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

Abstract

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.

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Notes

  1. 1.

    Although ID is often defined as something beginning before the onset of adulthood, dementia shares many characteristics with ID.

  2. 2.

    This is a question of distributive justice, the literature on which is extensive. Contemporary literature on distributive justice agrees that people owe material help to one another (see Fabre 2008). Moreover, from a broadly liberal perspective, “Healthcare is of special moral importance, because it helps to preserve our status as fully functioning citizens” (Daniels 2001, 4).

  3. 3.

    It is worth noting that, “in most Organization for Economic Cooperation and Development (OECD) countries, government pays for the majority of health care expenditures. Even in the US, government expenditures account for over 44% of total health care spending. Moreover, in most countries, health care is the most significant component of total government expenditures” (Flood 2000, 2).

  4. 4.

    AT can also help older people maintain a degree of independence. For example, an increasing number of people are being diagnosed with autism spectrum disorder (ASD). Again, AT can be of great benefit in helping people with ASD to live flourishing lives.

  5. 5.

    The capabilities approach stresses the importance of allowing people to form their own conception of the good and of non-discrimination on the basis of sex, race, ethnicity, sexual orientation, or religion.

  6. 6.

    The medical model of disability views disability as arising from mental or physical impairments (Wasserman et al. 2016).

  7. 7.

    The social model of disability sees disability as arising from socially constructed barriers and oppressive social norms (Terzi 2009).

References

  1. American Association on Intellectual and Developmental Disabilities. (2017). Definition of intellectual disability. AAIDD. http://aaidd.org/intellectual-disability/definition. Accessed 26 January 2016.

  2. Association for the Advancement of Assistive Technology in Europe. (2015). Report on global challenges in Assistive Technology. AAATE. http://assistid.eu/adminbackend/resources/report-on-global-challenges-inataaate-conference-2015.pdf. Retrieved 23 February 2016.

  3. Becker, L. C. (2005). Reciprocity, justice, and disability. Ethics, 116(1), 9–39. https://doi.org/10.1086/453150.

    Article  Google 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. https://doi.org/10.1080/09687599.2011.543862.

    Article  Google 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. https://doi.org/10.1352/0047-6765(2005)43[322:UOETBP]2.0.CO;2.

  6. Daniels, N. (2001). Justice, health, and healthcare. The American Journal of Bioethics, 1(2), 2–16. https://doi.org/10.1162/152651601300168834.

    Article  Google 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 http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199548439.001.0001/oxfordhb-9780199548439-e-39.

  8. Flood, C. M. (2000). International health care reform: A legal, economic and political analysis. London: Routledge.

    Google 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. https://doi.org/10.1007/s11948-013-9456-1.

    Article  Google 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. http://www.rcpsych.ac.uk/pdf/ID%20assessment%20guidance.pdf. 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.

    Google Scholar 

  15. Robeyns, I. (2006). The capability approach in practice. Journal of Political Philosophy, 14(3), 351–376. https://doi.org/10.1111/j.1467-9760.2006.00263.x/pdf.

    Article  Google Scholar 

  16. Roscam Abbing, H. D. C. (2009, December). Kiezen en delen; rapport van de commissie Keuzen in de zorg (Commissie-Dunning). https://www.ntvg.nl/artikelen/kiezen-en-delen-rapportvan-de-commissie-keuzen-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.

  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.

    Google 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 http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html.

  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. http://plato.stanford.edu/archives/sum2016/entries/disability/. Accessed 21 November 2017.

  24. WHO. (2016). Dementia fact sheet. http://www.who.int/mediacentre/factsheets/fs362/en/. Accessed 8 December 2016.

  25. World Health Organisation. (2016). WHO Assistive Health Technology (AHT). WHO. http://www.who.int/phi/implementation/assistive_technology/en/. Accessed 17 June 2016.

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Acknowledgement

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.

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Correspondence to Fiachra O’Brolcháin.

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O’Brolcháin, F., Gordijn, B. Inclusion of Assistive Technologies in a Basic Package of Essential Healthcare Service. HEC Forum 30, 117–132 (2018). https://doi.org/10.1007/s10730-017-9342-3

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Keywords

  • Assistive technologies
  • Intellectual disability
  • Justice
  • Distribution
  • Basic health package
  • Capabilities approach