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A THEORETICAL ANALYTICAL STUDY OF SOME ISSUES RELATED TO CARING FOR AND EDUCATING INDIVIDUALS WITH DISABILITIES FROM A SOCIO-CULTURAL AND LEGAL PERSPECTIVE
MAHMOUD MOHAMED ELTANTAWY12*
1Associate Professor of Special Education, Faculty of Education, Imam Mohammad Ibn Saud Islamic University
(IMSIU), Saudi Arabia
2Assistant professor of Special Education, Faculty of Education, Ain shams University, Egypt
mmeltantawy@imamu.edu.sa mahmoudeltantawe@edu.asu.edu.eg
Abstract: Nowadays, a group of issues related to educating and caring for individuals with disabilities have arisen, which raised a heated controversy as they relate to a highly debated socio-cultural and legal dimension and are still disputed among expert scholars in this field. These include problems related to vaccination and its role in causing children to suffer from some disabilities and disorders, the sterilization of individuals with intellectual disability, stem cells therapy and its role in limiting disabilities, using medical drugs to ameliorate or treat some disorder symptoms, and educating persons with disability in higher education institutes and its constraints. These have, undoubtedly, diverse effects on those individuals as well as their families, which requires an in-depth study to clarify the various views concerned with them in relation to the opinion of religious institutions, the prevailing societal and ethical stance, as well as the legal and legislative perspective related to them. This study, thus, aims at deeply studying these issues in order to clarify the ambiguity surrounding them.
Keywords: Individuals with disabilities, Vaccination, Sterilization, Stem cells, higher education institutes, medical drugs, Ethical issues, Legal issues.
INTRODUCTION
The revolutionary scientific development happening in all life aspects resulted in a variety of debatable issues; the response to which varies between support, opposition or neutrality, which made it difficult to adopt any of them as each has its justification and evidence. These have reached the domain of educating Individuals with disabilities and became clearer due to their specificity.
These issues have been affected by a group of variants controlling the society, such as religions, personal believes, societal values and traditions, human rights, as well as laws and legislations. The views concerning these problems differ among societies, countries, and even among the members of the same family. Among these are: vaccination and its role in causing children to suffer from some diseases, disabilities and disorders as well as the inclination of some families not to vaccinate their children, the sterilization of persons with intellectual disability and depriving them of one their rights as well as their self-determination, and stem cells therapy and its role in limiting disabilities as well as the religious, ethical, legal aspects related to it.
Another issue is using unmanufactured medical drugs to treat some symptoms suffered by persons with intellectual disability, with autism spectrum disorder, with attention deficit hyperactivity disorder, and a considerable number of those who suffer from developmental disorders, and how this violates religious doctrines as well as the customs and traditions prevalent in Arab countries. In addition, the problem of educating persons with disability in higher education institutes has raised criticism and arguments among experts, specialists and employers, due to the various troubles related to this issue, especially in what concerns evaluation methods and their equality to normal students.
Thus, it became mandatory to study these issues and clarify the ambiguity surrounding them with the aim of formulating a unified point of view which helps in resolving them and maximize the benefits for the sake of individuals with disability.
Through an in-depth study, some questions, still, require more research to reach valid answers. This is exemplified in the following: How does the Arab community deal with these issues? Were they studied objectively to reach a unified vision? Did scientists and experts foresee the impact of these issues and study their effects on normal people, in general, and on individuals with disability as well as their families, in particular? What is the opinion of religions and societal culture about them?
THE STUDY PROBLEM
The problem of the study is represented in shedding light on a group of issues related to individuals with disability, which deeply affects various aspects of their life, such as health, social, psychological, marital, and educational sides. The families of those individuals and the society are also affected, which necessitates dealing with them from a scientific perspective to identify and clarify the various perspectives related to them as well as delineate a holistic integrated image about them; this enables people working in the field of educating individuals with disability and taking care of them as well as their families to constitute clear perspectives, which directly affects their recognition and the way of dealing with them. The Arab society is, thus, disclosed to be in a bad need for a package of laws and legislations to control such issues and create a social consensus towards them.
