Given naturalism, one would expect that human wellbeing be extremely tenuous, and that any significant downward push, such as from disability, should push people into the illbeing range. The theist, on the other hand, has a rather better explanation of (2).

Of course the naturalist can talk about evolutionary and social mechanisms that make severely disabled people report satisfaction even though their lives are on balance unsatisfactory. But that isn't a naturalistic explanaton of (2). It is an explanation of (1) coupled with a patronizing denial of (2).

The theist, like the naturalist, might question people's self-reports. But she could also accept (2). Of course, the theist will then have a serious problem of evil in the case of the large numbers of severely disabled people whose life satisfaction self-report is negative. But since the theist has very good reason to think that life continues infinitely beyond death, a dissatisfaction—even a rightful one—over a finite initial period is not perhaps quite that surprising.

Fetal and our potentiality

Consider this standard story:

Whatever value fetuses have derives from their potentiality (and here various distinctions matter) to grow into humans that actually have various valuable features, features that are not simply potentialities. Typical human adults actually have the valuable features that ground their moral status, while fetuses only potentially have these features. The question of the moral status of the fetus, then, is the question of how far their potentiality makes it possible to extend to them the moral status that typical human adults have (and, likewise, to extend the moral status of typical human adults to atypical ones).

I have argued in earlier posts that the kind of potentiality fetuses have does call for the extension of moral status. But I now wonder if this whole line of thought doesn't presuppose a mistaken view, namely that the moral status of typical human adults is grounded in the actual possession of valuable non-potentiality features. Specifically, I worry that this line of thought has too optimistic a view of the human race.

The feature of human beings that matters most centrally seems to be the moral life. But in practice our moral life just isn't all that good. We are full of self-deceit, akrasia and dollops of malice, in different combinations. Is it really the case that typical human beings are morally good in such a way that their actual moral goodness gives them the kind of moral status we are thinking about?

And in any case, even if, say, 70% of adult human beings do have such moral goodness, what about those of us who are in the other 30%? They, too, have moral status. No matter how many crimes one has committed previously, no matter how wicked one is, one has the moral and legal right to a fair trial, to a punishment that does not exceed the gravity of the offense.

What I said about the moral life also goes for the intellectual life: the typical human's intellectual life just isn't much to be proud of. Just think of all the fallacious forms of reasoning we engage in. Plus, I do not know how central the intellectual life is to moral status. Suppose there was a race of super-intelligent mathematicians who had no drive but to prove interesting theorems and no moral life to speak of. Would they have the kind of moral status humans have? I don't know. (It could be that they would have to have the rudiments of a moral life, in that they would have to be attuned at least to the values of truth and beauty to practice mathematics well. So it could be that the thought experiment is impossible.)

Now, it may well be that the above thoughts are too pessimistic. The George MacDonad quote here seems quite significant. But I still think this is worth thinking about, and I think there is something to the idea that the moral status of typical adult humans comes not so much from actual valuable properties, but from their innate potentiality for the good moral life. It is what we should (eventually?) be, not what we are, that is central to our dignity on this suggestion.

Abortion for fetal disability

Even some on the whole pro-life people think that an abortion because of fetal disability can be justified. But such an abortion suffers from a particular vice. I am not saying it is worse than other kinds of abortion, since these others may have their particular vices, too, but it is morally bad in a uniquely problematic way.

The problem is that in such an abortion, a child is killed by one or both parents for not measuring up to a standard through no fault of her own. A way of seeing what is problematic with such an abortion is to reflect on the disposition of a couple who would have had such an abortion if their child had turned out to have a disability of a certain magnitude, but because their child either did not have a disability, or did not have a disability of that magnitude, they did not abort. Such a couple, unless they have changed their attitude (as hopefully they have), do not seem to love their child unconditionally. For they had a standard such that had their child not measured up to it, they would have had the child killed.

What I said above assumes that the fetus is the numerically same individual as the later child. I have argued for this thesis elsewhere, but to those who are not convinced by that thesis, what I said above will not be convincing. However, if one is generally pro-life, one likely accepts this thesis, and hence one should accept that to have a disposition to abort should there be a sufficiently serious disability--whether or not one acts on that disposition--is morally deeply problematic, both in regard to a child who is aborted and in regard to a child who is not.

