Ðœedical model of disability Essay Example

ÐÅ"edical model of disability Essay Example ÐÅ"edical model of disability Essay ÐÅ"edical model of disability Essay Today, the debates about people with various disabilities can be seen to have concentrated around two main departure points: the social and the medical models of disability. Considering the latter point first, it is likely to say that in the traditional style, particularly in UK society, disabilities have been seen as individual medical tragedies (Shakespeare 1993) in which the body and mind are considered as simply failing to meet normal standards of ordinary people. The hypothesis here is that the body of person with disability can be cured by largely medical treatments and technologies. The medical model of disability then is considered as a mechanism by which person with mind and body differences has been categorized by UK legislation and is especially associated with the development of medical science. In recent years, however, disability legislation has put forward a new social model of impairments which endeavours to address these issues, and which has been closely related to political fights for civil rights. At the heart of the new social model have been new definitions of impairment and disability. This work will evaluate the view that UK disability legislation reflects a medical model of disability and assess the current government response towards meeting the needs of people with a disability. To understand this policy, four points need to be considered: the dominant definition of disability, the association of disability with health and able-bodied people, the more important disability policies that have been legislated in the UK, such as the Disability Discrimination Act. Professional definitions of disability vary and generally reflect the diversity of interest in this particular policy area. Psychologists and educationalists consider disability in terms of intelligence testing, while health care workers such as nurses, physiotherapists or occupational therapists associate disability with environmental and physical barriers to performing daily living skills. Oliver (1996) provides a definition of disability that contains three elements: the presence of an impairment the experience of environmentally imposed restrictions self-identification as a disabled person. Disability as an issue of social policy is concerned with all that disables, injures or physically handicaps. This definition in reality provides only a minimal interpretation of the real extent of disability. A disability can range from mild to severe and can be emotional, physical or intellectual. The person with a disability can be a child born with cerebral palsy, a teenager paralysed following a road traffic accident, a mother suffering the severest effects of rheumatoid arthritis or an older person with Alzheimers disease. Interest in disability issues began with the medical professions in the 18th century and gradually philanthropist reformers of the 19th century became more prominent. In the 1970s the disability rights movement, led by disabled people, transformed the traditional perception of the disabled community. They pressured for a change in the focus of services for disabled people and demanded equal access to all aspects of society as a fundamental civil right. The net effect of the movement has been a set of public policies known as disability care policy (Redman 1993). The general public was surprised when, during the 1970s and 1980s, it became clear that there were militant persons with disabilities demanding equality of rights as citizens. Before this the general public assumed that disabled people were either incapable of organised concerted political action or else were content with their lot in terms of welfare and voluntary support. It appeared that if an individual had a problem, then society assumed that professionals (doctors, nurses, social workers) would satisfy her needs. Disability groups wished to highlight the fact that they did not want this form of service to be the only option (Oliver 1996). People with a disability are not a homogenous group. Their strengths and weaknesses differ widely and individual needs vary in complexity and require different kinds of help. In spite of these differences, all disabled people will have an interruption in their pattern and quality of life. If the disability becomes permanent it will cause additional disturbances in relationships and activities. Furthermore a person classified as disabled faces common social problems of stigma, marginalisation and discrimination in many areas of their daily living (Blaxter 1980, Hahn 1993, Szymanski Trueba 1994). Most models that address the needs of disabled people associate the nature and extent of their problems with the limitations that exist as a consequence of disability. The models focus on how they are to lead a life with a physical, sensory or intellectual impairment. The medical and social care professions have been particularly prominent in developing this idea. The medical model has led society to consider disability simply within the confines of the disease process, physical abnormality or personal trauma. This model has sometimes been referred to as the personal tragedy model. This is because societys involvement has been only to express concern and sympathy to the disabled person and her family (French 1994). Within this framework two things happened. First, society was absolved from any responsibility to assist or support the disabled person. It appeared that the association of inequality and incapacity with disability was a roundabout way of blaming the disabled person for the discriminative practices rather than the rest of society. Second, this strategy failed to provide a valuable framework wherein disabled people could try to pick up the pieces and resume their life (Hales 1996). Studies into the area of disability utilise a political strategy that encourages the debate to avoid the traditional personal tragedy model of physical impairment and limitation. Instead the political strategy promotes a consideration of the economic needs of disabled people as any other minority group. For example in being