THE OBJECTIVES OF THE STUDY
The current study aims at dealing with some issues related to individuals with disabilities as well as clarifying the prevailing points of view related to each issue form a socio-cultural and legal perspective.
THE IMPORTANCE OF THE STUDY
This can be summarized in the following points:
- Shedding light on some issues related to individuals with disabilities and present different views related to them, as well as clarify the role of religious and cultural variants in them.
- Forming a comprehensive image about these issues, which helps teachers, educationalists, caregivers and decision makers to understand the need of these individuals.
- The present study can be the starting point of future studies in the Arab environment.
- Providing a reliable theoretical framework fit to study theses issues experimentally and quasi-experimentally.
- The present study can be the starting point of future studies in legal aspects related to educating individuals with disabilities and caring them in the Arab region.
THE DEFINITIONS OF THE STUDY
The issue: A special event happening in a society due to emergent changes happening as a result of internal or external factors. In major cases, no logical solution is found; the main cause can be the split into two groups, one which supports this issue and considers it a development or a change which has to happen in society, which may happen because of personal benefits, and another group which opposes this issue, believes that it happened due to new external aspects, and refuses experimenting with it for any reason (Al-ghazzawi, 2004).
Vaccination: It is the stimulation of the natural human immune system to confront some disease causes like bacteria and viruses. Its aim is either preventing the illness, minimize its severity, or stop the dangerous symptoms. The majority of vaccinations consist of protein substances or parts of the bacteria that cause the illness itself, after being treated in special ways as they become unable to cause it but, at the same time, remain effective in stimulating the immune system to produce
immune materials which can fight the same type of bacteria if the body is exposed to it in the future (Al- bakri, 2014).
Sterilization: It is a process which makes persons unable to conceive through a number of medical techniques, and it is the most effective way of birth control. Sterilization also includes therapeutic and non-therapeutic methods; thus, it is a permanent irreversible process; in females, it happens through cutting uterine horns, while in males it is done through vasectomy without harming genital glands (Park, Hogan & Goldscheider, 2003).
Stem cells therapy: It is implanting human or animal cells to make up for damaged cells or tissues as an attempt to treat diseases. Stem cells therapy, together with genetic therapy, can be used to reach the best results, which means illness prevention or treatment. Implanting bone marrow is the most used type of stem cells therapy; some bloods derived from the umbilical cord can also be used. Serious research is still carried out to develop different sources of stem cells therapy in order to be used in treating neurology diseases, diabetes, heart diseases, and others. With the high ability of experts to isolate and implant fetus stem cells through transporting bodily atom cells and using techniques to create multi-capacity stimulating stem cells, the argument about abortion and cloning has appeared (Quimby, 2019).
Medical drugs: These are unmanufactured medical drugs used to minimize the severity of some diseases/disorders or of their symptoms.
Educating individuals with disabilities in higher education institutes: This means educating individuals like persons with intellectual disability, with autism spectrum disorder, with attention deficit hyperactivity disorder, or who suffer from developmental disorders ... etc, in high education institutes with implementing suitable modification in the learning environment, teaching methods, evaluation, as well as training staff members on their needs. What follows is a detailed discussion of these issues:
THE FIRST ISSUE: VACCINATION AND ITS ROLE IN SOME CHILDREN'S DISABILITIES AND DISORDERS
Health systems in different countries seek to vaccinate children against diseases, especially infectious ones which endanger their lives. Although vaccines are beneficial, their importance has been doubted as some cause disabilities and disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD). A critical question is, thus, raised: Do the merits of vaccines surpass their probable effect of making some children suffer of some diseases or disorders? (Gromis & Liu, 2018).
Some vaccines used in preventing measles have been accused of causing (ASD). (Burgess, Burgess & Leask, 2006) mentions that this was the major health issue in the United Kingdom in 1998 when health experts were surprised at the strength of the public opinion against measles vaccine. This argument had harmed the authorial efforts to vaccinating children against diseases. Some activists had attacked the vaccines due to their lack of awareness. A legend, thus, spread that some vaccines cause (ASD) and other developmental disorders (Patil, 2011). Nowadays, being hesitant against vaccines is classified by the World Health Organization to be among the top 10 threats against public health (Roberts, 2019).
