Towards inclusion Tom Schmid Abstract Historically, there are three phases of dealing with exclusion of persons with disabilities (framework is the debate on deinstitutionalisation): (1) Rehabilitation, (2) integration and (3) inclusion. Contradictions arise e.g. between the interests of carers and those receiving care, between interests of institutions and people, between needs and resources. Continuation of the discourse on deinstitutionalisation is therefore essential, as is radical criticism of these institutions, but also a viable way of dealing with these institutions and integrating these discourses into academic teaching. Disability as case of damage? In 2008, for the first time, a Supreme Court (S.C.) ruling awarded damages to compensate the cost of living to the parents of a special needs child to be paid by the hospital. Not the child itself is the damage, as per S.C., but the presumable life-long expenses for the (special needs) child. For had the hospital’s physicians identified the condition at the prenatal examination, as per S.C., the parents would have decided to have an abortion (Fragner 2008:1). Thus a contradictory situation arises: On the one hand “inclusion” becomes the guiding theme for the discourse on disability, on the other hand an Austrian Supreme Court declares a special needs child a compensatable case of damage, in precisely the same year (2008) as Austria ratified the UN Convention on the Rights of Persons with Disabilities. Schumann (2000) points to the importance of understanding inclusion as a prenatal right and thus turns against modern genetics (Convention on Bioethics, Genome Project) and the connected research, as the – ultimately eugenic – selection of “worth” and “worthless” life is made possible long before birth. Apart from medical risks, which are associated with prenatal diagnostics, this is evidently an ethical issue. Rifkin writes already in 1983: “The old eugenics was steeped in political ideology and motivated by fear and hate. The new eugenics is being spurred by market forces and consumer desire” (Rifkin 1998:128, cf. Rifkin 1983). And this financial utility finds its ideology in utilitarian ethics of Peter Singer, who considers it ethical, under certain circumstances, to kill a disabled baby even after its birth, if that would give the family the chance to have a new, healthy baby and thus maximising the family’s happiness (cf. Singer 1984). Ernst Klee, known from many studies on the racially motivated policy of extinction (also) of people with disabilities, emphasizes that not discarding diagnostics is needed, but comprehensive support (Klee 2000:23). Thus, a paper on the inclusive approach to modern disability policy, starts with the affirmation that the right to life, even with disabilities, is a human right, that people with disabilities – from conception – have the right to be spared from discarding diagnostics, and that people with disabilities have a human right to comprehensive support and care, to equality instead of segregation.

Concept of disabilities Logic of disabilities Many factors play a role in the development of an impairment, a limitation, a disability. Affects to the foetus/child can have prenatal, perinatal (immediately before, during and after childbirth) or postnatal causes. Already at the moment of conception (the fusion of an egg and a sperm to form an embryo with a new genome) disabilities which are the result of genetic defects (e.g. chromosomal defects) are inherent, such as Down’s Syndrome. During the course of the pregnancy, e.g. infectious diseases of the mother can cause foetal damage. During or shortly after childbirth, the main causes for disabilities are oxygen deprivation (neonatal asphyxia), infections or other complications, which are connected to childbirth or the newborn’s acclimatisation to new living conditions. Disabilities, which develop in the postnatal phase, are mostly caused by accidents, injuries, or serious illnesses (e.g. meningitis, encephalitis, Lyme disease etc.). Therefore, disabilities can be divided into hereditary (or genetic) and acquired. Hereditary disabilities are cause by physical, chemical and biological influences, by infections, malnutrition, but also by endogenic factors such as chromosomal defects. Acquired disabilities are mostly caused by accidents and progressive or degenerative diseases. At an older age they are frequently caused by a stroke or myocardial infarction. Other causes include accidents, infectious diseases or tumours. Not counted among disabilities are mental illnesses, which can emerge in childhood or adolescence (e.g. schizophrenia). But they bring in their wake similar stresses and strains to the affected persons and their families. This causes the lines between disabilities and mental illnesses to blur (cf. Prochazkova/Schmid 2009). Terminology of disability The term disability (German Behinderung) has only been in common usage since the middle of the 20th century. In the German language, it has replaced the term “Krüppel” (cripple), which was used for persons with physical impairments or limitations, and here mostly for war invalids. Those affected have vehemently rejected the term already after World War I (cf. Ernst et al. 1995:230ff). After World War II the term “Körperbehinderte” (physical handicap or disability) gained currency for people who were disabled from birth or adolescence. Other newly coined words differentiated the term further: sehbehindert (visually impaired), hörgeschädigt (hearing-impaired), sprachbehindert (speech-impaired), lernbehindert (educationally impaired) etc. After 1945, the term disability was expanded to include mental disabilities or multiple disabilities. Different national and supranational policies and norms use different definitions of the term “disability”. WHO tried to clarify the term in the late seventies and differentiated (in the ICIDH classification, see WHO 1980) three terms:  “Impairment” (German Schädigung)  “Disability” (German Fähigkeitsstörung)  “Handicap” (German (soziale) Beeinträchtigung) All three terms were defined in relation (deviation) to a norm (cf. Humphreys/Müller 1996:61). At the basis of this terminology is still the curative pedagogical aim of “normalisation”: people with disabilities were supposed to assimilate to “normal” people as far and fully as possible – a terminology, which is ultimately inconsistent with the strategy of inclusion (see below).

