[This post is the ninth in our new series of Thinking in Action posts, the series being devoted initially at least to discussion of talks at the Cognitive Disability conference in NYC in September. The first post in the series is here and the posts run Tuesdays and Fridays.]
In their talks at the disability conference, Anita Silvers and Leslie Francis look at questions about the role of the individual in the process of coming up with the things the person perceives as what is good for them, which includes reasons and motivations for accepting these goods as the person’s own. This is what is typically referred to as “a conception of the good” in the academic literature on social justice. Silvers and Francis argue that the accounts offered by Rawls and Nussbaum characterize this process in a way that is problematic for those with significant cognitive disabilities because they play up importance of the independence of the individual in coming up with their own good. If we adopt a picture of the individual as independent in this way, then it looks like those with cognitive disabilities will be excluded and left without any way to guard against being exploited by others in society. Is there a way to include individuals with severe cognitive disabilities in the process of conceiving their own good and in exercising their conception of the good to the degree required for social cooperation?
The answer, according to, Silvers and Francis in their talks, is ‘yes’. However, an account that includes those with significant cognitive abilities requires a shift in focus from independence to collaboration. The way in which Silvers and Francis suggest we make this shift is what I want to focus on. Part of their task involves expanding the picture by reframing the notion of conceiving of the good as a collaborative process, which involves “a reasonable dependence” on others in coming to one’s conception of the good. One way to illustrate the direction of the revision, which includes moving away from independence and toward reasonable dependence, is the use of trusteeship as a prosthetic process for those with cognitive disabilities. This way of thinking about collaboration and prosthetic processes in this way assists cognitively disabled individuals in coming up with their own good as well as with their interaction with others in coming up with a conception of the good for society (and thereby justifying justice). Before I get to questions about how we are meant to understand prosthetic processes, I’ll talk a bit about the role of independence and why Silvers and Francis find it problematic.
This is contrasted with Rawls’ and Nussbaum’s accounts of political liberalism, each of which relies on its own picture of persons as independent in the process of coming to their conception of the good. The emphasis on the role of independence within the individual’s process of arriving at and revising their conception of the good on their own has been the basis for the claim that his account of justifying justice excluded people with significant cognitive disabilities. And it is the independence of the individual in this way that invokes a “metaphysics of independence.”
What exactly does a metaphysics of independence refer to? While the collaborative approach clearly aims to avoid the metaphysical independence assumptions, it’s unclear that they succeed. I found it difficult to keep track of the work ‘metaphysics’ and ‘independence’ were meant to do. Sometimes, when presented as a differentiating claim about conceptions of the good for example, independence is used to promote the idea that each person comes to their conception of the good on their own. Other times it was a substitute for Kantian rationality. I can see why an attempt to offer an approach sensitive to taking seriously the equal value of persons that includes those with severe cognitive disabilities would reject a presumption of the superiority of full-blown Kantian rationality. However, with regard to the question of what counts as doing something “on one’s own” I am unclear as to whether there is a substantive disagreement.
The attempt to make clear the notion of trusteeship as a prosthetic, or partnered, process provides a potential answer. This task appears, at least on the surface, to recognize the importance and priority (or perhaps subjective nature) of an individual’s participation in their conception of justice. The main point of departure, as far as I can see, comes from focusing on the fact that everyone depends in some way or another on others in order to do pretty much anything. If we grant this, which seems reasonable enough, then we are committed to admitting our dependency on others. More importantly, we are dependent on others, particularly on those in our society, in or own process of coming to our conception of justice. Those with significant cognitive difficulties merely require more assistance from, dependence on, and collaboration with others, in what seems to be an instrumental way if we are to take the prosthetic metaphor in the obvious interpretation, in order to do things like become aware of and participating in the project of conceiving justice. The work trusteeship-as-prosthesis in assisting the severely cognitively disabled makes sense if we understand it as promoting their functioning with regard to this project in any relevant ways other individuals would. If this is in fact the purpose, then the prosthetic picture still employs a notion of a person that is arguably independent (as the subject of experiences perhaps?), but it emphasizes the need for interdependence at the social level for the severely cognitively limited, and indeed all of us, when we engage in the construction of justice. So what’s left?
Putting aside any of my usual concerns about metaphysics, I found the general ideas about collaborating, trusteeship, and including more persons in our conception of the good put forward by Silvers and Francis to be ones I could agree with, give or take a detail, and that I would like to hear more about.
That said, I was not quite sure what to do with Silvers’ answer to Henry Richardson (Georgetown) in the Q&A. Richardson asks if we should understand the notion of prosthetics in a very standard way; a prosthetic is used to reveal what a person can do. For example, a prosthetic for a runner reveals what the runner can do. But if this is how we’re meant to understand prosthetics, it seems to undercut the claim of dependency. To this Silvers responds by saying that the purpose of the prosthetic process as they intend reveals the personhood of the person. It does not reveal what the person can do. And this notion of prosthesis introduces a notion of dependency.
I am hopeful that some of you might offer your thoughts on what it means to say a prosthetic process reveals the personhood of the person in a way that is (significantly) different from revealing what they can do, particularly with regard to the discussion of trusteeship as a prosthetic process.