Researchers interested in the issue of vaccination were divided into two parties, one which strongly supports it and another that opposes it fearing for children's lives. These are presented as follows:
The first group: Vaccination proponents
Based on the findings of some studies and research papers published in scientific journals, which assured the safety of vaccines, this group believes in the necessity of children to get vaccines according to a specified schedule to protect them against spreading diseases, maintaining public health, and to stop the spread of infectious diseases.
Madsen, Hviid, Vestergaard, Schendel, Wohlfahrt, Thorsen, Melbye (2002) is among the studies which supported this idea. It was carried on (303.537) children vaccinated against measles, and it reached the conclusion that the relevant danger of children having (ASD) is equal in both vaccinated and unvaccinated children. This, according to the research group, means the lack of strong evidence against the hypothesis arguing that measles vaccine causes (ASD). The findings of Mrozek-Budzyn, Kieltyka & Majewska (2010) stated that there is not any relation between vaccinating children and having (ASD). Destefano, Price & Weintraub (2013) also assured that being highly subject to the antibodies found in vaccines does not relate to the danger of suffering from (ASD). Berger, Navar-Boggan& Omer (2011) have also stressed the necessity of being vaccinated against measles as it plays a crucial role in preventing nervous system disorders as well as (ASD).
In what concerns influenza vaccine, Hooker (2017) assured a negative correlation between mothers getting influenza vaccination during pregnancy and the child having (ASD). Zerbo, Qian, Yoshida, Fireman, Klein &Croen (2017) has also confirmed that no evidence is found between getting influenza vaccine during the first three months of pregnancy and the child having (ASD).
A huge argument related to using mercury and its role in inducing disabilities and disorders, especially those related to the central nervous system has emerged. As a result, many institutes and specialists researched the impact of this substance on children. The findings of Barile, Kuperminc, Weintraub, Mink& Thompson (2012), for instance, proved that mercury used in vaccines is one of the most controversial matters in relation to causing some diseases and disorders for children. This study sought to know the psychological and neurological effects of subjecting children to mercury, and it clarified that there is no relation between vaccinating children using mercury, on one side, and cognitive behavior, verbal memory, kinetic coordination, motor coordination, and language, on the other. However, there is a correlation between vaccinating them using mercury and the appearance of nervous syndromes in male children.
In the same vein, Children's Hospital of Philadelphia (2018) assured that mercury found in vaccines has a definite role in children's diseases. This was ascertained when it was removed from some vaccines aimed at children, but the ratio of their infection by (ASD); on the contrary, has increased. It also pointed out that the number of vaccines given to children has raised since the eighties of the twentieth century; which could be, according to some, a direct cause of (ASD); however, this has no evidence. Others focused on the role of aluminium substance used in some vaccines in causing (ASD); however, this could be refuted by the fact that aluminium exists in breast milk and other milks with a higher ratio than in the vaccines. The second group: Vaccination opponents
This group thinks that vaccines given to children in order to prevent diseases, disabilities, and disorders can have a negative impact on their growth, relying on the findings of some published research papers and studies. In this regard, Rimland & McGinnis (2002) have pointed out that vaccines can often be one of the stimulators of (ASD); many information have identified that children having (ASD) suffer from immunity deviance as well as weak resistance to infection, and a weak self-immunity. When children are given vaccines that contain mercury, serious neurologic effects as well as weakening self-immunity can be caused. (ASD) has many non-homogeneous reasons; some medics and parents believe that vaccines can be one of these. Qin, King & Broder-Fingert (2018) point out to the number of factors causing (ASD), as well as the role of environmental and genetic effects on the structure of neurologic cells of children suffering from (ASD).
Moreover, Destefano et al., (2013) state that although there are some speculations concerning the relationship between some vaccines and some neurologic disorders, being exposed to poisons, such as Ethanol and heavy metals (including lead, aluminium and mercury) strongly affects growth factor signals, which causes harmful effects on reactions. Some chemical substances play a crucial role in systematizing normal DNA functions and genetic change, which is highly critical in the infants and children's proper neurodevelopment. Scientists and practitioners referred to an increase in the number of persons with (ASD), especially attention deficit hyperactivity disorder, but the reasons are not fully clear till now.
