Beyond the medical model? Disability, formal justice, and the exception for the "profoundly impaired"

Supported Decision Making With People at the Margins of Autonomy

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the necessary conditions of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research.

Disability in cultural competency pharmacy education

Improving health care providers' knowledge and ability to provide culturally competent care can limit the health disparities experienced by disadvantaged populations. As racial and ethnic cultures dominate cultural competency topics in education, alternative cultures such as disability have consistently been underrepresented. This article will make the case that persons with disabilities have a unique cultural identity, and should be addressed as an important component of cultural competency education in pharmacy schools. Examples of efforts in pharmacy education to incorporate cultural competency components are highlighted, many of which contain little or no mention of disability issues. Based on initiatives from other health professions, suggestions and considerations for the development of disability education within pharmacy curricula also are proposed.

User-Centered Policy Evaluations of Section 508 of the Rehabilitation Act

The author examines user-centered evaluations of e-government Web sites for compliance with a policy related to persons with disabilities: the requirements of Section 508 of the Rehabilitation Act. Although Section 508 requires that federal e-government sites offer equal access to all users, research indicates that inaccessibility is still prevalent. User-centered evaluation approaches offer a vital way to discover areas of inaccessibility on Web sites related to the requirements of Section 508. Following an overview of accessibility, Section 508, and e-government sites, the goals of evaluation and various approaches to evaluating e-government sites are analyzed. The author then focuses on methods and issues in user-centered evaluations of e-government that measure accessibility, and considerations for universal design and future studies. Sample instruments and example data from a 2006 study of e-government accessibility are included to illustrate methods and issues. Evaluating e-government Web sites can ultimately prove quite informative in ascertaining compliance with laws intended to promote accessibility.

Disabilities and impairments: strategies for workplace integration

This article argues that disabilities are, within many of the U.S. debates, best understood as certain kinds of impairment affecting a person's capabilities to perform socially defined roles and functions within specific environments. We also argue that it is not the impairments per se that lead to claims about what we ought to do or ought not do for people with disabilities. Rather, it is only within the context of capabilities being linked to the concept of freedom--almost universally valued in the current U.S. socio-political environment--that disability issues take on an ethical tenor. Additionally, we link the notion of disability to that of social capital. In particular, we argue that any social organization that discriminates against people with disabilities by attenuating their opportunities within that environment also decreases the social cohesion that exists within that organization. Such corporate climates promote organizational structures and processes that fail to optimize facilitation of the mutual benefits of the members. Finally, we discuss three different kinds of accommodation strategy: assistive technologies, systemic personal change, and universal design. We suggest a case-based (casuistic) approach to problems caused by disabilities. Using methods from both philosophy and public policy, we then build policies for accommodations incrementally, based on an application of those methods to the cases, and resulting in a more nuanced process enabling the creation of policies that take account of the experiences of both disabled and non-disabled people.