Partial transcript below
Richardson: I was puzzled by what seems to be a point of tension at least at the rhetorical level of your talk between talk of prostheses and talk of dependence. I was wondering how this fits with Eva’s work on the importance of recognizing dependency. The prosthetic as you were describing it allows/reveals what the person can do. So that the prosthetic for the runner allows the person to reveal what the person can do. the trustee is prosthetic process is used to reveal what the person can do. A prosthetic for a runner reveals the person’s mobility. If the trustee acts as a prosthetic then the trustee is revealing what the person can do, [Silvers corrects him to say that they provide prosthetic processes], okay take it that way, the trustee is providing prosthetic processes which is revealing what the person can do. If it does reveal what the person can do, then the person can, I suppose, independently choose a conception of the good. So it seems to be undercutting your critique of Rawls in the second part of the paper. So I would have thought that the recognition of dependency and wanting to recognize that would push you away from the language of prosthetics.
Silvers: First of all, it doesn’t reveal what the person can do, it reveals the personhood of the person. We use the language of being dependent on artificial legs, on wheelchairs, on crutches all the time. And so this notion of prosthesis introduces a notion of dependency. But what we argue is that for anybody in a process of arriving at a personalized notion of the good, everybody is dependent on contributions from other people and in some of our earlier papers we’ve given more descriptions of this. [she continues a bit further, but it doesn’t seem relevant.]
Trustees as prosthetics to reveal the “personhood of the person” sounds like the person is already there, intact, needing some help to be recognized. That may be an appropriate conception when there is coarticulation and assistance in the articulation of one’s own good, but potentially misleading in other cases where one comes to articulate on behalf of another: instead of the person with dependency contributing to an articulation of her own conception of the good, others come to act for that person. One can do a better or worse job of acting as a trustee in such cases, but “prosthetic aid” doesn’t seem to do justice to the nature of the intervention.
Prostheses, cognitive or otherwise, are extensions of a person and the capacities that she has. I’m all up for such extensions, cognitive and otherwise: bring on the extended mind, I say. But they are such extensions because there’s already agency (of a certain kind) that they’re extensions of. Parents often act prosthetically in this sense. But they can also act in the place of agents themselves–e.g., by manipulating or deceiving them–and when they do, this doesn’t seem adequately captured by talk of prosthetic extension of an agent’s capacities, or their “personhood”.
[Because Angie has reposted her remarks under her own name, my comment to the post was deleted. I have resubmitted the comment with some editorial adjustments intended to clarify its content. – ST]
I would like to pose a question or set of questions that arises for me from this post, but which has also stood out as an issue for me in regard to other posts and comments in the series thus far. I hope that Angie won’t view this comment as diverging too far from the issues she dealt with in her thoughtful post. My comment is concerned with medicalization, language, signification, and classification.
I have already indicated my dissatisfaction with the term “people with disabilities,” in all of its variations. Bearing that in mind, let me ask the following: Why do many disability theorists, researchers, philosophers of disability, etc. regard it as acceptable, useful, relevant, politically appropriate, necessary, informative, and so on and so forth, to modify or enhance(?) those terms (people with disabilities, has a disability, etc.) with others such as “significant,” “severe,” “profound,” “moderate,” etc. ? In my view, these terms (not to mention what they modify) are remnants of a medicalized conception of disability, according to which disability is a property or characteristic of individuals. Now, I realize that the latter terms are also used in adverbial form (e.g., severely) to modify/enhance the term ‘disabled’. Same difference. Moreover, I think that the latter terms are often used because (as I have suggested elsewhere in the comments) two different conceptions of disability are being confused or collapsed into each other.
I would be very interested in reading some justification or explanation for the continued use of terms such as “severe disability,” “profoundly disabled,” etc. What work are they meant to do? What work are they actually doing? Is there a gap, or even a gulf, between what speakers intend them to do and what they are actually doing? What is their performative value or force? For whom does it hold this value? This force? And why? What are the implications of these terms? Their (perhaps) unintended consequences? Or perhaps they are believed to be somehow a neutral description like eye colour. How can this be?
Thanks for taking the time to send your post again. I would be interested to see answers to the questions you posed as well. I tend to work on questions about “mental illness/disorders” which has similar terminological complications. I have yet to find neutral terms that are able to describe the difficulties and differences those who suffer (though they sometimes benefit) from mental illness while at the same time avoiding implications that these people are somehow lacking when it comes to considerations of personhood.
From a perspective of justice or equity I can only venture a guess about what work these kinds of terms are intended to do. It seems to me, if we’re trying to construct a society which is roughly egalitarian, then it’s important to recognize that different people require different goods in different amounts. So, to say that someone is cognitively disabled (or challenged?) is just to trigger recognition that they will need more assistance in some areas than others. Of course, this is not to say I enjoy the terms. One of the points made by Silvers and Francis I found most friendly to eliminating terms like severly cognitively disabled (even though they used this term) was that we are all dependent on each other in many ways. If we recognize this, then we can see that dependency differs in degree rather than in kind. This may or may not be true, but it at least pointed in a direction that could move away from disability terminology.