Jessica Begon's book is one of the central contributions to current debates in both disability studies and theories of justice, as it interprets the determination of disability through the lack of what a person is entitled to as a matter of justice. Likewise, in a process of reflective equilibrium, the book invites us to shape our views about justice through insights that arise when considering questions of disability. The initial question discussed in Begon's book, and structured in the first chapter, concerns the determination of disability. Begon explains why one cannot be fully satisfied with either the medical or the social model of disability. This is why she opts for a hybrid view. The medical paradigm identifies disability primarily as something wrong with the individual's condition. According to the social paradigm, disability is to be interpreted primarily as caused by characteristics of the context in which individuals live. Such an environment is suitable for some people but structured in ways that hinder others. Begon opts for a hybrid view because she deems it important to consider disability in combination with environmental and social factors. Endorsing this view, which in a broad sense is already present in the debate, still leaves open the question of the specific normative approach that defines a condition as a disability. Begon rejects some traditional views, such as those based on normal species functioning or on wellbeing, or those that merely attribute a uniquely authoritative voice to disability activists. Begon's answer is presented in Chapter 2, which deserves to become an unavoidable component of future debates in disability studies. Disability is understood as a condition of being restricted in performing tasks that human beings are entitled, as a matter of justice, to have the ability to accomplish. This definition does not imply that paradigmatic impairments, such as those affecting the use of all our senses or usual motor capabilities, automatically constitute disabilities. As explained in detail later, our entitlements are more general than those related to paradigmatic impairments. There are multiple ways to instantiate these entitlements, depending on specific contexts and differing value assessments. Simply correcting an impairment will not always be the proper response. Impairments per se do not determine disabilities. What matters is the way impairments affect our entitlements, which can vary. In Chapter 3, while determining our entitlements of justice (and thus the criteria for identifying disability), Begon endorses the capability approach, that is, in standard terms, the approach that places effective possibilities of being or doing at the centre of consideration. However, in discussing capabilities, she distances herself from a framework that focuses on beings or doings that make individuals better off. Such a framework would justify excessive interventionism and normalization, or even the perfection of human functioning. In Chapter 4, Begon explains her view of the capability approach in more detail. In her view, capabilities, understood as entitlements of justice, are effective possibilities to exercise control over central domains of our lives. Accordingly, justice secures the capability to exercise control over work, not the capability to be an opera singer or a visual art critic; the capability to exercise control over communication, not the capability to communicate by speaking; and the capability to enjoy the arts, not the capability to enjoy the visual arts specifically. This definition is important. On the one hand, it leads to conclusions that will appear counterintuitive to many, because it does not link disabilities directly to paradigmatic impairments. She argues that we can exercise control over central domains of life even with such impairments. On the other hand, it makes it easier to reach consensus in defining the capabilities to which people are entitled, precisely because the generality of her definition allows for greater respect for pluralism in assessing undesirable conditions. In Chapter 5, Begon rejects the standard view of impairment as something intrinsically negative that should be removed, and instead presents it as a form of diversity. The standard view, she argues, improperly imposes values that are sectarian and not responsive to all people's perspectives, even though they are widely endorsed. In Chapter 6, Begon analyses divergences in the evaluation of impairments. She stresses the importance of attributing an authoritative role to people with lived experience of impaired conditions, especially in contexts marked by silencing or marginalization. However, she warns that we must not assume that the voices of people in conditions of oppression or deprivation are always the most reliable. For example, as a result of oppression, they may lack knowledge about the possibilities for improving their condition. In this context, Begon develops her original and illuminating discussion of adaptive preferences. In Chapter 7, Begon opposes the paternalistic aspirations of states to assess individuals' interests better than they themselves can. This implies strong respect for disabled individuals as autonomous agents whose voices must be authoritative in assessing their own interests. The wrong of paternalism also manifests itself in a focus on ensuring that individuals live the best possible lives. Instead, the goal must be to promote individuals' ability to control their own lives within an acceptable range of options. All topics are discussed in depth and with careful argumentation. I nonetheless raise a worry, grounded in the author's methodological commitment to the well-known method of reflective equilibrium. In brief, this method suggests that our reflection about justice does not start from fixed foundational beliefs. Instead, it is a virtuous circular process of forming a conception of justice. We begin with provisionally firm insights about justice and proceed by addressing emerging questions and new considerations. So long as our initial insights are compatible with these new insights and provide satisfying answers to emerging questions, we extend our initial commitments. However, at times we may see that our initial insights conflict with new ones, or