Neoliberalism, Bioethics, and
the Apparatus of Disability in a German Context
Draft of paper to be presented at
Emancipation Conference
Haus der Kulturen der Welt, Technical University Berlin,
May 25-27, 2018
http://criticaltheoryinberlin.de/en/event/emancipation/
Most philosophers do not consider disability to be pertinent subject matter for their philosophical analyses of social power and domination, but rather believe that disability is a prediscursive and philosophically uninteresting human characteristic, a natural disadvantage and personal misfortune that is most appropriately addressed in the domains of medicine, science, and bioethics rather than the fields of social and political philosophy and critical theory. In my philosophical work, I aim to undermine this medicalized and individualized understanding of disability by arguing that disability is an apparatus of power that political philosophers and social critics must no longer ignore. As I have pointed out, furthermore, the prevalence in philosophy of a medicalized and individualized understanding of disability is inextricably entwined with the exclusion of disabled philosophers from the profession of philosophy.
Foucault introduced the term apparatus to refer to a thoroughly heterogeneous and interconnected ensemble of discourses, institutions, laws, scientific statements, administrative measures, and philosophical propositions that responds to an “urgent need” in a certain historical moment. In other words, an apparatus, in Foucault’s sense, is a historically specific and dispersed system of power that produces and configures practices toward certain strategic and political ends. To understand disability as an apparatus is to conceive of it as a historically contingent matrix of power that contributes to, is inseparable from, and reinforces other apparatuses of force relations, such as the apparatuses of settler colonialism, gender, class, white supremacy, and sexuality. The apparatus of disability comprises, constitutes, and is constituted by and through a complex and complicated set of technologies, identities, and discursive practices that emerge from medical and scientific research, government policies and administrative decisions, academic initiatives, art and literature, activism, mainstream popular culture, and so on.
In my presentation today, I want to explain the relationships between the apparatus of disability, the field of philosophical bioethics, and the productive character of neoliberalism. I shall begin my discussion with a brief genealogy of the disabled people’s movement in Germany, including remarks about how disability and bioethics have been represented in the context of this movement.
In a history of the German disabled people’s movement, Swantje Köbsell (2006) writes that from its emergence in the 1970s, the activism of disabled people in Germany has aimed to de-medicalize disability, has demanded self-determination, the elimination of discrimination, and equalization, and has fought for disabled people’s right to life, their integration into the community, and their control of the services that they use. In the 1970s, the social barriers that disabled people in Germany confronted were endless: lack of accessibility to virtually all public buildings and to public transport, no accessible housing, and no personal assistant services, to name but a few. Adult disabled people who required assistance on a regular basis were forced to remain with their families or live in institutions. Although, at the time, a medicalized and individualized understanding of disability was still widely assumed, more and more disabled people themselves nevertheless began to recognize that the segregation that they experienced was due to the social production of disability rather than some natural defect inherent to them. Gusti Steiner, one of Germany’s earliest disabled activists, describes his politicization in this way:
I was denied access to buildings by steps and staircases which had been planned and built by others who were in power. I and other disabled people were denied access to public transport by the way in which busses and trains were planned, built and used. And this had consequences for our self-confidence! We had to go to the places where these conflicts were evident. …[W]e had to use our creative energy to self-confidently draw attention to the problems and change the disabling situation. (Steiner 2003, in Kӧbsell 2006)
Throughout the 1970s, a growing number of people in Germany became concerned about the social disadvantages that accrued to disabled people; however, the German disabled people’s movement did not tangibly coalesce until February 1980, doing so in response to a court decision now known as the “Frankfort Judgment.” In this highly-debated decision, the Frankfort District Court reduced the travel expenses of a tourist who claimed to be aggrieved because she had been forced to endure the sight of disabled people while on her vacation (Klee 1980, in Kӧbsell 2006). Protests arose all around the country immediately after publication of the decision. In May of that year, an unprecedented nationwide demonstration against the decision brought together 5000 protestors from throughout West Germany. Although the court’s decision was not subsequently reversed, the demonstration served as a huge impetus for the fledgling movement and, for the first time in German history, the resistance of disabled people was covered by national news outlets and other media venues in Germany (Kӧbsell 2006).
