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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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EthicsCloningClose toYouCoercion as CureCoercive Treatment in PsychiatryCognition of Value in Aristotle's EthicsCognitive Disability and Its Challenge to Moral Philosophy Comfortably NumbCommonsense RebellionCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentComprehending CareConducting Insanity EvaluationsConfidential RelationshipsConfidentiality and Mental HealthConflict of Interest in the ProfessionsConsuming KidsContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Social PhilosophyContentious IssuesContesting PsychiatryCrazy in AmericaCreating CapabilitiesCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCritical Perspectives in Public HealthCritical PsychiatryCrueltyCultural Assessment in Clinical PsychiatryCurrent Controversies in BioethicsCurrent Controversies in Values and ScienceCutting to the CoreCyborg CitizenDamaged IdentitiesDeaf Identities in the MakingDeath Is That Man Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDignityDisability BioethicsDisability, Difference, DiscriminationDiscrimination against the Mentally IllDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDown GirlDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied 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UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFacts and ValuesFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionForgiveness is Really StrangeFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting 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DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse 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When is discrimination wrong? This is a troubling question for anyone involved in a public institution, employment, development of public policy, or in social services. As with many important issues it is easier to pose the question than to answer it. Many of our intuitions about 'fairness' and 'justice' don't stand up to careful scrutiny; equally, many of our established practices in attempting to act fairly are susceptible to criticism, regardless of our good intentions. Deborah Hellman's book When is Discrimination Wrong? is an invaluable guide to the issue of discrimination, but those seeking a simple solution to specific problems of unfair treatment will be disappointed. They are in for some hard and careful thinking and must in the end attend to the details of the cases that trouble them rather than rely on an easy formula. However they will be well rewarded by Hellman's thoughtful and carefully argued theory of discrimination. And my sense is that they will be better able to consider how to argue about it. Hellman insists throughout the book that she is not offering justifications for particular decisions. Rather, she is outlining something much more useful. When is Discrimination Wrong? provides a definition of what discrimination is, on what questions to ask about discrimination, and the main alternatives to her theory, arguments that are commonly thought to defend various practices from charges of discrimination.
The book is written in two parts, the first outlining Hellman's theory of discrimination, and the second considering alternatives to this formulation. This is a highly useful format, as there is as much space given to considering how Hellman's ideas might not work as there is to how they do. In a relatively small book Hellman manages to cover both her own theory and the alternatives comprehensively.
Hellman offers a definition of discrimination as any distinction between people that demeans. This is an elegant definition as it accepts that making distinctions is an inevitable, necessary and useful part of social life, but one with the potential for consequences we should avoid. Those consequences are summed up in the term 'demean' and Hellman outlines in considerable detail exactly what she considers demeaning. To do this she draws on social justice theory. Distinctions should not treat individuals unfairly. They may not treat individuals equally, and they certainly don't treat everyone in the same way, but they rest on a foundation of the equal moral worth of every human being. Hellman treats this definition in considerable detail. She invokes many examples, something she has an endless store of, to ask how would this definition work in various cases. The examples are not always easy ones. Rather, they are designed to draw out different arguments, consider their merits and weaknesses, and so build a robust definition. If the answers are sometimes counterintuitive this, too, is helpful, as the task of asking the right questions makes no assumptions about cherished views about particular issues.
Something Hellman emphasizes in her discussion of cases is the dynamics of power. It becomes increasingly harder for an individual to discriminate as their social power diminishes. I cannot discriminate against you if my distinction-making merely expresses an attitude, however belittling or negative that attitude might be. Correspondingly, the more power I have the easier it becomes to discriminate, as I am able to give practical weight to my belittling attitudes. There is a real possibility that you will be impacted in a material way. Hellman also responds to critics like Harry Frankfurt who see discrimination as an issue of equality, and who argue that equality is an empty concept. Hellman argues that there is something 'inherently comparative' about our ideas of moral worth. It is not to do with an amount of respect; everyone is to be treated as equally worthy. If there was one aspect of Hellman's definition I was not altogether happy with it was the idea that an action is demeaning if it 'puts the other person down'. Depsite Hellman providing a perfectly satisfactory explanation of this term it struck me as inexact and potentially open to misinterpretation, or at least misuse. I was also not sure that it added to 'demean'.
In the second half of the book Hellman explores three possible alternatives to her own theory. These alternatives are merit, accuracy and irrationality, and intentionality. All three challenge the idea of discrimination as distinctions which demean, offering defenses for various forms of distinction making against a charge of discrimination. In each case Hellman argues that the alternatives don't work. The arguments become quite complex, especially when they show that objectionable practices can remain objectionable even if they don't discriminate. There might be reasons to argue against them, but discrimination is not one of those reasons. As in the first section Hellman uses a wide range of examples to test her arguments. Like different lenses in a lamp, the different examples show up different aspects of discrimination, so that our appreciation of the concept develops with each case. Hellman's work in this section is meticulous and painstaking. Just when you think she's nailed all the arguments there'll be another one, a little more subtle than the last.
When is Discrimination Wrong? is a concise and careful analysis of a vexing issue. In the conclusion Hellman comes back to the notion of context, emphasizing a point she makes in the first section, that what practices demean depends on social conditions, including cultural values. Hellman stresses that she is not arguing for simple relativism, but drawing attention to just how important arguments about discrimination are, and in particular how it is important to ask the right questions. Her analysis and discussion is an invaluable guide to thinking about discrimination, one which will need to be considered alongside empirical evidence of different social issues.
If I have a disappointment about When is Discrimination Wrong? it is minor, and arises from my own interests in mental health. Allegations of discrimination in mental health are especially problematic as they frequently seem to focus on the character of individuals and on deep seated cultural anxieties about madness. In the latter sense, mental health issues are no different to those of race or gender, but it is perhaps because mental health issues cut across the more easily recognizable social divides that they seem more troubling. 'Mental illness' is also a shifting and, currently, rapidly expanding category which may work both for and against discrimination as more people claim status as mentally ill, shifting the focus of efforts to reduce discrimination away from those who most need protection from anti-discrimination policies. Against that, the present estimates of high prevalence of mental illness should make more people aware of the need to give serious thought to what has previously been a category of exclusion. Those of us working mental health should find Hellman's analysis helpful in asking important questions about discrimination as it relates to people with mental illness.
© 2009 Tony O'Brien
Tony O'Brien RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, [email protected]