Biomedical Engineering Reference
In-Depth Information
have dismissed such reports as products of denial or self-delusion. They have
been prompted in doing so by a medical value system that finds it hard to
imagine patients enjoying a high quality of life unless they are cured.
Engineering ethics equally has discounted disabled people's views about
their own good, but for a different reason. Disabled people have been viewed
not as employers or clients, but instead as being subject to the decisions of
the real purchasers, namely, physicians or other therapeutic or rehabilita-
tion professionals, family members, or insurance systems. Engineering ethics
has tended to adopt these nondisabled people's attitudes toward the dis-
abled and for this reason has not granted primacy to disabled people's self-
determination based on their own ideas of the good for themselves.
1.4 The Standard of Normality
Both systems - medical and engineering - presume that the aim of their
efforts is to restore the disabled person as closely as possible to normality,
understood as species typicality. For medicine, species typical or normal func-
tioning is a component of health [
10
]. So for medicine, restoration to normal
functioning is therapeutic, or at least rehabilitative. Moreover, the closer to
normal functioning a person can achieve, the more comfortable the fit with
the usual ways of doing things and the less trouble for everyone else who
interacts with that person. Returning differently functioning individuals to
species typicality therefore may seem to contribute to the general welfare,
which aligns with the value engineering ethics places on preserving the pub-
lic good. Therefore, or at least so it may have seemed, the aims of medical
engineering's clients appear consistent with engineers' commitment to the
general good.
Adopting species typical functioning as a standard has both benefits and
costs. The impaired individual who can be made as good as new escapes the
social disadvantages aimed at disability, and society escapes the issues around
providing disabled people with special care. Society benefits insofar as one-
size-fits-all social arrangements meant only for the species typical may be
simpler to organize than practices allowing all to participate. Inclusive prac-
tice must be flexible and nuanced in order to respond to people's differences.
Further, to the extent that everyone functions alike, resentment from nondis-
abled people about special accommodations privileging disabled people, and
from disabled people about ordinary social arrangements privileging nondis-
abled people, disappears.
On the other hand, efforts to make disabled people as good as new also
have costs, both to society and to the subjects themselves. When normality is
the standard that social arrangements expect participants to meet, disabled
people feel themselves under great pressure to become as normal as possible,
