People with mental retardation do not enjoy much liberty—in spite of ideals of normalisation. Their lives tend to be organised through routines and plans formed by their assistants—with the client taking a rather passive part in the planning process. Whether we accept or object to this state of affairs depends on what we believe people with mental retardation are able to do. Because people with mental retardation differ dramatically in their personal characteristics, the issues of who should decide and how to interfere should be determined individually. We may still describe and analyse the moral problems in general and then suggest principles and procedures to be applied to individual cases.
The dissertation consists of three parts. The first part explains and justifies why we should ascribe equal moral status universally—in spite of the large variability we find in personal characteristics among human beings. Understanding people as individual centres of experience and sources of pro and con attitudes justify the egalitarian conception of moral status. We are all born as members of the human moral community. An inclusive attitude is characteristic for it. Because we all want membership for ourselves, in respect of being centres and sources as indicated above, there cannot be a moral justification for expulsion of other people. This motivates an attitude of sensitivity and equal respect and concern for every person we deal with.
The result is a conceptual framework for reflecting on what an appropriate care may be. People with mental retardation are partly different from most people. We should recognise this difference. They are not so different, however, that they fall outside the scope of morality. We should recognise this similarity. We can do justice to both the difference and the similarity by focusing on emotions and the way in which they play a role in our interpretation of people's actions, and by attending to how emotional reactions express how people are affected. We may do so within a common sense approach.
How far should people with mental retardation decide for themselves, make their own plans, and thus organise their own lives; and when are we able to hold them responsible for their decisions? Those questions are addressed in Part II. The following principle is suggested for assigning negative liberty to every human being: People should experience personal freedom insofar as they will benefit from it and concern for others allows for it. They should be allowed some negative liberty even when we cannot hold them responsible for their acts. Whether we may hold someone responsible for what he does is treated as a separate issue. Personal liberty should not be determined by whether the client’s capacity for autonomous decisions is above some predetermined level. Furthermore, it is suggested that practical competence depends on more than autonomy. It is also indicated how the assistants may try to enlarge the area of negative liberty that their client should enjoy; and how they may support him as a moral agent. Lastly, the dissertation inquires into how they may know what the client wants.
In Part III, the focus is on how other people should behave in case they find it right to interfere with the decisions and behaviour of mentally disabled people, and what the aim of controlling their lives and behaviour should be. The dissertation inquires into the moral problems produced by attempts to control other people’s life and behaviour. The issue is not exhausted by what is usually identified as paternalism. Part III also discusses how we should reason about legal protection intended to secure some negative liberty for all people with mental retardation. ‘Empowerment’ in the form of assistance and help will not increase the client’s social power. Lastly, some remarks are added on how far the assistants should aim at a coherent care and how to balance this concern against the aim of protecting the client's liberty and supporting his agency.