that they are inadequate to address new challenges of justice. We then proceed through back-and-forth revisions. This is what happens when our conceptions of justice, generally constructed for a society of abled people, encounter conditions of disability. At such points, we may need (and Begon shows that we do need) to revise our previous views of justice. My concern is whether Begon's conception of justice achieves an optimal balance, in reflective equilibrium, with respect to the autonomy and entitlements of people with impairments or disabilities (I focus specifically on children), and, more generally, with respect to those elements of theories of justice that attend to both freedom (understood as the effective capacity to form, revise, and pursue a conception of the good as a condition for authorship of one's life) and to a fair level of equality among citizens. The question I raise is whether Begon's conception of justice, centred on capabilities to exercise control over central domains of life (which implies the possibility of choosing among acceptable options, not necessarily very broad ones, and not necessarily including options typically available in human lives), is in tension with judgments concerning entitlements of justice in education. One implication of the values of freedom and equality is the robust demand to ensure good and fairly equal education, enabling children to enjoy fairly equal life opportunities and to develop a wide range of capacities that allow them to form, revise, and pursue a conception of the good (or, more concisely, to have the capacity for a conception of the good) as authors of their own lives. I take these judgments to be provisionally fixed points that organise our reasoning about a structured conception of justice and its applications. This does not mean that being in tension with them is necessarily a flaw in Begon's proposal. She explicitly states that she is not aiming to offer a proposal that merely aligns with currently dominant judgments. Instead, she seeks to reform our evaluative standards. However, I consider it problematic for a proposal of justice to conflict with policies that support fair equality of opportunity and the capacity for a conception of the good, and therefore with the educational policies implied by these values. It seems to me that Begon shares these values as well. For this reason, it is meaningful to investigate whether her proposal stands in tension with these ideals. I begin with the implications of Begon's conception of justice for the treatment of impairments. Imagine an impairment that limits the range of choices in various domains of life, including the choice of profession, forms of socialization, and ways of enjoying arts and leisure time. As already shown, we are not necessarily entitled, as a matter of justice, to treatment for it, and there is not necessarily a wrong done to a person if she is denied standardly available treatments. We are entitled to the capabilities to exercise control over opportunities for work, socializing, communication, and enjoyment of the arts. However, this does not necessarily extend to specific capabilities required for particular forms of socializing, manifestations of the arts, types of communication, or specialised professions. Accordingly, we are not necessarily entitled, for example, to treatments that allow the use of all five senses, so far as those we can use permit us to exercise control over work, socialization, enjoyment of the arts, and so forth. Therefore, there appears to be no entitlement for a child to be treated for an impairment of a particular sense, so long as their remaining senses allow them to pursue certain occupations, enjoy some artistic expressions, engage in some forms of leisure, and so forth. It seems to me that this stands in tension with the demands of justice for good and fairly accessible education. To test this, consider cases of multiculturalism in which communities refuse education for their children beyond what is required for their traditional way of life. For some, it is sufficient to learn to dismantle cars and resell parts, to work as a bricklayer, and to acquire similar skills traditionally relevant to the community. Reading literature, learning history, or understanding the natural sciences are regarded as unnecessary. Imagine a state that accommodates such communities and restricts public education for their children to the competencies required for choosing among only these few professions. It is not immediately clear that Begon's criterion of entitlement to exercise control over life domains can detect injustice here. Children are provided with general capabilities to exercise control (for example, in the domain of work or enjoyment of the arts) as adults, but their choices are limited to options traditionally endorsed by their specific community. However modest and limited these options may be, they may still count as acceptable (even if the standard of acceptability is quite low). Yet taking seriously the principle of fair equality of opportunity and protecting children's capacity (as future adults) for a conception of the good, as a condition for authorship of their own lives, requires a much more robust and comprehensive education. Otherwise, we would not be protecting children's capacity for a conception of the good as a condition for authorship of their own lives, but only their parents' capacity to determine and shape their children's lives, since parents would control the range of choices available to them. This is why it is reasonable to suspect that the entitlement to justice Begon favours here clashes with what is demanded to strongly support freedom and equality. Through coherent reasoning within reflective equilibrium, the same would hold for the denial of treatment for children's impairments. A possible answer I find in Begon's book is that education is special and therefore not comparable to medical treatment. Education's aim is precisely to develop our potentialities. But why should we attribute such a distinctive role to education? What grounds its normative status? Is this a self-justifying judgment? Or is the goal of education grounded in more general norms or ideals and then shared with other practices? It is doubtful that we can treat it as