The dignity of every human being : disability, eugenics, and a theology of healthcare rationing

Abstract

Could contemporary healthcare practices be eugenic towards disabled people? This thesis seeks to ask and answer this question through four substantive moves. The first is a conceptual analysis of eugenics through which we find that in order for this issue – here termed the problem of eugenic healthcare – to be legitimate it must be the case that our healthcare practices systematically deny that disabled people can flourish or entail belief that being disabled can sometimes rob an individual of their humanity or personhood. Moreover, it must operate on these assumptions for bad moral reasons. So, the second move articulates how we might understand disability to be something which does not necessarily impinge on well-being or, even in cases of profound cognitive disability, rob individuals of human personhood. This is to display how supposedly commonsensical views of disability’s inherent badness can be reasonably rejected. However, the third move then reveals that there are two highly disparate contexts in which healthcare rationing practices seem to systematically deny disabled people can flourish and entail belief that being disabled can rob someone of personhood. Particularly, the thesis examines practices of healthcare rationing in the UK and the US to demonstrate that, despite the vast differences between the way healthcare resources are allocated and utilized in each, bad moral reasons for rationing decisions mean the problem emerges in both. So, fourth and finally, the thesis provides a potential solution to the problem in the form of a theology of healthcare rationing. In so doing, it contends that theological ethical reflection on matters of policy is neither new nor necessarily untoward in the public square. The theology of healthcare rationing itself then establishes a framework in Protestant moral theology for evaluating decisions in healthcare economics through thoroughgoingly Christian senses of compassion and accountability.