Epistemic Injustice, Disability Stigma and Public Health Law

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By Daniel Goldberg

Public health law can integrate medical and social understandings of disability in ways that promise to reduce disability stigma and enhance epistemic justice.

However, models of disability currently embedded in public health law do precisely the opposite, at least partly due to the fact that public health laws have historically assimilated medicalized models of disability.

Such models were born in the 19th century, and they continue to exert outsized and problematic effects in shaping the impact of public health law on disabled people. Accordingly, it is impossible either to understand the deficiencies of prevailing (medical) models of disability codified in public health law, or to propose solutions, without sufficient grounding in the nearly 200-year-old roots of those models.

Moreover, while disability scholars and advocates have begun to argue for reconciliation between medical and social models of disability, public health law has been slow to incorporate such reconciliation. The result of this gap is continued perpetration of epistemic injustice and stigma against disabled people through the medium of public health law. This is ethically unacceptable.

Fortunately, the fact that public health law mediates disability stigma implies that conscious efforts to turn public health law to just ends are possible. Such efforts are ethical imperatives, and there are pathways to doing so by integrating medical and social models of disability in ways that maximize epistemic justice for disabled people. Such an approach acknowledges that some forms of medical and health services can be powerful tools in helping disabled people achieve meaningful and flourishing lives. At the same time, the integrative approach developed here is rooted in a historically-fluent framework that contextualizes the significant harms wreaked by purely medical models of disability.

Of course, the extent to which public health law can be an effective bulwark against disability stigma is an empirical question that requires analysis using #phlr & #legalepi methods. Nevertheless, given the ample evidence that public health laws historically mediate health and disease stigmas, there is no reason to doubt that such laws can be used as levers in the effort to ameliorate the devastating toll disability stigma inflicts.

Moreover, I think it is interesting to contemplate the extent to which legal interventions designed to address stigma can qualify as structural remedies. This matters because of the overwhelming evidence that stigma is structural, and that while it often manifests in interpersonal encounters, it is error to reduce stigma to the individual, microlevel, and even more significant error to implement methodologically individualist interventions in response.

While it is my opinion that law is generally a mediator, rather than a true fundamental cause, I suspect there are reasons to believe that some kinds of legal anti-stigma interventions can reach higher up the causal pathway and have powerful impacts in redressing stigma, even if they cannot eliminate health stigma.

In any event, these are topics and questions I look forward to exploring in my talk at the Petrie-Flom Center’s upcoming conference, Beyond Disadvantage: Disability, Law, and Bioethics.”

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