Gallagher & Goodman's (2008) findings highlighted that children, whose age ranges between one to nine years old, who obtained Hepatitis (B) vaccine were prone to receive special education services and early intervention nine times more than those who did not receive it. This study has found a statistical significance that males who received this vaccine in the USA during the period in which vaccines were made of mercury were more prone to developmental disorders than unvaccinated ones.
Gallagher & Goodman's (2010) findings pointed to the existence of a strong correlation between being vaccinated against hepatitis (B) and (ASD) and that the danger of having (ASD) in the American new born vaccinated with hepatitis (B) is triple than those who are not vaccinated. The study clarified positive correlations between this vaccine and ear, pharynx and joints inflammation. Gromis & Liu (2018) proves that parents strongly believe that in the negativity of vaccines through increasing the number of children that enroll in schools without being vaccinated, especially in highly economic level regions, and it showed that (ASD) does not relate to children's being vaccinated or not.
Based on the aforementioned, it could be reiterated that there is a huge discrepancy between the views of researchers, specialists and parents concerning the importance of vaccinating children. However, it is certain that it is not recommended to stop vaccinate children, but to put into consideration some criteria of vaccination as follows:
- Using components which have probable negative effects on children in vaccines, especially mercury, should be prohibited.
- The number of vaccines given to children should be augmented with the passing of years and with the advent of technology, and identifying unknown diseases should be put into consideration, which requires the medical systems responsible for children's health in the society to re-evaluate these vaccines.
- The harm caused to the child due to not taking vaccines in comparison to the limited positive results which can be obtained should be considered.
- There are some cases in which children should be prohibited from being vaccinated, such as the instances in which children are treated with cortisone, suffering from immunity weakness, being allergic to some vaccines or drugs, using chemical or radiological treatment, or other causes.
THE SECOND ISSUE: STERILIZING INDIVIDUALS WITH INTELLECTUAL DISABILITY
Obligatory sterilization is one of the flagrant historical violations which happened in the first half of the 20th century; individuals with intellectual disability were the primary target of this procedure as a part of negative eugenics. For many decades, active laws have allowed sterilization without the consent of concerned people. The negative long-term results on those who were involuntarily sterilized have not appeared until recently; in the second half of the 20th century human rights treaties were introduced to prevent this procedure, and courts implemented more strict criteria to issue sterilization decisions. Nowadays, there are enough guarantees to protect these persons from being obligatory sterilized, unless this is consented from the individuals themselves, taking into consideration the medical and social factors of each case (Rowlands & Amy, 2017).
The issue of compulsory sterilizing individuals with intellectual disability raises a number of ethical and legal problems. Thus, the individual with intellectual disability self-determination capacity in what concerns this operation is mandatory, even if parents or caregivers had a supporting view; the family members' welfare, their personal occupations, their feeling of sympathy should not bypass the rights of persons with intellectual disability; parents' role, thus, is only guidance (Barton-Hanson, 2015).
The issue of Hysterectomy in females with intellectual disability has raised a wide response among different societies, especially the Arab and Islamic one because it has religious, legal, social, psychological cultural, and medical dimensions. This issue is not new, but it started to appear again.
To clarify, the function of the uterus to women should be recognized, for it has different purposes top of which is pregnancy and menstruation. When it is removed, a woman cannot get pregnant, and her menstruation stops. Thus, whoever calls for Hysterectomy in female individuals with intellectual disability wants to achieve both of these aims, preventing them from having children with intellectual disability like them, on the one hand, and relieving family members from their special care they need during their menstruation, on the other. Others also fear that they may be subject to rape, which is another undeclared cause of these operations.
The findings of Aunos & Feldman (2002) review clarified that the parents of these girls support this view, but these results cannot be generalized in Arab and Islamic societies. Chou & Lu (2011), which aimed at identifying the reasons of sterilization and the person responsible for this decision, has also highlighted that among the causes are lacking the ability to take care of children and that the families cannot do this, as the disability can probably be inherited and transferred to children, pregnancy due to being raped, or the inclination of some families to take this decision to stop their menstruation. The responsible about this decision is one of the persons who have a direct relationship with this woman, such as husbands, parents, and in some cases the medics following the case. This mostly happens without considering the rights of these females. Insogna & Fiester (2015) findings assured that females with intellectual disability are four times subject to being raped, in comparison to others and that pregnancy can, in some cases, represent an emotional and corporeal dilemma for this category.
