Professional Ethics in Disability Healthcare: Understanding Rights and Barriers in India

When a person who uses a wheelchair cannot enter a hospital because there is no ramp, is the problem the wheelchair or the steps? This seemingly simple question sits at the heart of how we define, understand, and respond to disability – and it has profound implications for healthcare professionals, policymakers, and anyone working in disability and rehabilitation. In India, two landmark frameworks shape this understanding: the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), ratified in 2007, and the Rights of Persons with Disabilities (RPwD) Act, 2016. Together, they represent a decisive shift – from viewing disability as a personal medical problem to recognizing it as a social and rights-based issue.

Defining disability: what the law says 🔗

A foundational step in understanding disability rights is clarity on who is considered a person with a disability under the law. According to the RPwD Act, 2016, a person with a disability is defined as someone with a long-term physical, mental, intellectual, or sensory impairment, which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. This definition is drawn directly from the UNCRPD framework and is significant for one key reason: it does not locate disability solely within the individual. Instead, it recognizes that barriers – environmental, social, and attitudinal – are co-creators of disability.

The RPwD Act expanded India’s earlier 1995 legislation, which recognized only seven disability categories. The 2016 Act broadened this to cover 21 conditions, including dwarfism, acid attack survivors, intellectual disabilities, specific learning disabilities, autism spectrum disorder, and mental illness. It also introduced the concept of “benchmark disability,” referring to those with not less than 40% of a specified disability, who are entitled to enhanced legal protections and reservations in education and employment.

The core principles underpinning the Act include respect for inherent dignity, individual autonomy, non-discrimination, full and effective participation, and accessibility. These principles are drawn from the UNCRPD and were stated as the foundation for all empowerment efforts under the Act – a clear signal that disability policy in India must be rights-based, not charity-based.

Environmental barriers: the real disabling force 🔗

Understanding disability in isolation from the environment tells only half the story. The UNCRPD explicitly states that disability results from the interaction of impairments with attitudinal and environmental barriers that hinder full and active participation in society on an equal basis. This framing is critical – it shifts responsibility from the individual to the society that fails to accommodate them.

In India, these barriers are widespread and deeply entrenched. As of December 2020, less than 7% of public buses across the country were fully accessible for wheelchair users. Buildings without ramps, metro stations without functional lifts, footpaths occupied by vendors, and roads with no safe crossing points – these are not minor inconveniences. They are structural exclusions that prevent people with disabilities from accessing education, employment, healthcare, and civic life.

For the estimated 26.8 million Indians living with disabilities, inaccessible transportation is one of the most significant barriers to participation. According to the International Labour Organisation, failing to include people with disabilities in the workforce can cost a nation up to 7% of its GDP – making accessibility not just a rights issue, but an economic one.

Beyond physical infrastructure, attitudinal barriers are equally disabling. People with disabilities in India face what researchers describe as “invisibilisation” – systematic exclusion from educational institutions, public spaces, healthcare, and workplaces, denying them fundamental human rights. Many are confined to their homes due to inaccessible transport and infrastructure, or due to fear of social stigma, which also contributes to gross underreporting of disability in official data.

The Accessible India Campaign: policy intent vs. ground reality 🔗

Recognizing these gaps, the Government of India launched the Accessible India Campaign in December 2015, with aims to develop an accessible physical environment, transportation system, and information and communication ecosystem. The campaign set targets for making government buildings and public buses accessible by specific deadlines. However, implementation lagged significantly. More than two years after the campaign launched, only 3% of targeted buildings had become accessible – a stark reminder of the gap between legislative ambition and ground reality.

This gap is not simply a failure of will. Indian cities have developed organically, with footpaths that are pot-holed and uneven, roads that are nearly impossible to cross, and buildings where steps remain the only means of entry. Retrofitting decades of inaccessible infrastructure is both technically complex and financially demanding. Awareness gaps among architects, planners, and policymakers compound the problem – leading to environments that may technically meet legal requirements but fall short of genuine accessibility.

The medical model vs. the social model of disability 🔗

To understand why these gaps exist and how they can be addressed, it helps to examine the two dominant frameworks through which disability has historically been understood.

The medical model 🔗

The medical model views disability as a problem within the individual – a condition caused by disease, impairment, or injury that needs to be treated, cured, or rehabilitated. Under this model, the goal is to bring the person closer to a perceived “normal” standard of functioning. While medical intervention is undeniably important for many conditions, this model can have a limiting effect on how society responds to disability: if the problem is seen as residing entirely in the person, then there is no obligation to change the environment.

This approach historically shaped India’s disability policy. The 1995 Act, for instance, adopted a social welfare approach with the main focus on prevention and rehabilitation, treating disability primarily as a medical condition requiring professional intervention rather than a rights issue demanding structural reform.

The social model 🔗

The social model separates “impairments” – the effects of a health condition – from “disabilities,” which it defines as the limits set by society. Under this model, disability is not an inherent attribute of the person but rather a consequence of environments, policies, and attitudes that fail to accommodate human diversity. A person who is deaf is not inherently disabled; they are disabled by a world that communicates exclusively through sound and offers no sign language interpretation.