able to access training, education, employment and housing. The minority group argument suggests that persistent inequalities in society relate to social attitudes and negative public policies which, according to disabled groups, are the principal causes of problems for disabled people. It also attempts to reduce the social effects of disability, including the way disabled people interact with the able-bodied population and the negative attitudes that continue to persist (Hahn 1993). This revised political strategy has removed the functional limitation argument with some degree of success. Society now accepts that disabled people are the same as any other minority group who have to face prejudice and discrimination. Within the medical model a boundary exists that separates services that are provided by either social care or health care services. It is an area of professional and policy tension, particularly in the area of caring for people with disabilities. The boundary is not a single element but a series of overlapping differences. These include areas such as payment for care, the nature of care and responsibility between various professional groups. Health care tends to have a high social status because of its link with the medical profession and high tech interventions that promote curing. In contrast, social care has a low status because it appears to be an area from which medicine has, to a certain extent, withdrawn. Social care is considered low tech and includes people with a disability for whom there is little prospect of significant improvement in terms of a cure. In a survey carried out by Thorne (1993) on people with chronic disabilities, she describes how hospital staff gradually distanced themselves from patients. The staff used a range of strategies as a mechanism for withdrawing any long term responsibility for them. These include extended appointment dates, displaying a reduced optimism for progress and referral to support social care services (Thorne 1993, Twigg 1997). Although the person with a disability may initially feel rejected, in the longer term it can be a positive move. It also reflects the wishes of disability groups. They contend that within the social care parameters new relationships can be formed with a focus on empowerment and independence. For a long time disabled groups have expressed concern about the over-medicalisation of what are essentially life problems. This view is supported by critics of excessive health care interventions. They suggest that when this occurs individuals tend to transfer onto health care staff the responsibility for many of societys problems (such as loneliness, family disharmony or isolation). Fox (1990) argues that, as a result of technological progress, people living in the UK unnecessarily defer health care issues to health care professionals. The criticism is not of the technology but its effect on our view of health as something that we depend on experts and machines to provide for us. Social problems are very sensitive for the individual concerned. When this sensitivity combines with the high value that society places on health care it creates an unnecessary demand for health care. This is a demand that in the public mind only health care staff can solve. This is a form of imperialism which is very difficult to oppose. This has perpetuated the mystique of health care and further reduces the potential for society to take responsibility for meeting the needs of people with disabilities. The United Kingdom, along with the rest of Wester Europe, has in recent times had to face the problem of large numbers of people becoming unemployed. The social welfare response can be categorised into three groups: work-based interventions which provide opportunities for further training and branching out into a new career unemployment benefit which provides an income for those in between jobs disability benefit that provides a secure income for those so limited through their disability that they are unable to work. The structures for Disability Working Allowances are described in the Disability Living Allowance and Disability Working Allowance Act 1991. Disability Living Allowance is the main source of income for people who have either a physical or psychological disability. To receive this allowance the disabled person must need attention or supervision from someone in order to meet their daily needs. It is a tax free benefit and is additional to other benefits that the disabled person may receive. Disability Allowance consists of two components: one for care needs and one for mobility and individual needs. This benefit replaced Mobility Allowance and Attendance Allowance (for those aged under 65 years) in April 1992. There are a number of physical needs that entitle a person to the care component of the Disability Living Allowance. Lord Denning, in the Court of Appeal, gave a list of bodily functions that includes difficulty with: breathing, hearing, eating, walking, sitting, sleeping and eliminating (Davis 1996). The list does not include cooking, shopping or any of the other things that a member of the household generally does for the rest of the family. There are two key factors about the payment of Disability Allowance. First, disabled people receive payments for potential risk as well as an actual risk of injury. For example in the case of people who have epilepsy, much of the supportive care is potential in that they need assistance only when a convulsion occurs. Second, assessment focuses on the needs of the claimant irrespective of whether supervision already occurs. Thus someone who is not supervised but needs to be would receive benefit whereas someone who is supervised, but does not need to be, would not qualify. Disabled people receive Disability Working Allowance if they are in low paid work. This allowance permits disabled people to participate in work and remain part of the community and avoid the isolating effects of their disablement. At the same time they avoid being penalised financially. There are two distinct types of disability organisation, both of which evolved around the end of the 19th century. These are organisations of disabled people and organisations for disabled