Garrels & Arvidsson (2019) refer to the importance of self-determination skills for individuals with intellectual disability as they believe that despite the inverse relationship between the level of intelligence and self-determination skills, the findings of research papers state that persons with intellectual disability have these skills, but they show lower levels, in compassion to peers who do not suffer from an intellectual disability and that they do not use them much in their lives as they are complex cognitive abilities which are develop through social interaction with others. As a result, the researcher thinks that speaking about this issue is highly controversial as it has many intersective ramifications; removing a part of a human body has many negative effects, even if this human is a person with an intellectual disability. Discussing this issue needs an enlightened consideration of some factors including the following:
- It is not necessary that a woman with intellectual disability gives birth to a child with the same condition; many deliver healthy babies, especially when the intellectual disability is non-genetic, i.e. acquired. This leads to a thread of questions including why men with intellectual disability are not subject to processes of sterilization? Why all the responsibility is thrown on females suffering from the same condition? Is this equality? However, this is another issue.
- The medical consequences of this operation which are exemplified in lacking the ability to have children, the occurrence of hormonal changes during menstruation, as well as mood swings, and that cervix uteri excretes some hormones responsible for building the body and are crucial in women's psychological and corporeal status.
- The psychological consequences of this operation: Women can be subject to depression after Hysterectomy because they feel that they are not fully fledged or real women because some of her feminine parts were removed or because she cannot have children like others.
- The social consequences of Hysterectomy in females with intellectually disability can lead to being more sexually harassed, as offenders become sure that their assault will not result in pregnancy, and thus they will not be punished.
- The religious and cultural consequences of this operation: This operation can lead to an unneeded controversy, especially that it has a religious, ethical, and legal dimension that cannot be ignored; no one is allowed to get rid of the body parts of another incompetent person. Some religious scholars believe that it is religiously prohibited to Hysterectomize females with intellectual disability, whatever is the urge behind it, because this is a violation against a human body represented in mutilation, which is only allowed in medical cases which treatment depends only on removing this part. In addition, this act is considered an insult directed to the humanity and dignity of females with intellectual disability, and that this kind of operations prevents the
husbands of these women from their authentic right to have children, which is religiously and legally guaranteed.
The question which needs a response is "are there other alternatives which help in avoiding Hysterectomy in females with intellectual disability and to avoid this heated controversy?" the answer is: "yes", for there are a number of medical drugs which can be used to stop menstruation if this is the reason of carrying out this operation. Medical examination can be also used to know the possibility of genetically transferring intellectual disability to children, and thus preventing marriage that can result in disabled children.
The crucial matter which can end this controversy is "the sexual education of females with intellectual disability" through which they are taught adaptive behavior, the way they fulfill their needs within the religious and social constraints, how to take care of themselves during their menstruations, hygienic procedures, how to protect themselves from sexual, corporeal and psychological assaults, and what they are supposed to do if they experience such matters. Females with intellectual disability should be taught how to acquire self-determination skills, and they should be trained to use them effectively. Training programs which help them to choose responsibly should be designed. It is also important to note that the greater majority of females with intellectual disability suffer a simple form of disability, which makes them able to learn and comprehend the basics of sex education and to protect themselves from sexual harassment and, as a result, end this controversy. More research concerned with the medical, psychological, social, and ethical consequences of sterilizing these persons should be carried out.
