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Philosophical and Ethical Problems in Mental Handicap

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    Philosophical and Ethical Problems in Mental Handicap. By peter byrne (Pp175, £40.00). Published by Macmillan Press, Basingstoke, 2000. ISBN 0 312 23460 0.

    I cannot recommend this slim monograph highly enough to anyone working with people who have the disorders of neurological development that give rise to what we term mental handicap, mental retardation, or learning disability. It is tightly argued, well written, and thought provoking and bears reading much more than once.

    Psychiatrists are still the dominant medical profession working with people with learning disability, a fact of history that has been slow to change. Lothian has recently closed its large institution, one of several in Scotland that had around 1000 beds at its peak, with ward sizes to match. It is easy to condemn this partitioning of a whole section of society; it is much more difficult to reconcile and accept the fact that they do differ in a host of ways from most people and yet at the same time they have identical moral worth to any other human being. Professor Byrne's central tenet is that these are not mutually exclusive concepts, but can be—indeed must be—integrated to make philosophical sense. The other paths lead on the one hand to the concept that the labelling process has created a fictional disability, that its use is a method of social control, of maintaining power by the creation of an underclass, and this denial of intrinsic or primary disability is inherent in some of the concepts of full inclusion and normalisation. The other position, perhaps more worrying, is held by some philosophers of bioethics who would define humanity and moral worth on the ability to reason, placing people with cognitive disability in a separate domain in which it is permissible to use eugenic policies to select against them, to justify infanticide.

    Byrne argues with great care against both these paths, his arguments grounded on the commonality of humanity and what it is to be human, carefully dissecting and dismissing the accusation that this opens the way to the charge of speciesism. He progresses from the definitions of mental handicap, the moral status of the disabled, through the difficult terrain of euthanasia, abortion, genocide, and oppression, finally ending with theological interpretations that offer alternatives to humanism.

    An appreciation of a common humanity is the best protection for such people. I have usually found that the persons are not so concerned as to whether we describe their intrinsic cognitive condition as a mental handicap or a learning disability but as to whether we remember their first and second names.

    Psychiatrists may think that of course we know all this, and that of course we would not follow any of those extreme paths that are described by Professor Byrne. The 86 men who used to be herded together in one of the old wards that I inherited might not agree.