people. The control and management of organisations of disabled people is firmly in the hands of disabled people, whereas able-bodied people manage organisations for disabled people. The original organisations of disabled people in the United Kingdom were the British Deaf Association (founded in 1890) and the National League for the Blind (founded in 1898). Organisations for disabled people tended to hold the same political ideals as their sister organisations but were more influential in attracting financial and political support. They usually arose following a disaster or period of political turmoil. The Royal British Legion was a good example. It was set up to meet the needs of those injured and left with long term disabilities following the two great wars. Another similar support group appeared in the early 1960s to help those affected by the drug Thalidomide, prescribed by doctors for women during pregnancy as an antiemetic. As everybody knows, the drug caused catastrophic physical damage to unborn babies. There is similarity in the goals of the disability movement and other minority rights groups. Disabled people are striving to find a social order of equality that engages ideas of acceptance and tolerance. At the same time, underlying the debate, all minority groups accept that they are different and therefore need different treatment (for example, disabled people require structural changes to buildings). The paradox lies in the fact that disabled people require both equality and difference. They need equal treatment most of the time but in special circumstances, where they are genuinely different, they need special provision. The first attempts at putting antidiscrimination legislation against disabled people on to statute began about 1979. The Committee on Restrictions Against Disabled People considered a range of societal factors that created barriers for disabled people. The first of the reports 42 recommendations proposed that there should be legislation making discrimination illegal and that this should encompass every aspect of society (education, employment, transport and services). The delay in the publication of the report coincided with a change in government. As a result the issue was shelved, in spite of the fact that 1981 was set aside as an International Year for Disabled People, in which people with a disability were supposed to receive a special focus in terms of government policy. Nevertheless the momentum and pressure for change in the law increased and eventually resulted in the passing of Disability Discrimination Act 1995. The government recognised that disabled people were discriminated against in that they received different treatment to other people, particularly in areas such as housing, training, education and employment. Frequently the cause of this discrimination was related to either prejudice or a failure by those in authority to discuss the matter with the disabled person. It was simply assumed that an individual could not carry out a particular task or use a particular service. The Disability Discrimination Act 1995 began by redefining disability as a physical or mental impairment that has a substantial and long term adverse effect on a persons ability to carry out normal day-to-day activities. Under the law discrimination is said to occur when (Davis 1996): a disabled person is treated less favourably than someone else the different treatment is for a reason relating to the persons disability there is no legitimate justification for different treatment there is a failure to make a reasonable adjustment for a disabled person The Act applies to people with a substantial and long term physical, sensory or emotional disability. Severe disfigurement is also classed as a disability. People who have a disability and people who have had a disability in the past but no longer have one are both covered by the Act. An example of this second group could be people who have in the past suffered from epilepsy. There are a few circumstances in which it is not possible to treat disabled people as favourably as others. They include circumstances of either health and safety or where a person cannot understand the nature of a contract because of their disability. If, however, it is proven that the person is not a health or safety risk or does appreciate the nature of a contract then it is considered to be illegal if they are treated differently. The law does not prevent disabled people being treated more favourably in certain circumstances. For example if a professional football club wished to provide sideline positions for wheelchair bound people it would be able to do so. Similarly, cinema owners may continue to offer hearing impaired people front stall seats at the same price as more expensive seats in other parts of the building. The Disability Discrimination Act has tried to undermine the dominant medical model and its definition of disability and the provision of care within that philosophy. Out of this discontent a new social model has evolved that rejects the singular focus and responsibility of disability on the affected individual. It does not attempt to deny the existence of disability but relocates it within and as a part of society. Within the social model it is not individual limitation that is the problem but societys failure to adapt and move towards providing services that adequately meet the needs of disabled people. The Disability Discrimination Act attempts to disentangle the disempowering elements of the medical model of disability and replace it with a social or collective responsibility strategy. It has two objectives. First, it wishes to reduce the negative features traditionally associated with being disabled. As a replacement it supports new ideas of inclusiveness and integration, where disabled people avoid marginalisation and are made to feel a part of society. Second, the model would like to adjust the negative attitudes of society so that, on the one hand, disabled people will be able to enjoy equal rights and privileges, and, on the other hand, accept their responsibilities to contribute and play their role as good citizens. The Disability Discrimination Act brought in new rules that aim to end the discrimination