THE THIRD ISSUE: STEM CELL THERAPY AND ITS ROLE IN CURTAILING DISABILITY
The current age has witnessed a great leap in the field of stem cells research; the drugs based on stem cells, which are called "regenerative medicine" are considered one of the attendant promising solutions to treat many deficient organs like hearts or kidneys, spinal cord injury, diabetes, AIDS, Parkinson's diseases, Alzheimer, Joints inflammations, blindness and sight deficiency, neurological diseases, muscle atrophy, genetic diseases, and many disabilities. Stem cells are the key to treat these diseases, and they can be obtained from the patient himself. That is why no problems will arise from refusing the tissues, like what happens in cases of kidney implant or bone marrow from donors. Somatic cell nuclear transfer provides a strong method to structure stem cells with patients chromosomes; as a result, ideal tissue matching happens (Siniscalco, Kannan, Semprun-Hernandez, Eshraghi, Brigida & Antonucci, 2018).
The idea of cloning in live cells inspired producing a replica of a special person, without mating in the known sense. This is based on using the ovulum cell after removing its nucleus and using another one from the body aimed at producing similar version to it. If this procedure succeeds, an authentic fully fledged being will be the outcome, who resembles the human from which body cells the nucleus was taken. As the bodily cells contains a full number of chromosomes (46), implanting its cell in ovulum makes the latter qualified to produce a being without fusion with a male cell as it happens in sexual reproduction. Scientists warn against the probability of a defect in a genetic factor during nucleus implant. They also direct attention to the fact that the cells of the new cloned being will not contain the genetic material of the female origin from which the ovulum was taken (Sharaf El-Din, 2001, 51).
Others think that this process can have great benefits in combating diseases of a genetic nature, especially in families among which disabilities of a genetic nature spread. The problem here lies in how far are theses operations ethical as well as in their religious compliance. Ethics Committee of the American Society for Reproductive Medicine (2016) has stated that it is unethical to use Somatic cell nuclear transfer (SCNT) to treat sterility due to the fears related to safely and its unknown impact on children's families, and communities, as there are other acceptable methods which helps in childbearing .
This type is considered to be the second type of organ implant, but it uses cells instead of donor's organs which cannot be easily provided. Scientists, thus, lab-grow particular stem cells taken from different organs, which are used to enhance the same special cells, like heart, blood, or nervous
cells. Then, they can be implanted in the patient. For instance, if he suffers from a heart disease, cells can be implanted in heart muscle.; thus the healthy heart cells can fix the diseased heart muscle (Siniscalco et al., 2018).
Scientists and specialists in the field of stem cells believe that they are one of the promising cures of many disorders and disabilities as they can be used in treating (ASD) which is characterized by a continuous deficiency in social communication and interaction as well as limited and repetitive behavioral patterns. (ASD) results from incompatible heterogeneous and complex neurologic developmental disorders. In fact, stem cells show special immunity features which make it promising in treating (ASD) (Siniscalco et al., 2018).
Freitas, Trujillo, Carromeu, Yusupova, Herai & Muotri (2014) point out that human stem cells derived from re-programmed human cells, taken from live patients, present a new perspective to understand (ASD). Modern technology can complete other versions of fundamental research and develop treatment compounds aiming at restoring the case to its initial state or ameliorating it. Farhat, Majma, Ashrafzadeh, Akhondian & Mohammad (2018) assure the effective role of stem cells in treating cerebral palsy; the stem cells of the umbilical cord blood a huge success in treating (165) patients who suffer from this disease. The results of the research carried on humans and animals have shown the beneficial effects of stem cells treatment in curing different neurological diseases. Using the stem cells of umbilical cord blood can be considered a strategy to treat cerebral palsy patients. These cells have also shown an intense amelioration in kinetic and perception functions and memory of patients who suffer from cerebral palsy.
The findings of Luan, Qu, Du, Liu, Yang, Wang & Du (2013) study proved the clinical efficacy of implanting stem cells to treat intense vision weakness resulting from new born brain injury, in comparison to traditional rehabititational training. Tang, Chen, Zheng, Shi, Ding, Qian & Chen (2016) results have also highlighted that genetic correction of stimulating stem cells derived from the bodily cells of patients who suffer from Sensorineural Hearing Loss (resulting from a genetic factor) is an promising way of treatment because the correction of genetic mutation helps in restoring the normal cell functions.
The ethical and legal problem concerning stem cells treatment remains the core of the issue; that is why Muslim scholars stated that there should be some religious controls which guarantee human dignity. These include the following:
- The procedure should not harm any creature.
