I define “impairment” as the underlying disease process that impacts a person (e.g. in Parkinson’s disease it is loss of nerve cells in the brain). The identification of a particular aberrant function of the body and attempts to eliminate or manage the disease process is the responsibility of the medical profession.
Impairment is part of what Heidegger calls the “thrownness” of the impaired person; in other words, part of the state in which that person exists, as determined by events before her birth (or before she was “thrown into the world”). Agency, defined as self-determination, arises only after we are born. It follows that thrownness, which is set up before birth, is not self-determined: meaning that the impaired person is not responsible for the impairment or indeed any aspect of thrownness. It is true, the person possesses the impairment but she is not the agent responsible for the possession (there is no agent responsible for thrownness, it just is).
Criticism of the medical profession for “pathologising” the impaired person is misplaced for two reasons; firstly, it is a form of self-denial to believe the impairment is not present; second, the pathology describes a small part of thrownness and since the impaired person isn’t responsible for their thrownness the pathologising misses the whole person and just hits upon the impairment.
The concept of “disability” arises from comparing the impaired person to those whom are different to her. An example will demonstrate this: we all have an impairment in that we can only see in the visual part of the light spectrum. But this isn’t called a disability because no one can see the rest of the spectrum; disability is a relative term, it needs others with a comparative ability to have any meaning.
The impairment is important here only as a means of differentiating the impaired person from those around her. But, we were all thrown into the world with varying abilities and impairments and therefore, depending on whom we are compared to, we can all be defined as disabled. Disability is a fragile and muddled concept.
The notion that disability is made by the inaccessibility of the environment is predicated on a false expectation of similarity among all people (i.e. ignoring the presence of the impairment). Environmental disability has nothing to do with the impaired person; it is due to the assumed ability of the “average” person that the urban planners catered for. It is gratifying to see during the past 30 years the definition of “average” has broadened to include varying abilities, resulting in a more open environment. However, there is no environment that can eliminate the presence of the impairment, it can only lessen its impact.
“Ability”, “disability”, “average person” are all relative terms and cannot be absolutely defined. In contrast, the “impairment” is either present or absent. Therefore, I see disability as a weaker concept in that it relies on the (usually negative) comparison with other people and misses the impact of the impairment on the impaired person. I believe it is crucial, as far as possible, to empower the affected person with knowledge, tools, adaptations, financial support and psychological help to enable, despite the impairment, a free exercise of their agency. Those of us with greater difficulty in expressing our agency should receive more help. Such social care must be for some purpose, an enabling of agency, and not an end in itself; for example, a person is helped to shower and dress in the morning but left all day to stare at a blank wall; the care has led to nothing and therefore has lesser value.