Resumen de Ethics in caregiving services for people with serious intellectual disabilities
This article questions the reason behind ethics in caregiving services for people with serious intellectual disabilities, the reasons changes have taken place in medicine, in the kinds of illnesses, social changes and changes in how hospitality is envisioned, which lead us to reconsider the usual way of doing things, the traditional morals on which their treatment has been based. However, the traditional ways of dealing with those disabled individuals have also become obsolete and are ethically reproachable: based on charity and beneficence, goodwill and paternalism, if not on ignorance and vulnerability.
Likewise, we suggest that the concept of dignity be revived in order to serve as the underpinning of respect for people who are not autonomous, rather extremely dependent and will remain so for their entire life. Bioethics has unquestionably put too much stress on fostering and respecting autonomy, but it has not always outlined what kind of dignity should be recognised for a person who can hardly serve as their own moral agent. Thus, we suggest making a distinction between dignity in the lax sense, a dignity that everyone has, and dignity in the strict sense, a dignity that only a moral agent can have.
In this way, all people have dignity, both the most perverse murderers and the anencephalic child, but neither has dignity in the strict sense: the former, because they have abused their autonomy and the latter because they are unable to exercise this autonomy. And we, the ones who interact with them, gamble with our strict dignity in how we treat them if we forget that they are always people, despite the immorality of the former and the disability of the latter.
We also stress the ethics that must be made explicit in services targeted at disabled people: civic ethics, or justice at the service of dignity; professional and organisational ethics, at the service of the disabled individuals' quality of life, with attention on the kind of relationship established with the patient and the families and their concepts of quality.
We finish by upholding the need, fundamentally in the institutions where these people live, to not depersonalise treatment. This depersonalisation takes place when the relationship is standardised for the smoothing running of the centre, when disabled people's degree of interaction or other affective-sexual dimensions are not taken into account.