- Its cause should be legal and compatible with Islamic Shari'ah purposes.
- The demerits of this process should not be equal to or more than its merits because warding off harm takes precedence over bringing interests .
- Using stem cells treatment should not oppose any Shari'ah texts.
- Checking the consent of the persons on which this kind of treatment is carried out or their representative (Al-ghamidi, 2010).
Muslim scholars believe that it is acceptable to get stem cells from placenta, umbilical cord, and amniotic fluid after the consent of parents. It is also permissible to get stem cells from adults under two conditions: not harming donors and their acceptance. There are two opinions concerning the stem cells extracted from aborted fetuses; if fetuses are spontaneously aborted or aborted due to a therapeutic reason, stem cells are allowed to be taken from them, but if they are purposefully aborted, this is not allowed. Concerning the remains of in-vitro fertilization and medical cloning, scientists were split into two groups each of which provides evidence to support its claim (Al-ghamidi, 2010).
Based on the aforementioned, the great role of stem cells in treating some diseases, disorders, and disabilities becomes clear as they represent a bright future in curing some disabilities. The discrepancy between the benefits of using them and their religious, ethical, and legal threats is also apparent.
THE FOURTH ISSUE: USING MEDICAL DRUGS IN DECREASING THE INTENSITY OF SOME SYMPTOMS AND SOME ACCOMPANYING DISORDERS SUFFERED BY INDIVIDUALS WITH DISABILITY
The problem of using medical drugs to lessen the severity of some symptoms suffered by Individuals with disability, especially those with developmental disabilities, is considered one of the contentious issues which have several cultural and religious dimensions, especially in Arab environments. Taking these substances are religiously and socially prohibited; however, scientific papers started to study their effects and diagnose the positive and negative ones. The coming few days can witness an expansion in using such cures which depend on medical drugs. In this vein, Efron, Taylor, Payne, Freeman, Cranswick, Mulraney & Williams (2020) state that treating troubled behavior of Individuals with intellectual disability and developmental disorders is very hard. The psychological interventions are mostly inefficient with these persons. That is why some medics are inclined to use some medicaments like depression and psychosis although they are extremely dangerous for children and teenagers with disabilities. Cannabis plant (Cannabidiols) and its derivatives, including marijuana, are increasingly used in treating some medical and psychological cases. A great interest of the probable curing effect of this plant has been witnessed. Manufactured cannabis compounds (Tetrahydrocannabinol) which are used in some drugs have a variety of side effects like hallucinations and paranoia, as opposed to non-manufactured cannabis which can have positive benefits in some cases.
In Barchel, Stolar, De-Haan, Ziv-Baran, Saban, Fuchs & Berkovitch (2019) that was carried out to investigate the effect of cannabis on some behaviors of children and teenagers with (ASD), (53) persons with (ASD) whose age rages between (4-22) with an age range of (11) years old and who took Cannabidiol for (66) days, which caused the decrease of self-harm and anger behavior with a percentage of (67,6 %) of the sample members, whereas these were worse in (8.8 %) of the sample. Hyperactivity decreased in (68.4 %) of the sample members, no change was witnessed in (28.9 %), and it increased in (2.6 %) of the sample. Concerning sleeping issues, they were ameliorated in (71.4 %), and worsened in (4.7 %). As for anxiety behaviors, they were improved in (47.1 %) and aggravated in (23.5 %). Parents' reports showed that this plant has a great effect on the disorders comorbid autism.
The findings of by Silva Junior, Medeiros, Torro, Sousa, Almeida, Costa & Albuquerque (2021), which reviewed a group of studies that using cannabis to cure some symptoms suffered by persons with (ASD), showed that cannabis derivatives increased their number and the severity, including hyperactivity, self-harm, Anger, sleep, insomnia, irritation, aggressiveness, and depression and ameliorated perception, sensory sensibility, attentiveness, social interaction and language, whereas the most prevalent side effects were sleep disorders, insomnia, nervousness and appetite disorders. The results of Babayeva, Assefa, Basu & Loewy (2022) review illustrates the promising effects of cannabis to combat the symptoms of autism disorder and its accompanying disorders, ameliorating social and emotional aspects.
