Authors’ response

Sir,

There has been a fundamental shift in the motivation for benefits provided to persons with disabilities. The earlier charity based provision of disability benefits has now evolved to a rights based approach where benefits to disabled are not provided due to sympathy but rather as a right of the disabled towards being able to participate in the society on an equal basis. If a person fulfils the disability criteria as enacted in the legislation, he/she has the right to get the benefits that they are entitled to. It would be unjust and illegal to link disability benefit to treatment or refusing treatment or stigma. This understanding is critical for all stakeholders including policy makers towards effective functioning of the system.

Further, providing disability benefits equips persons with disability with an equal opportunity for full participation in the society and to fight against the stigma. Disability is not dependent on diagnosis or incurability or outcome of the illness. United Nations Convention on Rights of person with Disability (UNCRPD)1 clearly defines that persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

With regard to the requirement of a specific duration of illness for certification process, we have clearly suggested in the section on ‘Measurement of Disability’2 that there is a need to consider “Months of illness during the last two years (MY2Y)” as the unit. This will help address measurement of disability certification in episodic or short duration illness. In case of permanent disability, current legislation allows the board to certify the permanent disability. Hence, during the assessment of disability the clinician needs to focus more on activity limitations, and participation restrictions. This definition has been emphasised by the International Classification of Functioning, Disability and Health (ICF)3, which defines disability as an umbrella term for impairments, activity limitations, and participation restrictions. World Health Organisation has clearly emphasised that disability is a complex, dynamic phenomenon, reflecting an interaction between features of a person's body and features of the society in which he or she lives4.