Penn Bioethics Seminar (PBS): Jasmine E. Harris, JD

Locating Disability Within a Health Justice Framework

Jasmine E. Harris, JD
Professor of Law, University of Pennsylvania Carey Law School

Via Zoom
Boxed lunches will be provided for in-person attendees.

Paper presentation (Journal of Law, Medicine, & Ethics)
Except from intro:

According to William Kissick, three core principles—access, cost, and quality—tradeoff to shape the contours of healthcare law and policy. Concerns with these tradeoffs have occupied health law and policy for decades. Health justice scholars have moved the needle beyond the “iron triangle” to recognize that this understanding of health law “lacks the ambition and scope” to respond to difficult cross-cutting structural issues. Part of their efforts to expand the relevant lens of research and scholarly inquiry has focused on the causes of inequitable healthcare outcomes by attending to the social determinants of health. The rhetorical, analytical, and practical positioning of disability within a health justice framework affects problem identification and remedial efforts, but also sends a clear message to disabled people about disability as identity and their quality of life.

This article contributes to ongoing conversations about the relationship between disability and health justice, identifies points of overlap, tension, and departure through a case study, and calls for greater integration of disability into health justice scholarship and practice. For purposes of this discussion, disability refers to a physical or mental impairment that limits an individual’s functional capacity while also recognizing the “disabling” nature of the impairment can be rooted in and exacerbated by structural and institutional choices that fail to account for nonnormative bodies and minds. The relationship of disability to health and health law is complex and the subject of scholarly debate due to narrow conceptions of disability as an individual health outcome rather than a socio-political identity. Is disability a medical impairment, a diagnosis, a “bad difference” or a “mere difference” on a broad spectrum of human capability? These debates are outside of the scope of this Article; however, the very existence of these debates affects whether and where disability appears in health justice conversations.

Disability is more than just a downstream data point that evinces inequities along other axes of marginalization such as a race, gender, class, sexuality, or immigration status. Disability should be a meaningful part of upstream legal and policy interventions to make good on the theory and practice of health justice. Reduction of disability to health outcomes reinforces the medical model of disability—a limited view of disability as individual, physiological deficit—that the disability rights movement has worked to change. Disabled people encounter barriers to healthcare access, and research suggests that when they access healthcare institutions, they may experience poorer outcomes. But access barriers and poor outcomes are only part of the story.

Attention to the complexity of disability as socio-political identity and as health status positions disability as a critical analytic point of entry into a discussion of social inequities that, at times, uses disability as a label or tool of structural subordination and social sorting. Asking the disability question, as Professor Mari Matsuda has explained, can identify cross-movement points of oppression or subordination as well as opportunities for liberation. Thus, examining where disability is situated in the health justice agenda opens a discussion about disability as identity or disability as evidence of health injustice. Moreover, it continues the work of scholars concerned with how to reconcile antidiscrimination and health law.

For more information, contact Mary Pham, Mary.Pham@pennmedicine.upenn.edu.