In nature, ill, incapacitated or vulnerable animals are, generally speaking, abandoned or the first victims of predators. Thus, we may admit that rejecting a different offspring, or with differences, particularly with a disability, may be a normal attitude.

Despite the huge progress made so far, particularly of a cultural nature, well expressed by the recognition of rights, such as right to life, to education, to leisure, to sexuality, to parenthood, to professional training and employment, and of the right to the family placement of people with a mental disability, among others, there is still no satisfactory answer to the more important issues of an ethical and legal nature provoked by this disorder. For us, the big ethical dilemma with regard to society’s attitude towards people with mental illness is to decide between the primacy of the concept of life quality and the primacy of the concept of life from an ontological perspective, that it, independently of its qualities and attributes or, even better, their appearances (disability, thus, corresponds to a mere appearance or quality). For us, the value of life undoubtedly superimposes the value of the person’s quality of life.

The first movements that fought for the integration of people with disability, namely children, in the several layers of society emerged in the second half of the 20th century, in the aftermath of World War II. The integration of people with mental disability or bearers of some sort of stigma, whether of a racial, cultural, religious, physical or any other nature became, from then on, an ethical imperative for many groups of professionals, such as doctors, who, as a result of their oath, should be informed by the humanistic ideal. In its broader sense, integration presupposes adopting a normal lifestyle, without resorting to special institutions that are susceptible of inevitably promoting segregation, which is the case, in a paradigmatic manner, are the special education schools or institutions for the handicapped.

In our view, to fundament the integrationist ideal, one should not advance arguments like educational advantages, learning of conventional behaviours by imitation, peer humanization, the degrading sight provided by artificial concentration of people with disability, the low expectations of special institutions, or even other arguments normally evoked in discussions on this topic. We believe that the main argument lies in the undoubtedly anti-natural but obviously civilisation’s right to integration, independently of the characteristics (appearances) of a physical, mental, cultural or of other nature that distinguish an individual from the majority of people. Therefore, and independently of the results on how it is enforced, integration, as stated earlier, is an ethical imperative. And when we come across results that are not so good when applying the integrationist ideal, what we need to do is to alter the strategies that led to ineffective intervention and not abdicate of the ethical principle that informs it.
At the end of the 1980s, the concept of integration developed into the concept of inclusion. What is required now is not that the person with a disability is merely accepted or tolerated by society’s ordinary structures, but that he or she starts to play a relevant role in it

The ideal of positive discrimination of people with disability was also inherent to this new paradigm: Our co-citizens must be paid more attention, particularly regarding their sanitary, educational, and, generally speaking, social needs.

In the 21st century, more precisely in 2009, following an extraordinary and visionary formulation made by the great Portuguese advertiser, Dr. Pedro Bidarra, the concept of inclusion underwent a major evolution. Much more than including or positively discriminating people with disabilities, handicaps or vulnerabilities, what is now required is that they are valued for their differences. This means we need to stop being understanding, respectful or tolerant of people who are different, but that, instead, we value, in a positive way, the differences that each one of them have. This is not an easy process at all, given that it will require a profound change of mentalities. However, this is unquestionably the utopia we will pursue in future.

It is for the sake of engaging with this utopia – Valuing Differences – that we appeal to the entire Medical School, particularly its students.

The present text is dedicated to Dr. Ofélia Guerreiro, an unparalleled figure of Portuguese paediatrics who, despite having views that differ from ours, has fought all her life, in an unmatched and intransigent way, for the dignity of the newly born bearers of disabilities.

Miguel Palha
Paediatrician
Child Development Centre DIFERENÇAS (DIFFERENCES)
Lisbon
miguelpalha@diferencas.net