Neoliberalism, Bioethics, and the Apparatus of Disability in a German Context

In the fifth chapter of Foucault and the Government of Disability, I assert that philosophers and theorists of disability should recognize that the subfield of bioethics is a neoliberal technology of government, that is, a concerted biopolitical enterprise whose aim is normalization (and hence control) of populations. Given the scope of my critique of bioethics in the fifth chapter of the book, philosophers and theorists of disability (among others) have, predictably, been reluctant to take up the arguments of the chapter. On this weekend last year, however, I presented a version of the argument, copied below, in “Power and Domination,” a session at EMANCIPATION, a conference that took place at Technical University Berlin. (The presentation was simultaneously posted to Discrimination and Disadvantage here.)

[Description of coloured photo below: panel of presenters sit across a stage in a crowded lecture hall with laptops, bottles of water, and name cards on the long table in front of them. A blackboard hangs on the wall behind the speakers. From left to right, the presenters are: Shelley Tremain, Nancy Fraser, Kristina Lepold, Martin Saar, Didier Eribon, and Isabell Lorey. Some of the presenters are looking at Didier who is speaking. The backs of the heads of some members of the audience, including Charles Mills, also appear in the photo. Photo credit: Sally Haslanger.] There were about 400 people in attendance at the session. Indeed, the room was packed, with people sitting on the floor, on windowsills, stairs, etc. 

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[I’d like my presentation to be as accessible as possible. So, I’ve now posted it to Discrimination and Disadvantage, the philosophy blog that I coordinate which focuses especially on underrepresentation and discrimination in philosophy and in academia more generally. To read my presentation on your device as I read aloud, type “Discrimination and Disadvantage blog” into your browser and follow the link to the blog.

Before I begin, I’d like to convey my sincere thanks to the conference organizers for generously inviting me to participate in this outstanding event. I’d especially like to thank Kristina Lepold, Carolin Botos, and Maria Ebert for the attention that they paid to my inclusion in the conference.]

Neoliberalism, Bioethics, and the Apparatus of Disability in a German Context

Section One: An Introduction

Most philosophers don’t consider disability to be pertinent subject matter for their philosophical analyses of power and domination, but rather believe that disability is a prediscursive and politically neutral human characteristic, a natural disadvantage and personal misfortune that is adequately and appropriately addressed in the domains of medicine, science, and bioethics, not social and political philosophy and critical theory. As I argue in my recent book, Foucault and Feminist Philosophy of Disability, the prevalence in philosophy of this individualized and medicalized understanding of disability is inextricably entwined with the exclusion of disabled philosophers, especially disabled philosophers of disability, from adequate employment in the profession of philosophy. In my philosophical work on disability, I aim to undermine this individualized and medicalized conception of disability by arguing that disability is an apparatus of power that political philosophers and social critics must no longer ignore.  

Michel Foucault introduced the term apparatus to refer to a heterogeneous and interconnected ensemble of discourses, institutions, scientific statements, administrative measures, and philosophical propositions that responds to an “urgent need” in a given historical moment. 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 settler colonialism, white supremacy, gender, and class. The apparatus of disability constitutes and is constituted by and through a complex set of technologies, identities, institutions, and discursive practices that emerge from medical and scientific research, government policies and administrative decisions, academic initiatives, art and literature, popular culture, and so on.

In my presentation today, I want to advance an argument about the relationships between the apparatus of disability, the field of bioethics, and the productive character of neoliberalism. I shall begin my discussion with a brief genealogy of the disabled people’s movement in Germany.

Section Two: German Disabled People’s Resistance

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, integration into the community, and 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. Many adult disabled people who required assistance on a regular basis were forced to live in institutions. Although, at the time, an individualized and medicalized understanding of disability was still widely assumed in Germany, more and more disabled people here 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. …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)

The German disabled people’s movement coalesced tangibly in 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).

Section Three: Disabled People and the Third Reich

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 in the early 1980s. Although in the 1970s many Germans knew what the Nazis had done to disabled people, the sheer scope of  Aktion T4—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 Germans 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 titled, “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 seemed inconceivable, now seemed possible again (Waldschmidt 2006; Kӧbsell 2006, 1987).

Section Four: Disability, Bioethics, and Neoeugenics

Anne Waldschmidt (2006) has argued that, within German disability discourse on bioethics, 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) notes 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. Although this juridical model of argumentation has been very successful, she writes, 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. Neoeugenics, 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 a “eugenics of risk” (Lemke 2002, 288, in Waldschmidt 2006). In my view, nevertheless, 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).

Section Five: Biopolitics, Neoeugenics, and Neoliberalism

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 such as autonomy, well-being, and liberty. I maintain, however, that the repeated iteration of these values in research agendas and clinical protocols 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” of a certain population and the eradication of others. In short, bioethics is a pernicious enterprise, a mechanism of racism against the abnormal, as Foucault (2007) referred to it.

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 (Tremain 2017). Consider Foucault’s remarks about the three main 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, in Foucault’s sense, responds to a certain requirement in 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. Bioethics enables the intellectual and popular acceptance of normalization in certain contexts, to achieve certain aims. 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 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, (neo)liberal values, 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. Neoliberal governmentality enables subjects to act in order to constrain them. Indeed, neoliberal normalization functions most effectively precisely through the subject’s exercise of autonomy and choice. Nowhere have these values and ideals 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).

Thank you very much for your attention!

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.

Hall, Melinda. 2015. “Continental Approaches in Bioethics.” Philosophy Compass 10 (3): 161–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, S. 1987. Eingriffe. Zwangsterilisation geistig behinderter Frauen.München: AG SPAK.

Köbsell, 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, U. 1986. Erbgesundheit und genetische Beratung – Spuren der Vergangenheit. Behindertenpädagogik, 25 (1): 17-23.

Sierck, U. and Radtke, N. 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.

1 Response

  1. […] At present, jobseekers who specialize in philosophy of disability must represent their work in medicalized terms, that is, as a form of bioethics in order to be regarded as serious candidates for positions in the field. In other contexts, I have argued that bioethics is first and foremost a technology of modern government whose aim is normalization of the population. My argument is, thus, that insofar as philosophers of disability are compelled to package their work as bioethics (or as critiques of aspects of bioethics) in ways that leave the fundamentally pernicious nature of the enterprise of bioethics intact, philosophy of disability and philosophers of disability are effectively put in the service of a form of neo-eugenics. […]

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