Rethinking systemic ableism: A response to Zagouras, Ellick, and Aulisio

Abstract

Introduction This article is a response to Zagouras, Ellick, and Aulisio who presented a case study justifying the questioning of the capacity and autonomy of a young woman with a physical disability who was pregnant and facing coercive pressure to terminate. Case description Julia is described as a 26-year-old woman with a neurological disability that requires her to receive assistance with activities of daily living. She was described as living with her parents who provided her with personal care assistance. Julia became pregnant and her parents wished her to terminate because they did not want to care for her child in addition to her. In fact, Julia's parents threatened her with institutionalization if she did not elect to terminate the pregnancy. Her health care team questioned her decision-making capacity based on her alleged “mental age” and experiences of being sheltered and excluded. The health care team used directive tactics to convince Julia to terminate the pregnancy, which describe as both an ethical and feminist intervention. Discussion The current authors take issue with the case analysis provided by and argue that they neglected to account for numerous instances of systemic ableism that adversely affected Julia, demonstrated prejudicial and judgmental attitudes toward pregnancy and disability, inappropriately questioned her decision-making capacity by infantilizing her, misconstrued the feminist concept of relational autonomy, and colluded with coercive interference from family members. This is a classic example of discriminatory and culturally incompetent reproductive health care for a disabled woman.

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“…Ableism is discrimination and social prejudice against people with disability (cognitive, mental, sensory, and physical) and chronic medical conditions (Bogart & Dunn, 2019). Ableism and racism manifest at the individual (i.e., beliefs and attitudes), interpersonal (i.e., between individuals), institutional (i.e., organizational policies and practices), and structural (i.e., overarching systems across institutions and society) levels, and therefore, they are embedded in each ecological system (Andrews et al, 2022; Saucier, 2000). Ableism and racism are systemically maintained by social structures of power (including greater access to resources and more influence in societal decision-making) and create disadvantage, lack of privilege, and oppression (Andrews et al, 2021).…”