self-justifying. Yet it becomes challenging to explain why this justification holds for improving specific capabilities through education but not through medical intervention. The claim that parents lack the right to deny children access to parts of the standard curriculum, yet retain the right to deny treatment for impairments that prevent the application of what is taught, requires further elaboration. To be sure, Begon maintains that the standards of capabilities that must be secured vary over time. As new opportunities become available and are used, new standards of entitlement arise. At some point, therefore, allowing only the capabilities endorsed by traditional forms of living within certain communities may become insufficient. However, by analogy, it seems that parents' entitlements to make decisions regarding medical treatment for their children's impairments would also be limited by the level of medical resources generally available and used. If the level of capability augmentation to which people are entitled in education rises as general conditions improve, why should this not also apply to the treatment of physical or mental impairments? We thus seem to face a tension between Begon's fundamental entitlements of justice, grounded in her explication of capabilities to exercise control over relevant domains of life, on the one hand, and the demands associated with protecting the capacity for a conception of the good as a condition for authorship in one's life, along with their implications for justice in the educational domain, on the other. I now consider two arguments in favour of Begon's position. First, Begon argues that, in determining entitlements (provided certain conditions are met to guard against adaptive preferences), the voice of the alleged beneficiaries is crucial. In some cases, individuals may be satisfied with their level of capability to exercise control over central domains of life, even though others might regard it as too limited. In such cases, provided their stances are not deformed by the wrong kind of adaptive preferences, promoting treatment would not be justified. The same holds where individuals are dissatisfied with their level of control but do not lament their impairment. They may wish to improve their condition through environmental modification rather than by treating the impairment. In such cases, treatment is not demanded by justice. It would constitute an imposition. I am inclined to agree when speaking of competent adults who choose their own forms of life. They have the right to be offered alternatives to medical treatment in order to secure capabilities for control, provided there are no overriding concerns, such as excessive costs or harm to others' entitlements. However, difficulties arise when we consider children. In such cases, Begon's proposal appears to generate responses that conflict with rights grounded in equality and freedom, and a duty to treat their impairments appears justified, for the reasons outlined above. It must be left to them, when they become adults, to choose whether to use the specific capacities, just as it must be left to future adults to decide whether to make use of the capacities acquired through education. Begon offers another argument that could justify parents' rights to oppose medical interventions aimed at treating their children's impairments, even if this runs counter to a wide range of choices. She argues that no one is entitled to be provided with all the capabilities to function that they might desire. One is not entitled, as a matter of justice, to the capability to practise costly hobbies, or to pursue particularly expensive aesthetic ideals. This insight plays a role in Begon's reflective equilibrium reasoning, supporting the claim that entitlements must focus on general capabilities to exercise control over domains of life, rather than on specific capabilities to function. Begon is undoubtedly correct that no one is entitled to all the specific capabilities they may desire. At the same time, the range of choices must not be overly restricted by the choices of others if an individual's capacity to pursue a conception of the good, as related to the authorship of their own life, is to be meaningfully respected. Educational policy illustrates this point. The question is how to strike the right balance. There are no sharp or definitive answers. Begon relies on this indeterminacy to support the view that entitlements should attach to general capabilities to exercise control, rather than to specific capabilities to function. Yet this position sits somewhat uneasily with what is typically regarded as a fair and appropriate principle of justice in education. A valid school system provides opportunities for learning across the various forms of functioning regarded as valuable, in order to respect individuals' entitlement to fair equality of opportunity and their capacity for a conception of the good as a condition for the authorship of their own life. The question, then, is how this conclusion relates to parents' entitlements to refuse medical treatment for their children's impairments, or to children's entitlements to receive such treatment. One plausible answer is that children are entitled to those treatments that enable them to access the specific capabilities generally sustained through school education. Thus, if learning to practise or appreciate an art is typically included in the school curriculum, there is a reason to justify providing treatment for impairments that hinder the ability to engage with that art. This reason is pro tanto. For example, treatment may be excessively expensive or risky and therefore fall outside the scope of justice. I do not attempt to formulate a fully developed alternative proposal. The aim of this text is to comment on Begon's book rather than to advance a competing theory. In conclusion, although Begon's book is an exceptionally valuable contribution that will be unavoidable in future research on justice and disability studies alike, the question remains whether it fully succeeds in achieving reflective equilibrium among our considered judgments about justice. The risk is that it may deprive justice of something important from the standpoint of freedom and equality.
Elvio Baccarini (Wed,) studied this question.