I also think the above considerations have some weight even if one drops the assumption that the fetus is the numerically same individual as the later child, but instead assumes--as seems very plausible--that the fetus is sufficient to determine the identity of the later child. (I.e., that it is false that in one world, fetus A grows into child B, while in another world, the same fetus A grows into a numerically distinct child B.) For in such a case, we can reasonably say that to judge whether or not to abort on the basis of what the child is going to be like is indeed to pass judgment on that later child, since there is a definite possible future child whose numerical identity is already determined, and to do that is to endanger unconditional love for that child should that child live. (This is different from a case of contraception, where typically there is no definite child determined at the time the contraception is used; it may be that some argument like this can be adapted into an argument against contraception, but this argument as it stands does not of itself seem to prohibit contraception.)

This argument is a special case of one that I have made elsewhere. But I think the case of disability is a particularly clear case of the more general problem. To give credit where credit is due, both arguments are inspired by insightful remarks Wilfried Ver Eecke once made in a conversation with me about unconditionality of love, psychoanalysis and abortion.

Evil, privation and disability

Theism entails that evil is not a positive reality, since all positive reality either is God or is continually sustained in existence by God. Augustine thinks that evil is a privation of good. A privation is more than a lack. Leglessness in a dog is a privation, but in a snake is just a lack. If evil were just a lack, then the problem of evil would be easily solved by the consideration that, of necessity, everything other than God is lacking, since only God is infinite. I want to suggest that seeing evil as a privation of good still helps vis-a-vis the problem of evil. This argument continues two earlier posts of mine on prosblogion which discuss an Augustinian theodicy (Part I; Part II).

Imagine two closely related alien species, the flerts and the grents. Both are four-legged, and have basically the same habits. Flerts and grents are solitary and reproduce asexually, never knowing their parents (e.g., the parents produce spores which mature away from them), but the flerts have wings in addition to their four legs and can fly away from predators, while the grents are confined to the ground. Suppose now that Gribby is a normal grent, while Flibby is a flert that, due to a genetic defect, never developed wings.

Winglessness is a lack in Gribby and a privation in Flibby, but unless Gribby and Flibby observe their conspecifics, they are not going to know this. It is not an evil that Gribby is stuck on the ground, but it is an evil that Flibby can't fly. But Gribby and Flibby look and behave in pretty much the same way. They eat the same food, they have to run from predators and cannot fly from them, and so on. They have the same joys and the same pains, and they live pretty much the same lives. All this makes plausible the following:

Claim: Flibby is not worse off than Gribby.

I think this claim is plausible. One might think that Flibby is worse off because he suffers from an evil from which Gribby does not suffer. But "suffers" here is a tendentious choice of word. There is no conscious suffering here, we may suppose. We could imagine that when Flibby is faced with a predator he feels an urge to fly and the inability to fly is painful to him; but we can also suppose--and let us do so--that Flibby also has a second privation, namely that his instincts to fly are missing. Flibby suffers from an evil merely in the sense that he is subject to an evil. But his life is just like Gribby's, and the concrete goods that Gribby's life instantiates are also instantiated by Flibby's life. Another way to see this is to imagine some minor concrete good that Flibby has but Gribby does not. Maybe, Flibby happens to be a slightly better at fishing than Gribby is. Then, if per impossibile we were choosing whether to be Flibby or to be Gribby, we would be very reasonable in choosing to be Flibby. But if Flibby is worse off than Gribby, he is significantly worse off--winglessness is not a minor evil. So if Flibby is worse off than Gribby, it wouldn't be all that reasonable to choose to be Flibby just for some minor concrete good.

Still, it's undeniable that Flibby is subject to an evil, while, as far as the story goes, Gribby is not. We now have two conflicting intuitions: first, that Flibby is no worse off than Gribby, and, second, that Flibby is worse off than Gribby, because Flibby is subject to an evil that Gribby is not subject to. I want to argue that the second intuition is mistaken. For Flibby has a more distinguished nature--by nature he has the dignity of being a winged creature. This good that he possesses, the good of being by nature winged, is a good that Gribby does not have. Because he has this good, he is capable of being subject to an evil that Gribby is not--viz., the evil of being deprived of wings. The additional good outweighs or cancels out the additional evil. Hence, we can consistently say that Flibby is no worse off than Gribby even though Flibby is subject to an evil that Gribby is not.

I want to suggest, now, that if Gribby would have no right to complain to God about being created a grent, likewise Flibby would have no right to complain to God about being created a flert without wings.

Evil is not just a lack but a privation. However, possessing an evil also means one possesses a certain good, namely the dignity of being such as to naturally have the good that the evil deprived one of.

In particular, it follows that while an adult whose intellectual functioning is like that of a child thereby is subject to an evil, the developmentally challenged adult is not thereby less well off than the child. (She may be thereby worse off if she compares herself to others, or if others treat her poorly.)

How far one can take these thoughts in the direction of a theodicy, I do not know.