As I’ve noted, disabled people’s right to life has been a central concern of the German disabled people’s movement from its inception. Although in the 1970s many Germans knew what the Nazis had done to disabled people, the sheer scope of the T4 Program—the so-called “destruction of life unworthy to live” project that involved the extermination of 300,000 disabled people—was not well known and had not yet been investigated. Nor was it well known that the Nazis had sterilized 400,000 disabled people. Some members of the early German disabled people’s movement were in fact survivors of the Nazi regime. Furthermore, some members of the early movement reportedly encountered nondisabled people who ominously pointed out to them that, under Hitler, they would have been gassed. In short, eugenics remained an integral part of the lives of disabled German people well into the 1980s (Kӧbsell 2006, 1987; Waldschmidt 2006).
In 1984, Udo Sierck and Nati Radtke published “The Mafia of Benefactorns,” in which they traced continuities from the beginnings of the Nazi system of ideas to their own historical and cultural context, criticizing the individualized conception of disability that laid the ground for eugenic thinking. Other members of the movement researched the enshrinement of the Nazis' “Law on the Prevention of Offspring of People with Hereditary Diseases,” drawing attention to the fact that involuntary sterilization of disabled women and girls remained a pressing concern, with the surgery performed about 1000 times a year until 1992, even though the law was repealed at the end of the Second World War (Waldschmidt 2006; Köbsell, 2006, 1987).
When newer campaigns to legalize assisted suicide were launched in Germany, members of the German disabled people’s movement protested vehemently. In the aftermath of the Third Reich, these campaigns represented a reminder of the consequences of the idea that the lives of certain people are “not worth living.” When, in 1989, a major German organization for disabled people invited Peter Singer to give a lecture entitled, “The Right to Life of Severely Disabled Newborns,” modern bioethics had effectively arrived in Germany. For members of the German disabled people’s movement at the time, the denial of disabled people’s right to life which, in the years following the Nazi experience had been inconceivable, now seemed possible again (Waldschmidt 2006; Kӧbsell 2006, 1987).
Anne Waldschmidt (2006) has argued that by analysing German disability discourse on bioethics, we can see that, within the discourse, power continues to be represented as a primarily disciplining, repressive force. Waldschmidt quotes Sierck, who, in a 1986 article, concludes:
[H]uman geneticists are upholding a social-strata model of society based on the premise that some people are biologically inferior. (Sierck 1986, 19, in Waldschmidt 2006)
Waldschmidt (2006) asserts that this “repressive” or “juridical” model of argumentation, which equates the old eugenics with modern preventive genetic diagnostics, has dominated disabled people’s discussion of human genetics in Germany. She argues that although this juridical model of argumentation has been very successful, it relies upon an obsolete political theory that does not take account of how the relationships between the state, society, and the individual have changed due to the democratization and liberalization of postwar Germany.
The new eugenics, Waldschmidt (2006) points out, relies upon individual autonomy and self-responsibility. Nowadays, she writes, human geneticists act not on their own authority, but rather on the authority and wishes of their clients. Neo-eugenics, she explains, has developed a democratic and individualistic approach. Coercion and pressure, open repression, and control are no longer necessary. Society and the state no longer need to urge people to do their eugenic duty. For people voluntarily adhere to eugenic reasoning, without expressly being told to do so.
I agree with Waldschmidt that we are now witnessing compliance with eugenic reasoning through the normalization of an “eugenics of risk” (Lemke 2002, 288, in Waldschmidt 2006). In my view, however, there is more continuity between the old eugenics and the current regime of eugenics than Waldschmidt allows. Biopower, through which human biology has become the object of a political strategy, enables this continuity (Foucault 2007, 1).
Mainstream bioethicists generally assume that their role is to apply the allegedly universal and ahistorical principles of deontology, utilitarianism, and virtue ethics to medical situations, that is, they presuppose that these situations are occasions for the expression and application of pre-existing individualistic values and ideals such as autonomy, well-being, and liberty. I maintain, however, that the articulation of these supposedly extant values and ideals is performative, repeatedly generating and configuring them anew (see also Hall 2015, 169; Hall 2016). My argument is that the academic discipline of bioethics is an institutionalized vehicle for the biopolitics of our time, that is, bioethics is a predictable product of biopower, a technology of government that provides intellectual resources designed to ensure the “strengthening” (that is, fitness) of a certain population and the eradication of others. In short, bioethics is a pernicious enterprise. Nevertheless, as I (2017) indicate in another context, these forms of biopolitical intimidation have by no means gone unchallenged by disabled people, including by disabled philosophers.
