Conceptualizing Disability as a Public Health Issue: Impairment, Enhancement and Emerging Biotechnologies

Introduction :

There is broad evidence indicating that the total number of persons experiencing disability has increased substantially in recent times, and that this is partly due to the development of medical technology. Very premature babies who previously would have died, and older persons who have suffered a significant cerebrovascular event (that formerly would have been catastrophic) constitute just two groups of individuals who now survive what would have been a fatal insult in the recent past. This ‘epidemic of survival’ has created a cohort of people who live with disability as an unintended consequence of their treatment. Emerging biotechnologies offer the possibility to affect and transform (and disrupt) many aspects of life of those labelled as having a disability. In recent decades, developments in prosthetics technology and other biotechnologies designed to restore ‘impaired’ physical functioning have raised pressing ethical, social and legal questions about the category of ‘disability’. In emerging fields such as biomechatronics—technology that combines human physiology with electromechanics—we see much more than the restoration of the body to some notion of ‘native’ or ‘normal’ functioning, but the concrete possibilities of super human enhancement (consider the case of Oscar Pistorisus who was barred in 2008 from competing for a slot on the South African track and field Olympic team because his prosthetic legs gave him an unfair advantage over the ‘able’ bodied runners). As the possibilities for bodily ‘restoration,’ enhancement and augmentation arising from emerging biotechnologies, in the context of ‘correcting’ disability, become concrete realities, pressing questions emerge within public health policy, biomedicine and disability ethics. These questions concern both conceptual challenges in terms of delimiting concrete categories, with respect to parameters such as ‘treatment’, ‘enhancement’, ‘normal’, ‘disability’ and ‘impairment’, while also concerning practical matters for public health bodies regarding the allocation of resources, research and development of biotechnologies, the ‘ability rat race’ (raising the bar of what is considered ‘normal’ or ‘adequate’ functioning), issues around inclusion and exclusion with respect to treatment and services, and the extent to which restrictions on enhancement technologies are ethically defensible. Theoretically the possibilities for the development of disability-diminishing technologies are limitless but only a fraction of these may ever be developed. How is technology development prioritised – does it relate solely to profitability? Should prioritisation depend on the societal benefits that might be expected to deliver to those with the greatest need rather than on the fiscal gain? Should pubic policy have a role in determining which technologies are developed and made available?

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