In the year 2001, WHO published a new classification, which only retained the first term – impairment (German Schädigung). The others were replaced by the terms activity limitations (German Aktivität) and participation restrictions (German Partizipation). This new classification emphasises the necessity to focus on the capabilities of a person and his or her integration in society (Procházková 2009). The UN Convention on the Rights of Persons with Disabilities, which was adopted by the UN general assembly in 2006 and ratified in Austria in 2008, is based on the following guiding principles (art. 3): Respect for inherent dignity; non-discrimination; full and effective participation and inclusion in society; respect for difference and acceptance; equality of opportunity; accessibility (Welke 2011:22) and inevitably demands a term for disability, which can not (any longer) be expressed using the ICIDH classification. These function-orientated definitions were challenged already in the 1990s by people with disabilities and by integration science, “because they defined the challenges of disability as a simple, causal consequence of an individual’s attributes and characteristics” (translated from Humphreys/Müller 1996:61). A more complex understanding of “disability” recognises an interdependency of personal and structural factors. Therefore, “disability [can generally be] defined as a (changeable) incompatibility of a person’s capabilities and the environmental factors, which limit the satisfaction of needs. (…) Even a, as it were, ‘primary’-appearing form of disability, such as a walking impairment, becomes a disability only in consequence of the incompatibility of the person’s capabilities and the norms of the environment, not only social norms (e.g. performance standards), but also norms of the physical environment, which in the civilisation process have become increasingly identical with the man-made and versatile ‘artificial’ environment.” (translated from Humphreys/Müller 1996:62). Three approaches and a cross-section In the history of social engagement with disability and the social (non-)association with it in the last century, three approaches to the problem can be differentiated. These approaches have principally arisen chronologically, but also posses aspects of simultaneity. Thus, for instance, in the age of “inclusion” the classic “rehabilitation” – e.g. in the context of the reform of the Austrian disability pension – got its second wind. Here one finds measures, which were simply called “curative treatment” (German Krankenheilbehandlung) only a couple of years ago, under the new title “medical rehabilitation” (German medizinische Rehabilitation). These three approaches are  rehabilitation,  integration, and  inclusion, with the concept of “rehabilitation” being the physical orientation (physical dimension), the concept of “integration” meaning integration into society and encompasses the dimension of institutional justice; and lastly the concept of “inclusion” corresponds to the metaphor of being an “active member of society” and demands support management that is needed to separate a person from his/her (anomalous) features, to remove stigmas (Goffmann 1975). Especially the terminologically sharp differentiation between “integration” and “inclusion” has not been solved in all discourses. Therefore, such a sharp differentiation of the three terms and their definitions follows. The connected issue of de-institutionalisation, however, has to be addressed beforehand.

Cross-section: De-institutionalisation De-institutionalisation is defined as the discourse on the resolving of institutional constrains of in-patient, out-patient and in-home care. This discourse should not only be understood as a one-way street from “more” to “less” institution, as it also has countertendencies, namely the preservation and expansion of existing institutions – ranging from nursing wards to special needs school classes. In this light, this discourse can be seen as embedded in a conglomeration of different interests (from a human rights orientation to preservation of jobs; from anti-authoritarian formlessness to supporting, caring and protective measures) – a conglomeration, which makes it difficult to take the one “right” position, if one concerns oneself with soundness and respectability. Starting point of the discourse on de-institutionalisation is the debate on those care structures, which place more importance on “care in dependence” than capacity building (helping others to help themselves), which would eventually make the care institutions (for the individual) redundant. The conventional practice of working with persons with disabilities is still characterised by the opposite of integration: of segregation in “special needs facilities” – such as special needs schools, sheltered workshops, assisted living in the form of groups, care homes, and specialised clinics. This disability policy does not appertain to inclusion into a society, which understands otherness as a “normal” practice of its existence, but marginalisation and exclusion to a specialised world of “otherness” – it remains undecided if this is supposed to be to the advantage of the affected person, or in pursuance of vested interest of the institutions involved and a society, which closes its mind to the struggles of having to (and wanting to) live with being different. Democratic deficiencies of marginalising institutions, anyway, are apparent, at least from the viewpoint of the excluded, for “exclusion usually happens by concentration of affected persons in institutions, which goes hand in hand with the loss of the right to self-determination. For this reason, exclusion and oppression are closely connected.” (translated from Reichmann-Rohr 1999:34) At least since Goffman (1973), excluding and isolating institutions have to be seen as total institutions, even though they not always appear in their most extreme forms as “asylum” (Foucault 1994) (German Irrenhaus) or prison. Ultimately, every special, segregating institution for people with disabilities has to be regarded as a total institution. “A total institution may be defined as a place of residence and work where a large number of likesituated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life.” (Goffman 1968:11) Goffman defines these total institutions by four more or less shared and constitutive characteristics: “First, all aspects of life are conducted in the same place, and under the same central authority. Second, each phase of the member’s daily activity is carried on in the immediate company of a large batch of others, all of whom are treated alike and required to do the same thing together. Third, all phases of the day’s activities are tightly scheduled, with one activity leading at prearranged time into the next, the whole sequence of activities being imposed from above by a system of explicit formal rulings and a body of officials. Finally, the various enforced activities are brought together into a single rational plan purportedly designed to fulfil the official aims of the institution. (…) The handling of human needs by the bureaucratic organization of whole blocks of people – whether or not this is a necessary or effective means of social organization in the circumstances – is the key fact of total institutions (…) In total institutions there is a basic split between a large managed group, conveniently called inmates, and a small supervisory staff. Inmates typically live in the institution and have restricted contact with the world outside the walls. The staff often operates on a eight-hour day and is socially integrated into the outside world.” (Goffman 1968:17f)

