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Reflections on Autism: Ethical Perspectives on Autism Spectrum Disorder in Health Care and Education
Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Arts and Sciences.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Reflektioner om autism : Etiska perspektiv på autismspektrumstörning i hälsovård och utbildning (Swedish)
Abstract [en]

In the four papers presented in this dissertation I analyze and discuss various value statements and moral stances, which I regard as unjustifiably harmful for persons with Autism and obstacles for the creation of an Autism-friendly society. In the papers I try to show that the positions underpinning the Autism-phobic moral stances are not warranted and cannot be defended in a good way. In doing so, I hope to transform the harmful moral intuitions underlying these positions into autism-friendly ones. The first paper investigates the Neurodiversity claim that ‘Autism is a natural variation’. The claim is interpreted and investigated and an argument is given that, contrary to Low-Functioning Autism, High-Functioning Autism can indeed be seen as a natural variation, without necessarily being seen as a disability. The second paper focuses on the problem for persons with Autism to adapt to prosocial lying, which is saying something not true but socially acceptable in a situation. By comparing a Kantian approach and a care ethics approach, the paper ends up recommending teaching persons with Autism to lie in a rule based and empathic way. The third paper deals with the morality of embryo selection in IVF. Based on a widely shared intuition of natural capabilities, arguments are given that it is morally legitimate to choose an Autistic embryo instead of a ‘normal’ one, contrary to arguments given by proponents of ‘every child should have the best chance of the best life’. The fourth paper deals with moral education. An argument is given that due to problems with cognitive empathy children with Autism should be taught pro-social behavior in a rule based way.

Abstract [sv]

I de fyra artiklarna, som presenteras i denna avhandling, analyserar och diskuterar jag olika värdeuttalanden och moraliska ställningstaganden, vilka jag anser inte kan berättigas och är skadliga för personer med autism och utgör hinder för skapandet av ett autismvänligt samhälle. I artiklarna försöker jag visa att de ståndpunkter som ligger till grund för autism - fobiska moraliska ställningstaganden inte kan berättigas eller försvaras på ett rimligt sätt. På så sätt hoppas jag att omvandla de skadliga moraliska intuitioner som ligger bakom dessa positioner till autismvänliga sådana. Den första artikeln undersöker påståendet från förespråkare av neurodiversitet att ”autism är en naturlig variation”. Påståendet tolkas och utreds och ett argument ges att, i motsats till låg fungerande autism, kan högfungerande autism faktiskt ses som en naturlig variation, utan att nödvändigtvis ses som ett handikapp. Den andra artikeln fokuserar på problem för personer med autism för att anpassa sig till att ljuga prosocialt, nämligen att säga något som är osant men socialt lämpligt i en viss situation. Genom att jämföra en Kantiansk strategi med en omsorgsetisk strategi rekommenderar artikeln att undervisning i att ljuga på ett regelbaserat och empatiskt sätt bör ges till personer med autism. Den tredje artikeln behandlar moralen kring väljande av embryo i IVF. Baserat på en allmänt delad intuition om förekomsten och betydelsen av naturliga förmågor ges ett argument för att det är moraliskt legitimt att välja ett autistiskt embryo i stället för ett ”normalt”, i motsats till argument som ges av förespråkarna för ”varje barn ska få bästa chansen till det bästa livet”. Den fjärde artikeln handlar om hur barn ska bibringas moral genom utbildning. Ett argument ges att på grund av problem med kognitiv empati så bör barn med autism undervisas i pro - socialt beteende på ett regelbaserat sätt.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. , 78 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 606Linköping Dissertations on Health and Society, ISSN 1651-1646 ; 24
Keyword [en]
Autism, applied ethics, health care, moral education, Neurodiversity
Keyword [sv]
Autism, tillämpad etik, hälsovård, utbildning i moral, neurodiversitet
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-104418DOI: 10.3384/diss.diva-104418ISBN: 978-91-7519-402-8 (print)OAI: oai:DiVA.org:liu-104418DiVA: diva2:696956
Public defence
2014-04-10, Aulan, Hus 240 (ingång 15), Campus US, Linköpings universitet, Linköping, 10:15 (Swedish)
Opponent
Supervisors
Note

The series name Dissertations on Health and Society is incomplete. The correct and complete name is Linköping Dissertations on Health and Society.

Available from: 2014-02-17 Created: 2014-02-17 Last updated: 2014-04-11Bibliographically approved
List of papers
1. Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement
Open this publication in new window or tab >>Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement
2012 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 20, no 1, 20-30 p.Article in journal (Refereed) Published
Abstract [en]

Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals.