This paradigm shift was driven by decades of advocacy from disability rights activists and culminated in the adoption of the UNCRPD in 2006, which embraced a human rights-based approach. The social model places responsibility on the State and society to create an inclusive framework – not to “fix” the individual.

The ICF: bridging the medical and social models 🔗

Neither the medical model nor the social model, on its own, provides a complete picture. The International Classification of Functioning, Disability and Health (ICF), developed by the World Health Organization in 2001, offers a more integrated and practical framework.

The ICF conceptualizes disability not solely as a problem residing in the individual, but as a health experience that occurs in a context. Disability and functioning are outcomes of interactions between health conditions and contextual factors – both environmental and personal. Environmental factors include physical infrastructure, transportation, social attitudes, policies, and services. Personal factors include age, gender, education, and coping styles.

Unlike the medical model, which locates disability within the individual’s body, and the social model, which attributes disability entirely to societal barriers, the ICF offers a balanced approach – acknowledging the role of impairment while also recognizing how social structures enable or restrict participation. This bio-psychosocial perspective means that interventions can target both the person’s health condition and the environment that surrounds them.

The ICF has been accepted as one of the United Nations social classifications and provides an appropriate instrument for the implementation of stated international human rights mandates as well as national legislation – making it directly relevant to the implementation of India’s RPwD Act, 2016.

Why this matters for disability healthcare professionals in India 🔗

For rehabilitation professionals – physiotherapists, occupational therapists, psychologists, speech therapists, and social workers – this conceptual foundation is not abstract theory. It directly informs how they assess clients, design interventions, and advocate for systemic change.

A physiotherapist who works only within the medical model may focus exclusively on improving a patient’s gait or muscle strength. A professional who also understands the social model and ICF framework will simultaneously advocate for ramp access at the patient’s workplace, flag attitudinal barriers within the family, and coordinate with community workers to ensure inclusive participation. This expanded lens is what transforms a clinician into a rights-based practitioner.

Professional ethics in disability healthcare, then, begins with this understanding: the person in front of you exists within a social, physical, and policy environment that is either enabling or disabling them. An impairment on its own would not lead to disability should there be a completely inclusive and comprehensively accessible environment – which means that every professional in this field carries a responsibility not just toward the individual, but toward the systems that shape their life.

Disability as both a medical condition and a social construct 🔗

One of the most important insights from the UNCRPD and ICF framework is that disability is not a binary state – you are not simply “disabled” or “not disabled.” The ICF provides a descriptive profile of an individual’s pattern of functioning, not a yes-or-no answer about whether someone is disabled. The degree to which someone experiences disability depends on the match – or mismatch – between their health condition and the environment they inhabit.

This means disability policy cannot be effective if it only addresses one dimension. Medical and rehabilitative interventions are relevant to body-level aspects of disability, while environmental and social interventions are relevant to restrictions in participation in educational, economic, social, cultural, and political life. Comprehensive policy – and comprehensive professional practice – must address both.

India’s RPwD Act, 2016, attempts exactly this. By mandating accessibility in buildings, transportation, and information systems; reserving seats in higher education and jobs in government for persons with benchmark disabilities; and establishing grievance redressal mechanisms and special courts, the Act seeks to transform the treatment of people with disabilities from being objects of charity to subjects with rights who can claim those rights. The challenge – and the professional responsibility – lies in ensuring that this legal intent translates into lived reality.

What do you think? If disability is partly created by inaccessible environments, does that mean every architect, urban planner, and policymaker carries ethical responsibility alongside healthcare professionals? And in your view, is India’s RPwD Act 2016 doing enough to shift the focus from individual rehabilitation to systemic inclusion – or are there critical gaps that still need addressing?

References

1. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
2. https://idronline.org/article/rights/a-primer-on-indias-disability-law/
3. https://divyangkalyan.maharashtra.gov.in/en/frequently-asked-questions-faqs/
4. https://www.ldexplained.org/rights-lp/the-rights-of-persons-with-disability-act-rpwd-act-2016/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC5419007/
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC6482682/
7. https://www.aljazeera.com/features/2022/3/30/indias-mumbai-living-with-a-disability-in-the-megacity
8. https://www.linkedin.com/pulse/breaking-barriers-challenges-accessing-public-transport-persons-gx76f
9. https://theylacproject.com/wp-content/uploads/2024/11/Final-White-Paper-The-State-of-Disability-in-India-f-print-4.pdf
10. https://www.bu.edu/sph/news/articles/2016/the-intersection-of-poverty-and-disability-in-india/
11. https://depwd.gov.in/en/accessible-india-campaign/
12. https://www.ijurr.org/spotlight-on/disabling-city/disability-and-the-pursuit-of-mobility/
13. https://aseq-ehaq.ca/en/medical-model-vs-social-model-of-disability/
14. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
15. https://pmc.ncbi.nlm.nih.gov/articles/PMC3104216/
16. https://hubsociology.com/the-international-classification-of-functioning/
17. https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf
18. https://gsdrc.org/topic-guides/disability-inclusion/background/definition-of-disability/
19. https://www.unescap.org/sites/default/files/Chapter2-Disability-Statistics-E.pdf