Not only in psychiatric hospitals, but in special needs facilities in general, the “dictate of professionals”, of disability care workers, doctors and psychiatrists, is key central aspect. Their expertise rules the proceedings in the institution and thereby regulates the life of its inmates, whereas the expertise of the persons affected on their problems and needs is not in demand. It is assigned – if at all – an inferior, marginal role. “The relationship of doctor and inmates (in more general terms: the relationship of professional and patient) was primarily a relationship of submitting to authority and only secondly (if at all) a relationship of assistance” (translated from Pirella 1982:51), one of Basaglias’ associates describes the situation of psychiatric institutions – which likely as not applies to most of the excluding institutions for persons with disabilities. Every total institution can therefore be seen from three perspectives:  perspective of the “inmates”  perspective of the institution’s administration and personnel  society’s perspective. The “inmates”, whose “happiness” total institutions are (supposedly) all about, only exist as objects – professionals work “for them”, not “with them”, much less on their behalf. They have to assimilate and subordinate, unlike the personnel or the administration, who have conflicting interests; on the one hand they are – frequently with a profound conviction – working for inmates, on the other hand they have a vested interest in the continuation of the total institution. Measures of a client-centred care, which lead to inclusion of “inmates”’ into society and thereby ultimately to the dissolution of the total institution, endanger their existence as personnel and administration of total institutions. They tend to be against successful capacity building that would help to overcome the institution. From the state’s perspective, lastly, a total institution has the dual tasks of care and control, of support and securing. But ultimately, politics will always be closer to the control function, to the guarantee of public peace and order, than to the care for individual, excluded persons. Total institutions are prone to hiding noticeably “different” people and their problems from public perception – the problems and the associated people, who would be visible in our everyday reality in case of successful integration. Basaglia and Basaglia-Ongaro on that point, referring to psychiatry as a textbook example of total institutions: “A psychiatrist invariably has a double role as scientist and representative of order. But the two roles are a flagrant contradiction to each other, as the scientist should endeavour to protect and care for the sick, whereas the representative of order sees his role in guarding and protecting the healthy. Which of the two opposed roles is (…) of more importance?” (translated from Basaglia/Basaglia-Ongaro 1972:26) If we substitute the term “psychiatrist” here with “special education teacher” or “care worker for the disabled”, the social double role of total institutions is comprehensively described, but the “double mandate” of these professions is addressed as well. Socially speaking, a social problem is already being ascribed to a certain institution through a definitional categorisation by the “relevant” social systems. This sets the course of the person’s biography, which, by the systems of “disability care” and “politics” working together, leads to a “collusive linking1” – a linking of the total institution’s interest in its own continuation and (the state’s) politics’ regulatory interest in hiding problems without attracting attention – admittedly at the expense of persons with disabilities and the (no longer possible) free development of their life.

1

Strunk 1988:111: „collusive“ means the cooperation or agreement of two parties to the disadvantage of a third party.

Of course this setting usually causes severe or even non-correctable harm to the affected person and his/her biography. It does not do justice to the complexity of the problem from the affected persons’ standpoint, indeed it can not do it justice. “From the wide range of aspects of individual living situation, the one standing out is being singled out and addressed, and everything else only plays a minor part: For the disabled it is institution of disability care, for the elderly it is geriatric care, for mentally ill persons it is the psychiatric ward.” (translated from Simons 1980:16) This is the logical consequence for the public service provider: efficient utilisation of facilities and human resources, as well as comprehensive social planning is made possible. Institutions have clearly defined tasks and do not run the risk of being “bogged down in details” that is to say they withstand the critical look of both the Court of Audit and the interested public. This efficient utilisation, at any rate, puts them in the position of being able to continually reproduce their assigned task. From the viewpoint of the overall system of public services, however, fragmentation of complex social and health issues is not that unambiguously efficient. The fact that social issues are not as clear-cut as the assignment to specialised institutions would suggest, leads to a plethora of inappropriate health care, oversupply and supply gaps. The oversupplied, over-cared person, the one trapped in a total institution, does not only receive inefficient care, but – and this is where the third perspective of the affected individual comes in – is by and large robbed of his/her self-determination and his/her chance to be expert of his/her own needs. In the end the task of guarding wins over supporting. In total institutions principles of sanctioning and exclusion prevail over principles of therapy, rehabilitation and empowerment. In many total institutions, in addition to the task of guarding, there is the task of exploitation (Toresini 2005), in many respects: Firstly, inmates are coerced to perform work – often titled “therapy” – with no or inadequate remuneration that never reflects effort and performance and for which no social security contributions are made. Secondly, they occasionally serve as study objects of the medical-scientific personnel’s research. They are studied and published in textbooks, usually without their consent. Thirdly, their presence secures the total institutions’ existence, since there wouldn’t be a demand for total institutions, if all inmates were integrated in “normal” society. And lastly, inmates serve as involuntary instruments of an excluding social policy. This exclusion satisfies the fears of the “different”, “foreign” and the “not normal” that a considerable percentage of the population faces, as they feel threatened in their social position. This exclusion – the fourth level of exploitation of inmates of total institutions describes this quite well – “is apparently also suited for defining and categorising the growing number of social issues, which social state bureaucracies face and which increasingly overextends them.” (translated from Kronauer 2002:10f) Total institutions as ultima ratio of an overextended social policy? Rehabilitation Starting from welfare for war victims of the 1920s and 1940s, a differentiated system for rehabilitation was developed in Austria in the second half of the 20th century that consists of three areas: “medical rehabilitation”, “occupational rehabilitation” and “social rehabilitation” (cf. e.g. Ernst et al. 1995). Due to federal allocation of competencies, responsibility for rehabilitation measures can be found in many areas of the welfare state’s service delivery. From the tradition of thought and the approaches, rehabilitation primarily refers to (acquired) physical disabilities with the main goal of restoring (physical) functionality. Which means it primarily relates to “impairment” (German Schädigung) and

