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The contemporary German philosopher Karl-Otto Apel is best known for his wide-ranging ‘transcendental pragmaticxs’ approach to a range of issues in theoretical and practical philosophy. This approach accords argumentative discourse and its essential normative presuppositions a fundamental role in all other philosophical inquiries for which justifiable validity-claims are raised, for example epistemology, normative theories of rationality, critical theory, and ethics. If such presuppositions exist, then any interlocutor’s communicative intention to waive them will conflict with the construal of that debate as rationally meaningful, since it involves the interlocutor in the kind of inconsistency that Apel (like Habermas), drawing on speech-act theory, conceptualises as a “performative self-contradiction”. Apel (unlike Habermas) develops this concept into the doctrine of rationally definitive justification (). Apel deserves to be better known as the originator of Discourse Ethics (), the central contention of which – that some presuppositions of discourse have universally valid moral content – he developed in the mid-1960s.

My aim in this paper is to offer an oblique approach to the question of biomedicine and the limits of human existence by discussing the role of a care-based ethic in contemporary discussions of disability. Contemporary discussions of disability have resisted the notion that disability is essentially a matter of biology and medicine – that biomedicine has any exclusive right to define, or even to redress, the adverse living conditions that physiological impairments can impose on individuals. In this paper I endorse this critique, but at the same time want to urge caution in a concomitant rejection, which is also found in the disability literature, of the conception of care. Care addresses the limits and limitations of human existence, and disability is a condition in which humans at once encounter and challenge those limits. In this respect, disability shares with many issues of biomedicine questions of vulnerability and dependency. An ethics based on care offers distinct resources for discussions of biomedicine, but I will confine my remarks to exploring the importance of these for disability.

Anthropologists working in the fields of health, illness, and medicine share a focus on norms, values and practice with scholars and practitioners of bioethics. Yet there is also a substantial anthropological mistrust of the field. This mistrust is based on what anthropologists often take to be the ahistoricity and ethnocentricity of much bioethical discourse. By “ahistoricity”, I intend to signal two concerns: first, the foundational premises of classical bioethics developed in relation to a specific moment in Anglo-American analytic philosophical traditions. Yet these premises are often incorporated into bioethical discussions in universalizing terms, without sufficient acknowledgement of their embeddedness in time and place (e.g. relevant critiques include Kleinman 1999; Lock 2001; Marshall 1992; Rosenberg 1999). Other perspectives and methods, for example, those drawn from the reflexive and phenomenological perspectives that are the trademark of Continental philosophy and critical social science, have held far less sway in US bioethics. Yet these are the discursive traditions with which many US anthropologists now work. Second, the social movements and institutional changes which spawned bioethics are rarely analyzed in relation to its accomplishments. Yet the field developed under the influence of health reform movements in the USA. In attempting to protect the subjects of medical interventions and experiments, activists made powerful regulatory claims which were rapidly institutionalized in American hospitals and the governmental research apparatus. Ironically, recognition of this activist success was quickly muted in relation to the more successful

“The field of bioethics is beginning to take its own narrative turn. Long dominated by the aspirations to objectivity and universality as embodied in its dominant ‘Principlist’ paradigm, bioethics is now witnessing an explosion of interest in narrative and storytelling as alternative ways of structuring and evaluating the experiences of patients, physicians, and other health care professionals” (Arras 1997: 66).