Reconsidering Intellectual Disability

L'Arche, Medical Ethics, and Christian Fellowship

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Jason Reimer Greig
Moral Traditions
  • Washington, DC: 
    Georgetown University Press
    , August
     304 pages.
     For other formats: Link to Publisher's Website.


In 2004, the parents of “Ashley X,” a six-year-old girl with profound cognitive and physical impairments, began to explore medical treatment options to mitigate the complications early-onset puberty presented for their daughter’s well-being and continued care in the home. After consultation with medical professionals and review by an ethics committee, the parents moved forward with what has henceforth been termed the Ashley Treatment (AT): a treatment plan consisting of a hysterectomy, the removal of breast buds, and growth attenuation therapy. When Ashley’s parents made their family’s story public, voices rose in support and in opposition to the implementation of the AT, yet Christian moral theologians remained mostly silent. Jason Reimer Greig’s Reconsidering Intellectual Disability: L’Arche, Medical Ethics, and Christian Friendship seeks to fill this lacuna.

Greig begins his project by discussing the specifics of Ashley’s embodiment, the development of the AT, and the arguments raised in support and in opposition to the AT. The details of Ashley’s embodied life of total dependence “[interrupt] the claims of universal or transcendent moral theories,” leading Greig to propose an examination of the AT “through the lens of a moral community rather than individual self-determination” (3). To accomplish this goal, Greig draws on wide-ranging fields of thought, including the Christian theological tradition, moral philosophy, disability studies, medical ethics, feminist theory and ethics, and political theory.

Greig offers a significant contribution to disability studies and disability theology in his engagement with the medical model of disability (chapter 2) and the social model of disability (chapter 3). In his examination of the medical model, Greig meticulously uncovers the relationship between Baconian medicine’s discourse of bodily control and elimination of human contingency and the oppression of persons with profound cognitive impairments. In the following chapter, Greig raises common critiques regarding the social model’s focus on self-determination, as well as its strict bifurcation of individual impairment and socially produced disability. However, Greig builds on these critiques by examining the function of the social model in the works of disability theologians Nancy Eiesland and Sharon Betcher. The result is an incisive criticism of the social model’s influence on disability theology, revealing how these theologies of liberation for persons with disabilities inherently “disqualify those persons with intellectual impairments because of [the social model’s] strong demand for agency” (106). In other words, disability theology based in the social model places persons with profound cognitive impairments back under the oppressions of the medical model.

This critique draws Greig away from models of disability and toward a strand of the Christian tradition that emphasizes friendship with God as the human telos. Greig’s constructive proposal unfolds over his final three chapters, beginning with an explanation of biblical, theological, and philosophical understandings of friendship (chapter 4), continuing with a construction of an ecclesiology of friendship (chapter 5), and concluding with an exploration of L’Arche communities as a model for the church on how to be a community of friends (chapter 6). Throughout these chapters, Greig weaves together the themes of trinitarian theology, friendship, footwashing as a habitus of the Christian life, and human dependence to create a vision of the body of Christ as a moral community that rejects the AT and offers an alternative, life-giving narrative for persons with profound cognitive impairments.

One of the strengths of Greig’s project is his emphasis on the notion of asymmetrical friendship. As he highlights in his discussion of Eiesland and Betcher, a common issue that stymies theologizing in relation to persons with profound cognitive impairments is the (im)possibility of equal reciprocity. Rather than try to account for a form of equal reciprocity between persons with and without profound cognitive impairment, Greig eschews the notion that equal reciprocity is necessary for true Christian friendship. Rather, Greig argues for an understanding of equality grounded in human dependency, exemplified in the friendship offered by the infinite triune God to finite human creatures. By drawing on Christian understandings of friendship to answer this (im)possibility of reciprocity, Greig reveals the rich resources the Christian tradition offers for responding to the challenging questions faced by disability theorists, activists, ethicists, and theologians today.

Greig’s discussion of the use of the social and medical models in disability theology also raises significant questions regarding the efficacy, or lack thereof, of models of disability in disability theology. While Greig discusses these two predominant models at length, he mentions other models in the footnotes, particularly the cultural model of disability. While engagement with alternative models lies outside the bounds of his project, further exploration of the cultural model might hold promising possibilities for strengthening his overall argument without necessitating a total turn away from models of disability in his constructive work. While Greig’s critiques of Eiesland and Betcher offer a necessary intervention, to not utilize models of disability at all could have dangerous implications for work in the wider field of disability theology and Christian ethics, including a harmful de-centering of the complex contexts inhabited by persons with disabilities that models of disability seek to clarify.

By plunging himself into a cavernous gap in Christian ethical discourse regarding persons with profound cognitive impairments, Greig takes a risk that pays off. Through his use of the case of Ashley X, Greig puts flesh on the need for sustained and responsible theological reflection with and around persons with profound cognitive impairments, and offers the initial fruits of such reflection. The result is a vision of the church as a moral community as exemplified in L’Arche, a network of intentional Christian communities where core members with intellectual disabilities live in mutual relationship with nondisabled assistants. Out of his research and work within L’Arche, Greig offers important first steps in shifting how disability theology and Christian (bio)ethics engages questions surrounding quality of life, communal care, human worth, and inclusion of persons like Ashley, and, truly, persons of all embodiments.

About the Reviewer(s): 

Lisa Hancock is a doctoral candidate in systematic theology at Southern Methodist University.

Date of Review: 
October 18, 2017
About the Author(s)/Editor(s)/Translator(s): 

Jason Reimer Greig spent eleven years with L'Arche, an international federation of Christian communities supporting people with intellectual disabilities, as a house assistant and spiritual life coordinator. He holds an MDiv from Anabaptist Mennonite Biblical Seminary and is working on his PhD in theology at VU Free University of Amsterdam.


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