“disability” (German Beeinträchtigung). The focus is on influencing the affected person (e.g. optimizing the use of therapeutic aids and appliances), the personal environment is merely secondary. Mentally disabled persons or persons with a mental illness are rather (if at all) at the periphery in this notion of rehabilitation. Already in 1981 however, WHO has taken on a broader definition of the concept of rehabilitation: “Rehabilitation includes all measures aimed at reducing the impact of disabling and handicapping conditions, and at enabling the disabled and handicapped to achieve social integration. Rehabilitation aims not only at training disabled and handicapped persons to adapt to their environment, but also at intervening in their immediate environment and society as a whole in order to facilitate their social integration. The disabled and handicapped themselves, their families, and the communities they live in should be involved in the planning and implementation of services related to rehabilitation” (WHO 1981:9) At the root of the concept of rehabilitation is the notion of a minimisation of capacity due to physical, mental and intellectual reasons. Rehabilitation henceforth has the goal and the task of counteracting this loss of efficiency, and thus ultimately increasing the commercial viability and commodification of the person undergoing rehabilitation for the disability at hand (Esping-Andersen 1998). Other dimensions of the human personality are alien to this concept or at best a therapy-supporting side effect. The concept of rehabilitation is ultimately a very (labour-) market oriented concept. In the seventies it was therefore supplemented with the concept of “integration”. Integration Integration emanates from critique of a deficit-oriented classification that sees the deficiency (the abnormality) as the categorising characteristic and negates individual manifestations. “To say, for instance, that’s a group of children with trisomy 21 or that’s a group of kindergarteners, does not state anything about any of these children that defines them as unique individuals. Thus, every attempt at grouping individuals according to homogenising aspects in terms of excluding features or characteristics, is an abstraction of reality of the individual and pedagogic or therapies to that end can not be considered subjectively logical. In our education system, this is true for all children and adolescents.” (Feuser 2000:70, emph. in original) Integration emanates from a holistic view and inclusion in all areas of life. Markowetz (translated from 2005:17) points out “that the right on full social participation of people with disabilities should not be restricted to school years, but has to span all phases and areas of life”. Hovorka (translated from 2000:298) emphasises the holism of integration: “The theoretically sound relativity of relationships is only tangibly evidenced when the connection to the social environment in question is made, the objecthood of persons, who are being disabled in the first place by many visible and invisible barriers, is discarded and a project and research strategy is pursued that is open to change. It is more feasible to make the social dimension and the reciprocal relationship of disability and integration visible in practice, research and teaching, and to interdisciplinarily understand and influence it in an inter- and transdisciplinary work context, when looking at seemingly trivial affairs of mastering daily life.” According to Hovorka, integration can be characterised by the following six connected requirements:  integration is indivisible  integration is discourse-oriented  integration focuses on clients

 integration is holistic (all problems)  integration respects clients’ expertise  integration includes the “right to be different" Integration pursues the objective of full de-stigmatisation and wants to achieve that people with and without disabilities can coexist in equal normality; they should have the same possibilities of access and participation. Thus, integration pursues the goal of including people with disabilities in a “not disabled system”. It is, however, not looking for a status change of disabled – not disabled. Inclusion In recent years this demarcation of integration strategy has become the starting point for an inclusion-oriented strategy and orientation. „Inclusion is not a strategy to help people fit into the systems and structures which exist in our societies; it is about transforming those systems and structures to make it better for everyone. Inclusion is about creating a better world for everyone.“ (Richler, cited in Daniels 2005:68). Thus, inclusion is no longer a policy of compartmentalization (that, like integration, is concerned with the persons to be integrated), but a policy that focuses on the essence of society and wants to change society as a whole to make it worth living for everyone equally. Thus, inclusion also provokes a dismissal of a sectoral guiding principle: “This calls for a double rethinking in pedagogy, a discussion of objectives is unnecessary. Whereas it is essential to free up space for own experiences, suggestions and directions to reflect on experiences, as well as for presenting approaches to reflect on personal history, cultural and collective-historical backgrounds.” (Daniels 2005:83) The concept of inclusion also has to be seen from its antonym exclusion. Exclusion is a term that was introduced into political language by the European Commission in 1989 under the motto “combating social exclusion” and refers to persons who are or are put on the margins of society. Thus, exclusion means social exclusion (German soziale Ausgrenzung) and encompasses not only poverty, but also long-term unemployment, belonging to a minority or regional exclusion. A report of the European Commission attempts a definition of “social exclusion”: “’Poverty’ was no longer the right word. The phenomenon was not simply related to material wealth, or lack of it, but involved a complicated interaction between – wealth, certainly – but also access to social rights, attachment to the labour market, the strength of informal networks”. (Kronauer 2002:9f) The terms “exclusion” and “underclass” are metaphors of social transformation. “They refer to social change that questions historical forms of social interaction, as they developed in the post-war ear, at a fundamental level. In the sense of a historical break, it would become possible of speaking of a problem of exclusion, whatever the variety it manifests in in different countries. Because the quality of social ties and threats to these shift to the centre of attention, the terms exclusion and underclass differ dramatically from a conventional definition of poverty, which focuses on distribution of (more or less) income.” (translated from Kronauer 2001:37) In conclusion, the term exclusion differs from the conventional understanding of poverty, as it emphasises the processual character of exclusion. And this in a dual sense: On the one hand, exclusion refers to social instances (strategies of businesses, institutional rules and regulations, social conduct) that cause exclusion. At the same time the term exclusion forces erosion of social security and the increasingly tenuous employment situation, and thus the nuances of social deprivation, into focus. On the other hand it draws attention to a biographical

