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Autism – The Ethical Issues

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Autism – The Ethical Issues
Tim Cadman, PhD
Introduction
Aim:to introduce theethical, social and philosophical issuesOverview:Ethical issuesTheoretical backgroundMedicalvsSocial conceptions of autismHuman flourishingPractical questionsChoosing non-autistic childrenBehavioural interventionsResource allocationConclusions
What are the ethical issues?
Practical:Development of technology to choose non-autistic children(antenatal screening, selective implantation,termination)Acceptability of certain behavioural interventionsDecisions about the allocation of resources
What are the ethical issues?
Theoretical backgroundConceptualisation of autism (disordervsdistinct cognitive style)Humanflourishingand thequality of life of autistics
Theoretical issues 1: MedicalvsSocialConception of Autism
Medical model of disabilityStill dominant model in some quartersTo bedisabled is to be impaired in a way which inherently limits one’sfunctioningDisability is a ‘problem’ which lies with the affected personIt is a ‘harmed condition’
Theoretical issues 1: MedicalvsSocialConception of Autism
Social model ofdisabilityAcknowledgement of differences from the normImpairment ≠ disabilityImpairments disabling only because of circumstances of society (e.g.Achondroplasia)“Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society. Disabled people are therefore an oppressed group in society” (UPIAS)
Theoretical issues 1: MedicalvsSocialConception of Autism
MedicalAutism as a disorder (“ASD”)Autism as inherently impairingTreatment and cureSocialAutism as a distinct cognitive styleDifficulties caused by attitudes and structures of societyAutism analogous to ethnicity or sexuality
Theoretical issues 1: MedicalvsSocialConception of Autism
ConclusionNeither view is satisfactoryMore nuanced position required for autism: cluster of different propertiesSocial explanation persuasive for some difficulties, but not all.However, useful for debate to draw this distinction
Theoretical issues 2: Human flourishing
What does it mean for a life to go well for the person living it?ObjectiveCertainthings are good or bad for a person regardless of their attitudes to thosethingsE.g. safetyand security, friendship, sexual relationships, freedom to pursue one’s interests,knowledge, work, leisure.Overly paternalistic?SubjectiveExperiential accountDesire-satisfaction account
Theoretical issues 2: Human flourishing
Theory of well-being affects judgements about quality of life of autistic people.Example 1: Intellectual disabilityObjective and subjective accounts conflictExample 2: FriendshipObjective and subjective accounts may conflictHowever, many people with autism have unsatisfied desires for friendship – accounts can coincide
Practical issues 1: Choosing non-autistic children
Arguments in opposition to technologyStrong opposition from sections of autistic communityArguments from social model:mislocatesproblemNarrow conception of flourishingDiscrimination: implication that autistic lives have less value
Practical issues 1: Choosing non-autistic children
Arguments in favour of technologyReproductive autonomyGenuine concern about quality of lifeProcreative beneficenceBalancingautonomy with concerns about social harm
Practical issues 2: Behavioural Interventions
Are certain behavioural interventions harmful?E.g. interventions designed to reduce hand-flapping or encourageeye contact.These could cause anxiety and distressParticular worry as children aren’t able to consent to theseSocial model argues that there is nothing wrong with thesebehavioursInterventions should focus on improving well-beingAttitudes in society need to be tackled.
Practical issues3: Allocation of Resources
Where should resources be targeted?Research into causes and early identificationProviding support and enacting social changeIssue of intergenerational justiceDecision making process needs to be democraticInclude views of those with autism, philosophersand ethicists,carers, policy makers, scientists and thepublic
Conclusions
Complex theoretical and practicalissuesImportant to note diversity ofopinion within autistic communityAgreement may never be reachedKey is to involve range of opinion in debate

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Autism – The Ethical Issues