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


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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  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).


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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).

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