accumulation, to a gradual intertwining of consequences and experiences of exclusion. Thus, exclusion stands for a condition and a process, force and effect at the same time (cf. Kronauer 2002:18). The term inclusion was introduced into sociopolitical debate (and into discourses on “disability policy”) in the 1990s as the antonym to processes of social exclusion. Declaration of Madrid Inclusion, as it was formulated in the 2002 “Declaration of Madrid” for the European Year of People with Disabilities 2003, demands in no uncertain terms for every person with or without disabilities the right to full, indeed unrestricted, social affiliation (cf. Theunissen 2006:53). Key to an inclusive strategy thus is to see all people with disabilities (or people struggling with unemployed, poverty etc.) as part of the community and society. „Being in a community is not the same as being part of the community ... Community is merely a first step (deinstitutionalisation; integration G.T.). Being in the community points only to physical presence; being part of the community means having the opportunity to interact and form relationships with other community members. Today, this is referred to as inclusion“ (Bogdan/Taylor, cited in Thönnisen 2006:53; emph. and omissions in original). Inclusion is a non-personal (that would be rehabilitation) and non-situational (that would be integration) strategy, but a system-related strategy. Like Gender Mainstreaming or “Health in all Politics”, it’s equality politics (distinguished from equal opportunity (German Chancengleichheit) or even equal rights (German Gleichberechtigung)2), which means it is a comprehensive top-down strategy, for which those at the top are responsible (and not a department or even the affected person him-/herself); it is outcome-oriented, not output-oriented. Strategy of inclusion is it therefore to support living and decision making, but not (ample) care in a total institution. This meets the requirements of the Convention on Human Rights and the UN Convention on the Rights of Persons with Disabilities, but it reaches the limits of social reality. Structures, structural interests and (a lack of) resources (presently) stand in the way of implementing these strategies of inclusion. What remains open In the meantime the concept – of inclusion – of accepting variety and diversity in society gains more and more acceptance, along the lines of “it’s normal to be different” (translated from Humphreys/Müller 1996:68). “Normalisation” in the sense of adaption of abnormal life, this includes persons with disabilities or impairments, to as uniform a social norm as possible generally seems to be a thing of the past (cf. e.g. Hovorka/Sigot 2000). Inclusion (cf. e.g. Feyerer et al. 2005) as a strategy tries to create equal opportunities in life for people with and without disabilities. Nevertheless, some questions and inconsistencies remain, which will be discussed in brief below: Inclusion strategies, which originate in the enforcement of undivided human rights for everybody, draw from a – usually unquestioned – concept of justice. It remains open which justice is required: distributive justice, contributional justice, utilitarian justice, justice in the sense of fairness etc.? (cf. Schmid 2006, 2007, 2011; Sen 2009) On this abstract level a demand for “justice” can ultimately not be answered. It is, 2

Equal opportunity (German Chancengleichheit) is actually a neo-liberal concept, as it holds the affected persons responsible for the outcome (they could have used the chance); Equal rights (German Gleichberechtigung) of de facto unequal persons/circumstances can lead to less, not more, equality and thus differs from positive discrimination (cf. e.g. Schmid 2011).

however, necessary to discuss and clarify in advance which concept of justice is taken as the basis of the specific inclusive objective at hand. It can be assumed though that, for instance, utilitarian concepts of justice can not be reconciled with an inclusive objective, as utilitarianism condones exclusion of a few (thereby accepting it as just), if this increases the happiness of the many. And it is my point of view that for this reason Singer’s (cf. Singer 1995) (utilitarian) ethics or prenatal diagnostics for eugenic reasons cannot be reconciled with an inclusive approach. But the objective of “equality” that is the basis of strategy of inclusion, also has to be discussed and clarified, should this strategy of inclusion indeed seek empowerment: Does it mean equality in the sense of “egalité” (translated in the sense of numerical equality) or “parité” (in the sense of equality of content)? (cf. Bendl et al. 2007, Schmid 2011) If one refrains from these discursive clarifications, because it is assumed that “everyone” already knows the meaning of “justice” or “equality” in this context, one runs the risk of an excellent strategy (from an inclusive standpoint) causing (operationalising) real inclusion to be replaced with symbolic inclusion. Furthermore, inclusive strategies cannot refrain from addressing conflicts of interest and finding rules for dealing with them in a solution-oriented manner. There can be conflicts of interest between e.g. demands for self-ownership of time by the person receiving care, and time demands of the (professionally or private) carer. The four dimensions of responsibility of “care” (cf. Tronto 1996) could help finding a solution to this discourse. Conflicts of interest can arise whenever it comes to distributing scarce goods and negotiating access to these. This could be access to the labour market (does positive discrimination lead to exclusion of other persons or groups?), disputes over distribution of (or access to) scarce medical goods or services (e.g. transplant organs) or an equality-oriented juxtaposition of the specific employment interests of a (not disabled) woman and a man with disabilities. For solving all these conflicts, however, it is inevitable to hold the discourse behind it and to not cover up any inconsistencies that may arise. Tensions that arise from a contradiction of an inclusive orientation and a structured sector of institutionalised “disability policy” have to be addressed and discussed as well. The problem of occupational therapy that is in fact work has to be mentioned here, as it is experienced as employment, but neither offers Social Protection nor is there pension cover arising from it, which to all intents and purposes makes it “forced labour” in accordance with Toresini (2005) – and is thus against the Convention on Human Rights. Abolishing occupational therapies, however, is no alternative. As a first step it has to be granted the same rights and obligations as other forms of employment, legally and in terms of Social Protection (considerations on this can be found e.g. in Nationaler Aktionsplan Behinderung, cf. BMASK 2012:79) and as a second step they have to be separated from excluding, and ultimately total institutions. In this context the issue of ownership of these institutions, which operate in “disability care”, has to be raised. Under principles of inclusion, is it justifiable that these institutions are non-profit associations (or non-profit PLCs), whose members and administration are not the affected persons themselves? An inclusive approach would be to convert these institutions to co-operatives, owned by the beneficiaries (the persons receiving care), with administration and personnel clearly visible as being employed by the beneficiaries. Only thus inclusive self-