that many disabled people have faced in the past. The Act gives disabled people new rights in the areas of employment, accessing services and buying or renting land or property. The Act requires schools, colleges and universities to provide specific information for disabled people. It allows the government to set minimum standards so that disabled people can use public transport more easily. In addition, it requires the setting up of a National Disability Council to advise the government on the need for policy changes or of any potential for discrimination against disabled people. The law places a significant responsibility on employers. Following the implementation of the Disability Discrimination Act, it will be illegal to treat a disabled person less favourably than someone else because of their disability, without good reason. This applies to all aspects of employment matters, including selection, interviewing, recruitment, training, promotion and dismissal. Furthermore, employers must look at and make changes that could possibly affect the potential recruitment of an individual with a disability. In so doing it is argued that the employer will be able to recruit the best person for the job irrespective of the presence of any form of disability. The law also signalled the end of disabled people registering their disability and the quota system that previously existed. The law affects anyone who provides any goods or service to the general public. This could range from buying a drink in a pub, eating out in a restaurant or doing the weekly shopping in the supermarket. It will be against the law to refuse to serve anyone because of their disability. It will also be illegal to offer a disabled person a service that is not of the same standard as would be offered to everyone else. For example it will be unlawful to ask someone with a hearing problem or disfigurement to sit in a special place in a restaurant. The government anticipates that in time all disabled people will have full access to all forms of public transport. This will include buses, coaches, trains and aeroplanes. The government believes that, for example, all people who use wheelchairs will be able to hire a taxi in the street or at a rank, the same as everybody else. The National Disability Council is responsible for advising the government on all issues related to the employment and training of disabled people. The main objective of the council is to eliminate and reduce the incidence of discrimination against disabled people. The council also has a monitoring role in terms of the full implementation of the Act and has to produce a report each year. The report, which will go before parliament, will outline the activities it has engaged in throughout the preceding year. The council also advises the government on the need for further policy change if this is necessary. Before advising the government they are expected to have carried out an audit and costing of the net effects of implementing their advice. In addition they should have consulted with other relevant bodies that have an interest in the matter that is being proposed. The council is composed of between 10 and 20 members appointed by the Secretary of State for Social Security. The membership must appreciate the needs of disabled people; have a disability; or have experience of business, industry or the professions. Most curricula for health care professionals have expanded to be more inclusive of diverse elements in society. Some of the more common themes pursued by undergraduate programmes address the experiences of different countries health and social care services; the experiences of women; ethnic problems and racial problems. Disability debates rarely achieve the same degree of intensity as these, even though there are far more people with a disability and more diverse needs than other minorities. Some specialised public policy programmes mention disability in the context of health issues, or education, or long term care for the elderly for example. They do not, however, consider disability in the context of civil rights nor do they address the spectrum of need between, for example, those people with physical or learning disabilities. There is a necessity to rethink both the idea of employment and the idea of disability with the purpose to refigure the debate over the disability-employment relation. Legislation has not only to find a sufficient route that deals with the underlying socio-economic cause of disabled peoples exclusion from employment, but also needs to include the experiences and issues of being a disabled person in or out of work. The social model has become central for a useful social and political campaign, most importantly considering the idea of what is a normal person in society and making a difference between impairment and disability. References Blaxter M. (1980). The meaning of disability, 2nd edn. Heinemann, London. Davis K. (1996). Disability and legislation: rights and equality. In: Hales G (ed) Beyond disability towards an enabling society. Sage, London. Fox R. C. (1990). Training in caring competence in North America. Humane Medicine 6(1):15-21. French S. (1994). On equal terms: working with disabled people. Butterworth Heinemann, London. Hahn H. (1993). ‘The potential impact of disability studies on political science’ (as well as vice-versa). Policy Studies Journal 21(4):740-751. Hales G (ed) (1996). Beyond disability towards an enabling society. Sage, London. Oliver M. (1996). Understanding disability from theory to practice. Macmillan, London Redman B. K. (1993). The process of patient education. Mosby, London. Shakespeare, T. (1993). Disabled peoples self organisation: a new social movement? , Disability, Handicap and Society 8:249-64. Szymanski E. M, Trueba H. T. (1994). ‘Castification of people with disabilities: potential disempowering aspects of classification in disability services. ’ Journal of Rehabilitation 60(3):12-20. Thorne S. (1993). Negotiating health care: the social context of chronic illness. Sage, Newbury Park, California. Twigg J. (1997). ‘Deconstructing the social bath: help with bathing at home for older and disabled people. ’ Journal of Social Policy 26(2):193-210.