HEC Forum

, Volume 30, Issue 2, pp 117–132 | Cite as

Inclusion of Assistive Technologies in a Basic Package of Essential Healthcare Service

  • Fiachra O’BrolcháinEmail author
  • Bert Gordijn


This paper outlines the potential and necessity of the development of assistive technologies (AT) for people with intellectual disabilities (IDs). We analyse a policy recommendation designed to determine the contents of a basic health package supplied by the state, known as the Dunning Funnel. We contend that the Dunning Funnel is a useful methodology, but is weakened by a potentially relativistic understanding of “necessity” in relation to the requirements of people with IDs (i.e., community standards will determine whether AT are necessary). We remedy this defect by using the capabilities approach as outlined by Martha Nussbaum. We argue that this approach provides a strong normative case for ensuring that communities provide help to people with IDs, if those communities are to achieve a minimal standard of justice. However, the capabilities approach does not offer much specific guidance on how AT ought to be distributed, nor does it offer guidance on risks, like the bottomless pit problem. We propose that the Dunning Funnel used in combination with the capabilities approach will provide a suitable heuristic for determining the distribution of AT in a basic health package.


Assistive technologies Intellectual disability Justice Distribution Basic health package Capabilities approach 



This research was supported by funding from the charity RESPECT and the People Programme (Marie Curie Actions) of the European Union’s Seventh Framework Programme (FP7/2007-2013) under REA Grant Agreement No. PCOFUND-GA-2013-608728.


  1. American Association on Intellectual and Developmental Disabilities. (2017). Definition of intellectual disability. AAIDD. Accessed 26 January 2016.
  2. Association for the Advancement of Assistive Technology in Europe. (2015). Report on global challenges in Assistive Technology. AAATE. Retrieved 23 February 2016.
  3. Becker, L. C. (2005). Reciprocity, justice, and disability. Ethics, 116(1), 9–39. Scholar
  4. Borg, J., Larsson, S., & Östergren, P. O. (2011). The right to assistive technology: For whom, for what, and by whom? Disability & Society, 26(2), 151–167. Scholar
  5. Carey, A. C., Friedman, M. G., & Bryen, D. N. (2005). Use of electronic technologies by people with intellectual disabilities. Mental Retardation, 43(5), 322–333.[322:UOETBP]2.0.CO;2.Google Scholar
  6. Daniels, N. (2001). Justice, health, and healthcare. The American Journal of Bioethics, 1(2), 2–16. Scholar
  7. Fabre, C. (2008). New technologies, justice, and the body. In J. S. Dryzek, B. Honig, & A. Phillips (Eds.), The Oxford handbook of political theory (pp. 713-728). Oxford: Oxford University Press. Retrieved from
  8. Flood, C. M. (2000). International health care reform: A legal, economic and political analysis. London: Routledge.CrossRefGoogle Scholar
  9. Gamberini, L., Alcaniz, M., Barresi, G., Fabregat, M., Ibanez, F., & Prontu, L. (2006). Cognition, technology and games for the elderly: An introduction to ELDERGAMES Project. PsychNology Journal, 4(3), 285–308.Google Scholar
  10. Jacquemard, T., Novitzky, P., O’Brolcháin, F., Smeaton, A. F., & Gordijn, B. (2013). Challenges and opportunities of lifelog technologies: A literature review and critical analysis. Science and Engineering Ethics, 20, 379–409. Scholar
  11. Joyce, T., Bankhead, I., Davidson, T., King, S., Liddiard, H., & Willner, P. (2015). Guidance on the assessment and diagnosis of intellectual disabilities in adulthood. The British Psychological Society. Accessed 21 November 2017.
  12. Nussbaum, M. (2006). Frontiers of justice: Disability, nationality, species membership. London: Belknap Harvard.Google Scholar
  13. Nussbaum, M. (2010). The capabilities of people with cognitive disabilities. In E. F. Kittay & L. Carlson (Eds.), Cognitive disability and its challenge to moral philosophy. Oxford: Wiley.Google Scholar
  14. Nussbaum, M. (2011). Creating capabilities: The human development approach. London: Belknap Harvard.CrossRefGoogle Scholar
  15. Robeyns, I. (2006). The capability approach in practice. Journal of Political Philosophy, 14(3), 351–376. Scholar
  16. Roscam Abbing, H. D. C. (2009, December). Kiezen en delen; rapport van de commissie Keuzen in de zorg (Commissie-Dunning). Retrieved 20 November 2017.
  17. Salvador-Carulla, L., Reed, G. M., Vaez-Azizi, L. M., Cooper, S. A., Martinez-Leal, R., Bertelli, M., & Saxena, S. (2011). Intellectual developmental disorders: Towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD-11. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 10(3), 175–180.Google Scholar
  18. Stein, M. S. (2009). Nussbaum: A utilitarian critique. Boston College Law Review, 50(2), 489–531.Google Scholar
  19. Terzi, L. (2009). Vagaries of the natural lottery? Human diversity disability, and justice: A capability perspective. In K. Brownee & A. Cureton (Eds.), Disability and disadvantage (pp. 86–109). Oxford: Oxford University Press.CrossRefGoogle Scholar
  20. United Nations. (2006). Convention on the rights of people with disabilities. New York: United Nations.Google Scholar
  21. UNESCO (United Nation’s Educational Scientific and Cultural Organization). (2005). Universal declaration on bioethics and human rights. UNESCO. Retrieved from
  22. United Nations. (2015). World population ageing. New York: United Nations.Google Scholar
  23. Wasserman, D., Asch, A., Blustein, J., & Putnam, D. (2016). Disability: Definitions, models, experience. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy. Accessed 21 November 2017.
  24. WHO. (2016). Dementia fact sheet. Accessed 8 December 2016.
  25. World Health Organisation. (2016). WHO Assistive Health Technology (AHT). WHO. Accessed 17 June 2016.

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Marie Curie ASSISTID Fellow, School of History, Anthropology, Philosophy and PoliticsQueens University BelfastBelfastUK
  2. 2.Institute of Ethics, School of Theology, Philosophy & MusicDublin City UniversityDublinIreland

Personalised recommendations