representation, as demanded by the UN Convention, is viable (cf. Richter/Schmid 2002)3. Possible next steps It is now imperative to take the discussion on inclusion further, to ground and solidify it. This means introducing the concept of inclusion into every and all discourses on disability and on persons with disabilities – knowing full well that the discourse on inclusion (in contrast to earlier discourses on rehabilitation and integration) demands radical de-institutionalisation, and therefore effective measures to sustainably abolish all excluding and special-needs institutions, de facto and in the minds of people – on the level of in-patient, out-patient and in-home care. To a certain extent this means questioning ourselves, as we find identity and tangible life experience in (probably total) institutions and changing the roles of those who these facilities were established for. To come from the object to the subject of disability policy, as previously mentioned, ownership of these facilities has to be challenged radically. Legitimate owners of such facilities can thus only be the affected persons themselves (co-operatives). Furthermore, it would be worthwhile to link the discourses on inclusion with those on Care Economy, to facilitate dialogue on interests and views of those (groups of) people who provide care for others and those who receive care. This also presents a challenge to be taken on to the scientific disciplines involved. To be consistent, the positions discussed in this paper also have to be represented in (academic) teaching. It is necessary here, though, to logically combine this radical objective with the pragmatism of today, in order not to educate them “out of touch with everyday life”. Inclusion means not to be excluded and not to exclude where we “learn, work, play and love” (WHO 1986:5). List of References Baader, Gerhard / Hofer, Veronika / Mayer, Thomas (Hg.) (2007): Eugenetik in Österreich – biopolitische Strukturen von 1900 bis 1945. Wien. Basaglia Franco / Basaglia Ongaro Franca (1972): Die abweichende Mehrheit. Die Ideologie der totalen sozialen Kontrolle. Frankfurt/Main. Bendl, Regine/ Leitner, Andrea/Rosenbichler, Ursula/Walenta, Christa (2007): Geschlechtertheoretische Perspektivenund Gender Mainstreaming. In: Bendl, Regine/ Leitner, Andrea/Rosenbichler, Ursula/Schmid, Tom/Schörghuber, Karl/Walenta, Christa (Hrg.): Qualitätsentwicklung Gender Mainstreaming. Band 2 – Grundlagen. Wien. S. 29 - 60 Bundesministerium für Arbeit, Soziales und Konsumentenschutz (BMASK) (2012): Nationaler Aktionsplan Behinderung 2012 – 2020. Wien. Daniels, Susanne von (2005): Inklusion mehrperspektivisch betrachtet. In: Kaiser, Herbert / Kocnik, Ernst / Sigot, Marion (Hrg.): Vom Objekt zum Subjekt. Inklusive Pädagogik und Selbstbestimmung. Klagenfurt/Celovec – Ljubljana – Wien. S. 67 - 90 Eberwein, Hans (Hrg.) (1999): Integrationspädagogik. Weinheim – Basel 3

Needless to say, the transfer of ownership cannot be to the detriment of the beneficiaries turned owners, e.g. by taking the value of the shares in the co-operative off the needsoriented guaranteed minimum resources (German bedarfsorientierte Mindestsicherung).