Place, publisher, year, edition, pages
Dordrecht: Springer, 2012
Keyword
Autism, Disability, DSM-V, Equality, Neurodiversity, Vulnerability
National Category
Ethics
Identifiers
urn:nbn:se:liu:diva-72172 (URN)10.1007/s10728-011-0169-9 (DOI)000300252300002 ()
Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2017-12-08
2. Living the Categorical Imperative: autistic perspectives on lying and truth telling-between Kant and care ethics
Open this publication in new window or tab >>Living the Categorical Imperative: autistic perspectives on lying and truth telling-between Kant and care ethics
2012 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 15, no 3, 271-277 p.Article in journal (Refereed) Published
Abstract [en]

Lying is a common phenomenon amongst human beings. It seems to play a role in making social interactions run more smoothly. Too much honesty can be regarded as impolite or downright rude. Remarkably, lying is not a common phenomenon amongst normally intelligent human beings who are on the autism spectrum. They appear to be 'attractively morally innocent' and seem to have an above average moral conscientious objection against deception. In this paper, the behavior of persons with autism with regard to deception and truthfulness will be discussed in the light of two different ethical theories, illustrated by fragments from autobiographies of persons with autism. A systemizing 'Kantian' and an empathizing 'ethics of care' perspective reveal insights on high-functioning autism, truthfulness and moral behavior. Both perspectives are problematic from the point of view of a moral agent with autism. High-functioning persons with autism are, generally speaking, strong systemizes and weak empathizers. Particularly, they lack 'cognitive empathy' which would allow them to understand the position of the other person. Instead, some tend to invent a set of rules that makes their behavior compatible with the expectations of others. From a Kantian point of view, the autistic tendency to always tell the truth appears praiseworthy and should not be changed, though it creates problems in the social life of persons with autism. From a care ethics perspective, on the other hand, a way should be found to allow the high-functioning persons with autism to respect the feelings and needs of other persons as sometimes overruling the duty of truthfulness. We suggest this may even entail 'morally educating' children and adolescents with autism to become socially skilled empathic 'liars'.

Place, publisher, year, edition, pages
Dordrecht: Springer, 2012
Keyword
High-functioning autism, Autobiographies, Truthfulness, Moral responsibilities, Moral education, Kant, Ethics of care
National Category
Ethics
Identifiers
urn:nbn:se:liu:diva-72173 (URN)10.1007/s11019-011-9363-7 (DOI)
Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2017-12-08Bibliographically approved
3. Human capabilities, mild autism, deafness and the morality of embryo selection
Open this publication in new window or tab >>Human capabilities, mild autism, deafness and the morality of embryo selection
2013 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 16, no 4, 817-824 p.Article in journal (Refereed) Published
Abstract [en]

A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder.

Place, publisher, year, edition, pages
Springer Netherlands, 2013
Keyword
autism, reproduction, genetic selection, ethics, human capabilities, procreative beneficence, quality of life
National Category
Ethics
Identifiers
urn:nbn:se:liu:diva-89704 (URN)10.1007/s11019-013-9464-6 (DOI)000327128500021 ()
Available from: 2013-03-04 Created: 2013-03-04 Last updated: 2017-12-06
4. Cultivation of empathy in individuals with high-functioning autism spectrum disorder
Open this publication in new window or tab >>Cultivation of empathy in individuals with high-functioning autism spectrum disorder
2013 (English)In: Ethics and Education, ISSN 1744-9642, E-ISSN 1744-9650, Vol. 8, no 3, 290-300 p.Article in journal (Refereed) Published
Abstract [en]

High-functioning individuals with autism spectrum disorder (HF-ASD) typically lack cognitive empathy, compromising their moral agency from both a Kantian and a Humean perspective. Nevertheless, they are capable of exhibiting moral behavior, and sometimes, they exhibit what may be deemed ‘super-moral’ behavior. The empathy deficit poses, to varying degrees, limitations with respect to their moral motivation and moral agency. To compensate for this deficit, individuals with HF-ASD rely primarily, and justifiably, on the formation and application of moral rules. Educators who focus predominantly on empathy, however, may be less effective in the moral education of individuals with HF-ASD because they neglect the preference for rules of the latter. In this article, I argue that an individualized balance of empathy-based and rule-based strategies in the context of moral education is needed to assist individuals with HF-ASD in their challenges with moral motivation and moral agency.

Place, publisher, year, edition, pages
Taylor & Francis, 2013
Keyword
Autism spectrum disorder, empathy, rules, education, Kant, Hume
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104417 (URN)10.1080/17449642.2013.878514 (DOI)
Available from: 2014-02-17 Created: 2014-02-17 Last updated: 2017-12-06Bibliographically approved

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