A neoliberal governmentality of security—in support of which the apparatus of disability and other apparatuses have amalgamated—undergirds the academic field of bioethics and has motivated its emergence and elaboration, including the incessant production within the field of questions and concerns about putatively natural “disabilities” and the refinement of positions that rationalize their prevention and elimination. Consider Foucault’s remarks about the three major forms that technologies of government take in their development and history: first, a given technology of government takes the form of a dream or utopia; next, the dream of the technology of government develops into actual practices or rules to be used in real institutions; finally, the practices and rules of the technology of government become consolidated in the form of an academic discipline (Foucault 1988, 145–62; see also Hall 2015, 166–69; Hall 2016). I contend that Foucault’s itinerary of the advance of a technology of government aptly explains the rise and growth of bioethics in the neoliberal university.
Recall that an apparatus, as Foucault defined that notion, responds to a certain requirement within a given historical moment. The requirement to which the apparatus of disability serves as a response is normalization that facilitates the efficient expansion of neoliberalism as a form of governmental reason. The field of bioethics—as both product and mechanism of biopower—enables the intellectual and popular acceptance of normalization in certain contexts. Moreover, the consolidation of the field of bioethics, which works in the service of forms of normalization whose goal is security, operates especially through the neoliberal touchstones of autonomy (construed as self-governance) and freedom (construed as individual choice), that is, bioethics, as a product of biopower, operates effectively by guiding and limiting the actions of subjects in accordance with their capacity to choose from a highly circumscribed set of possible actions.
Within bioethics and elsewhere, (neo)liberal values and ideals, best produced through the “doctrine of informed consent,” govern medical encounters in accordance with a juridical representation of power as external to autonomy and freedom. Indeed, neoliberal normalization functions most effectively precisely through the subject’s exercise of autonomy and choice; that is, neoliberal government enables subjects to act in order to constrain them. Nowhere have the values of autonomy and choice been more effective tools for normalization than in the production of the apparatus of disability that is achieved through reproductive and other genetic technologies, euthanasia and physician-assisted suicide, and the discourses co-constitutive with these technologies and practices (see Tremain 2017, 2006, 2010).
References
Foucault, Michel. 1988. Technologies of the Self: A Seminar with Michel Foucault. Edited by Luther H. Martin, Huck Gutman, and Patrick H. Hutton. Amherst: University of Massachusetts Press.
Foucault, Michel. 2007. Security, Territory, and Population. Lectures at Collège de France, 1977-1978, edited by Michel Senellart. Translated by Graham Burchell. New York: Palgrave Macmillan.
Hall, Melinda. 2015. Continental Approaches in Bioethics. Philosophy Compass 10 (3): 161–172. http://dx.doi.org/10.1111/phc3.12202
Hall, Melinda. 2016. The Bioethics of Enhancement: Transhumanism, Disability, Bioethics. Lanham, MD: Rowman and Littlefield.
Klee, E. 1980. Behinderte im Urlaub? Das Frankfurter Urteil. Eine Dokumentation. Frankfurt am Main: Fischer Taschenbuch Verlag.
Köbsell, Swantje. 1987. Eingriffe. Zwangsterilisation geistig behinderter Frauen.München: AG SPAK.
Kӧbsell, Swantje. 2006. Towards Self-Determination and Equalization: A Short History of the German Disability Rights Movement. Disability Studies Quarterly 26 (2). http://dsq-sds.org/article/view/692/869.
Lemke, T. 2002. Genetic Testing, Eugenics, and Risk. Critical Public Health 12 (3), 283-290.
Sierck, Udo. 1986. Erbgesundheit und genetische Beratung - Spuren der Vergangenheit. Behindertenpädagogik, 25 (1): 17-23.
Sierck, Udo, and Radtke, Nati. 1984. Die Wohltätermafia. Vom Erbgesundheitsgericht zur Humangenetischen Beratung. Hamburg: private publishing venture.
Steiner, G. 2003. Wie alles anfing – Konsequenzen politischer Behindertenselbsthilfe. http://forsea.de/projekte/20_jahre_assistenz/steiner.shtml.
Tremain, Shelley. 2006. Reproductive Freedom, Self-Regulation, and the Government of Impairment in Utero. Hypatia: A Journal of Feminist Philosophy 21 (1): 35-53.
Tremain, Shelley. 2010. What’s Still Missing From the Stem Cell Debates? Hypatia: A Journal of Feminist Philosophy 25 (3): 577-609.
Tremain, Shelley L. 2017. Foucault and Feminist Philosophy of Disability. Ann Arbor: University of Michigan Press.
Waldschmidt, Anne. 2006. Normalcy, Bio-Politics and Disability: Some Remarks on the German Disability Discourse. Disability Studies Quarterly 26 (2). http://dsq-sds.org/article/view/694/871.
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