Ernst, Karl / Fischlein, Theo / Sengstschmied, Elfriede / Svoboda, Michael (1995): Schicksal Kriegsopfer. Die Geschichte der Kriegsopfer nach 1945. Wien. Esping-Andersen, Gösta (1998): Die drei Welten des Wohlfahrtskapitalismus. Zur Politischen Ökonomie des Wohlfahrtsstaates. In: Lessenich, Stephan / Ostner, Ilona (Hrg.): Welten des Wohlfahrtskapitalismus. Der Sozialstaat in vergleichender Perspektive. Frankfurt/Main – New York. S. 19 – 58. Feuser, Georg (1995): Behinderte Kinder und Jugendliche zwischen Integration und Aussonderung. Darmstadt. Feuser, Georg (2000): Integrative Elementarerziehung. Ihre Grundlagen und Bedeutung als humane und demokratische Verpflichtung. In: Hovorka, Hans / Sigot, Marion (Hrg.): Integration(spädagogik) am Prüfstand. Innsbruck – Wien – München. S. 61 - 86. Feyerer, Ewald / Prochazkova, Lucie / Schmid, Tom / Wetzel, Gottfried (2005): Professionalisierung der Integrationsarbeit. In: Kowarsch, Alfred / Pollheimer, Klaus M. (Hrg.): Professionalisierung in pädagogischen Berufen. Purkersdorf, S. 311-324. Foucault, Michel (1968): Psychologie und Geisteskrankheit. Frankfurt/Main Foucault, Michael (1994): Überwachen und Strafen. Die Geburt des Gefängnisses. Frankfurt/Main Fragner, Josef (2008): Ein Kind als Schadensfall? In: Behinderte Menschen 2/2008. Graz. Goffman, Erving (1968). Asylums: essays on the social situation of mental patients and other inmates. Harmondsworth: Penguine. Goffman, Erving (1973): Asyle. Über die soziale Situation psychiatrischer Patienten und anderer Insassen. Frankfurt/Main Goffman, Erving (1975): Stigma. Über Techniken der Bewältigung beschädigter Identität. Frankfurt/Main Herkommer, Sebastian (Hrg.) (1999): Soziale Ausgrenzung, Gesichter des neuen Kapitalismus. Hamburg Hovorka, Hans (Hrg.) (1999): Behinderte und von Behinderung betroffene Menschen in allen Lebensbereichen und Lebensphasen. Klagenfurt/Celovec Hovorka, Hans / Sigot, Marion (Hrg.) (2000): Integration(spädagogik) am Prüfstand. Innsbruck – Wien – München. Hovorka, Hans (2000): Gemeindenahe schulübergreifende Integration(spädagogik) – eine bildungs- und sozialpolitische Herausforderung. In: Hovorka, Hans / Sigot, Marion (Hrg.): Integration(spädagogik) am Prüfstand. Innsbruck – Wien – München. S. 297 – 329. Humphreys, Anne / Müller, Kurt (1996): Norm und Normabweichung. In: Zwierlein, Eduard (Hrsg.): Handbuch Integration und Ausgrenzung. Neuwied – Kriftel – Berlin. S. 56-70. Kaiser, Herbert / Kocnik, Ernst / Sigot, Marion (Hrg.) (2005): Vom Objekt zum Subjekt. Inklusive Pädagogik und Selbstbestimmung. Klagenfurt/Celovec – Ljubljana – Wien. Klee, Ernst (2000): Behinderung als Menschenrecht. In: Hovorka, Hans / Sigot, Marion (Hrg.) Integration(spädagogik) am Prüfstand. Innsbruck – Wien – München. S. 19 – 32.

Kronauer, Martin (2002): Exklusion. Die Gefährdung des Sozialen im hoch entwickelten Kapitalismus. Frankfurt/Main – New York Markowetz, Reinhard (2005): Inklusion – neuer Begriff, neues Konzept, neue Hoffnungen für die Selbstbestimmung und Partizipation von Menschen mit Behinderung. In: Kaiser, Herbert / Kocnik, Ernst / Sigot, Marion (Hrg.): Vom Objekt zum Subjekt. Inklusive Pädagogik und Selbstbestimmung. Klagenfurt/Celovec – Ljubljana – Wien. S. 17 – 66. Obermann-Jeschke, Dorothee (2008): Eugenetik im Wandel: Kontinuitäten, Brüche und Transformationen. Eine diskursgeschichtliche Analyse. Münster. Ondracek, Petr (1999): Rehabilitation heute: Möglichkeiten und Grenzen der Integration in eine fraktale Welt. Betrachtet aus der Sicht der Betroffenen. In: Bandgesellschaft (Hrg.): Tagungsband vom Symposion „Rehabilitation heute: Möglichkeiten und Grenzen der Integration in eine fraktale Welt. Wien, S. 9 - 19 Österreichisches Komitee für Soziale Arbeit (ÖKSA) (2012): Umsetzung der UN Behindertenrechtskonvention in Österreich. Wien. Pirella, Agostino (1982): Die ausgegrenzten Institutionen der Psychiatrie; in: Simons, Thomas (Hrg.): Absage an die Anstalt. Programm und Realität der demokratischen Psychiatrie in Italien. Frankfurt/Main – New York, S. 43 – 66 Procházková, Lucie (2009): Podpora osob se zdravotním postižením při integraci na trh práce. Brno. Prochazkova, Lucie / Schmid, Tom (2007): Pflege und Betreuung zu Hause. (Erforderliche) Rahmenbedingungen. In: Pfeil, Walter J. (Hrg.): Zukunft der Pflege und Betreuung in Österreich. Wien. S. 139-161. Prochazkova, Lucie / Schmid, Tom (2009): Kindheit, Jugend und Behinderung. In: Knapp, Gerald / Salzmann, Gerald (Hrg.): Kindheit, Gesellschaft und Soziale Arbeit. Lebenslagen und soziale Ungleichheit von Kindern in Österreich. Klagenfurt/Celovec. S. 444 - 467 Reichmann-Rohr, Erwin (1999): Formen der Ausgrenzung in historischer Sicht. In: Eberwein, Hans (Hrg.): Integrationspädagogik. Weinheim – Basel, S. 33 - 39 Richter, Veronika / Schmid Tom (2012): Die UN Konvention und die Selbstbestimmung an der Schnittstelle von Schule zum Beruf. In: Prochazkova, Lucie / Pancocha, Karel (Hrg.): Towards inclusive Society through Education and Support – Durch Bildung und Förderung zu einer inklusiven Gesellschaft. Brno S. 15 – 26. Rifkin, Jeremy (1983): Algeny. New York: Viking. Rifkin, Jeremy (1988): Genesis Zwei. Biotechnik – Schöpfung nach Maß. Reinbek. Rifkin, Jeremy (1998): The Biotech Century: Harnessing the Gene and Remaking the World. New York: Jeremy P. Tarcher / Putnam. Schmid, Tom (2005): Integrace nebo segregace? In: Bartonova Miroslava / Pipekova, Jarmila / Vitkova, Marie (ed.): Integrace handicapovanych na trh prace v mezinarodni dimenzi, Brno, S. 102 – 113, übersetzt von Lucie Prochazkova Schmid, Tom (2006): Verteilungsgerechtigkeit – Gibt es das? In: Fischer, Michael/Dimmel, Nikolaus (Hrg.): Sozialethik und Sozialpolitik. Frankfurt/Main Schmid, Tom (2007). Gleichheit und Gerechtigkeit – zwei aufeinander bezogene Begriffe? In: Bendl, Regine/ Leitner, Andrea/Rosenbichler, Ursula/Schmid, Tom/Schörghuber, Karl/Walenta, Christa (Hrg.): Qualitätsentwicklung Gender Mainstreaming. Band 2 – Grundlagen. Wien. S. 81 - 106

