Should we give preference to rogini? an ethical perspective on disability, health inequalities and work

Tamin, Jacques (2018). 'Should we give preference to Rogini? An ethical perspective on disability, health inequalities and work' Paper presented at the annual conference of the HDCA, Buenos Aires, Argentina 2018.


Abstract


Key words: Disability, health inequalities and work; capability approach; ethical framework; social justice


Introduction


Sen describes a conundrum where one has to choose to whom we offer a job, and therefore some income, out of three poor unemployed labourers[1]. Rogini is not the poorest of the three, but she is debilitated from a chronic ailment, which could be alleviated by the income. Should her chronic health condition and disability sway us to preferentially treat Rogini? This poster presentation presents a research proposal that argues disability can lead to disadvantages in terms of work and health. It will further argue that we should “give preference to Rogini”, that is, we should ameliorate mismatches between the capabilities of people living with disabilities and the socially constructed environment. My thesis is that the capability approach provides us with a normative framework whereby giving such “preference” can be justified.


Methods


The initial approach will be theoretical-analytical. The aim is to propose a normative framework based on the capability approach, to enable critical reflection. Where possible, this ethical framework will then be tested against already available empirical data, such as from health inequalities publications[2]. It will also be tested against UK disability legislation. In addition, it is possible that I will have access to primary data on ageing and disability (from the Manchester Institute for Collaborative Research on Ageing). Through these approaches, the theoretical Disability, Health inequalities and Work (DHW) model will be interpreted in a dynamic way in “real world” situations.


Discussion


There is evidence that “good” work can be health enhancing[3], so there is a prima facie case for encouraging those with chronic health conditions and disabilities to work.  However, persons with disabilities (PwD) have greater difficulties in accessing “good” work, and other opportunities to improve their health. Assistive technologies may improve access to work. However, there is a danger that those who are still unable to work to become further stigmatised (as “freeloaders”). The medical assessments ought to take into account the complex issues that PwD may have to face, and which may not adequately be reflected in the binary outcomes (“fit” or “unfit” to work). The actual social circumstances and support available to PwD will greatly help or hinder their gaining and maintaining paid employment successfully. The capability approach has been used in the context of disability[4] and health[5],  but the overall DHW framework would be a new contribution to this field. This project aims to provide the critical reflection which could ultimately inform policy in the areas of disability, health inequalities and work.


[1] Sen A. Development as freedom. Oxford University Press, 1999: 54-55.


[2] Such as WHO. The solid facts. 2nd edition, 2003.


[3] Waddell G and Burton AK. Is work good for your health and well-being? London, TSO:2006.


[4] Mitra S. Disability, health and human development. Palgrave Macmillan:2017.


[5] Venkatapuram S. Health Justice. Cambridge:2011.


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