Schmid, Tom (2008a): Hochbetagte Menschen mit Behinderungen. In: Bundesministerium für Soziales und Konsumentenschutz (Hrg.): Hochaltrigkeit in Österreich. Eine Bestandsaufnahme. Wien. S. 263-284. Schmid, Tom (2008b): Armut und Behinderung. In: Knapp, Gerald / Pichler, Heinz (Hrg.): Armut, Gesellschaft und Soziale Arbeit. Perspektiven gegen Armut und soziale Ausgrenzung in Österreich. Klagenfurt/Celovec. S. 536-554. Schmid, Tom (2010): Was meinen die Menschen, wenn sie „Integration“ sagen? Integration zwischen Exklusion, Seperation, Assimilation und Inklusion. In: Österreichische Gemeinde-Zeitung 9/2010. Wien. S. 8 – 12. Schmid, Tom (2011): Was heißt es in Zukunft, eine solidarische Gesellschaft zu sein? In: ÖKSA (Hrg.): Langzeitpflege in einer solidarischen Gesellschaft. Herausforderungen und Chancen. Wien. S. 11 – 16. Sen, Amartya (2009): Die Idee der Gerechtigkeit. München. Schumann, Monika (2000): Aktuelle Entwicklungen in Biomedizin und Bioethik . neue Herausforderungen an eine Integrationspädagogik. In: Hovorka, Hans / Sigot, Marion (Hrg.) Integration(spädagogik) am Prüfstand. Innsbruck – Wien – München. S. 33 – 60. Singer, Peter (1984). Praktische Ethik, Stuttgart. Strunk, Andreas (1988): Arbeit in der Achterbahn oder: Die Verhinderung von Wohnungsverlusten bei Alleinstehenden. In: Specht, Thomas / Schaub, Manfred / Schuler-Wallner, Gisela (Hrg.): Materialien zur Wohnungslosenhilfe. Bielefeld, S. 107 – 119 Theunissen, Georg (2006): Unterstützungsmanagement bei Menschen mit geistiger Behinderung. Ein methodisches Instrument zur Inklusion. In: Behinderte Menschen 2/2006. Graz. S. 50 – 61. Tronto, Joan C.: Politics of Care: Fürsorge und Wohlfahrt. In: Transit 12, Frankfurt/Main, 1996, S. 142 - 153 Toresini, Lorenzo (2005); Die Psychiatrie und die Kultur der Internierung. In: Toresini, Lorenzo (Hrg): Die ungesellige Geselligkeit. Krise der Solidarität und Wege der Subjektivität. Bolzano/Bozen. S. 27 - 34 Toresini, Lorenzo / Mezzina, Roberto (eds.) (2010): Beyond the walls / Oltre I muri. Bolzano-Bozen Wintersberger, Barbara (1991): „Gesundheit für Alle bis zum Jahr 2000“ und das Gesundheitsförderungskonzept. WHO-Programme aus pädagogischer Sicht. In: Wintersberger, Barbara (Hrg.): Ist Gesundheit erlernbar? Beiträge zur Gesundheitspädagogik. Wien,. S. 17 – 55. World Health Organization (WHO) (1980): Ottawa Charta zur Gesundheitsförderung. Genf. World Health Organization (WHO) (1980): International Classification of Impairment, Disabilities and Handicaps (ICIDH). Genf. World Health Organization (WHO) (1981): Disability prevention and rehabilitation. Technical Report Series 668. Genf. World Health Organization (WHO) (1986): Ottawa Charter for Health Promotion. Geneva. Zehentbauer, Josef / d’Onofrio, Patrizia / Tullio, Francesco / Toresini, Lorenzo / Basaglia, Franco (1999): Die Auflösung der Irrenhäuser oder: Die Neue Psychiatrie in Italien. München

Zwierlein, Eduard (Hrg.) (1996): Handbuch Integration und Ausgrenzung. Neuwied Kriftel - Berlin.