The findings of Pavlovic (2017) study clarified that fundamental as well as pre-clinical research supports using cannabis in improving growth neurologic developmental disorders such as (ASD) and Fragile-X Syndrome, but there is an urgent need to carry out more research to identity the different benefits/harms which are probable to happen when using it.
The aforementioned clarifies that there is a strong trend to use medical drugs in treating some symptoms and accompanying disorders of individuals with disabilities, especially those with intellectual disability, (ASD), attention deficit hyperactivity disorder, and some other developmental disorders, which poses a legal and ethical issue, especially in Arab countries, due to criminalizing these substances and their derivatives. This requires an urgent need for religious, medical, legislative and media institutions to study the use of these substances and issue some regulations and protocols to using them.
THE FIFTH ISSUE: EDUCATING INDIVIDUALS WITH DISABILITY IN HIGHER EDUCATION
INSTITUTIONS
Enrolling students with disabilities in higher education institutes has become one of the major issues discussed on the international level, as it is known, different communities made a good progress in educating individuals with visual and hearing handicap. However, when speaking about other categories of persons with disabilities in the university stage, such as students with intellectual disability, (ASD), or developmental disorders. This issue resulted in different points of view divided between opponents and proponents as well as a heated debate between the service providers and beneficiaries. The problem becomes more difficult when educating females in these institutions was introduced due to the other obstacles which gender can necessitate. Students with intellectual disability were first enrolled in USA higher education institutes in the 70s of the 20thcentury. The efforts of social, political, and civil rights movements were assembled to issue a bunch of laws and legislations which modified the educational scene for all persons, as these movements sought to achieve justice and general access, which were reflected as fundamental values in the legislations related to people's lives. The following acts were issued: in 1968, the architectural barriers act, in 1973 rehabilitation act, in 1975 educating children with disabilities act (known now as individuals with disabilities act and its modifications), in 1988 Technology act, in 1990 Americans with disabilities, and in 2008 its modifications. These lead to increasing the number of students with disabilities in higher education as well as benefiting from legal protection which guarantees non-biased treatment. Often, the access to education through particular legislations of academic facilities aimed at reducing their effects without changing the initial elements of the educational programs (McGuire, 2011)
individuals with intellectual disability, thus, have enjoyed the right to be enrolled in universities all over the USA since issuing The Higher Education Opportunities Act (HEOA), 2008. However, some issues still hinder the success of this experiment, including fulfilling educational needs on the faculty level, surpassing feelings of anxiety related to moving with the campus, reaching educational classes on time, understanding the university special requirements, finding enough time to interact with peers, the inability of faculty staff to understand the requirements needed to teach courses and lacking awareness of the intended learning outcomes of these persons (Love, Baker & Devine, 2019).
At present, (248) university programs which serve students suffering from intellectual disability in the USA are founded. These consist of a group of personals and specialists performing various roles (such as program coordinators, academic trainers, tutors, physiotherapy specialists ... etc). Their initial role is supporting these students in university environment.
These employees are the safety valve to guarantee that the support reaches these students everywhere in their programs. It also ensures that backing reaches faculty staff and trainers who will accompany students in classes. University reports concerning persons with intellectual disabilities show that the staff find a difficulty to deal with them and that they prefer to teach them in a separate manner than their normal peers or to reconsider the contents of their curricula, besides the burdens thrown on the staff. It is important also to know that students with intellectual disabilities have special needs that differ from those of other students and that the university staff will be faced with needs that they know nothing about (Love et al., 2019).
Research and studies' findings refer clarify that the number of secondary stage students who suffer from disabilities is steadily growing. However, the number of students with disabilities who got their university degree does not comply with this growth. The findings of some studies stated that concerning academic success, these students lag behind in their classes in comparison with their peers, as they suffer academic deficiency, besides an increase in the level of dropouts. It is also interesting to note that the most important aspect which hinders the academic success of students with intellectual disabilities is their negative optimal access to public curricula designed for normal people (Griful-Freixenet, Struyven, Verstichele & Andries, 2017). The findings of the studies ensure that this gap affects the opportunity of these students to get highly skilled specialized professions. For instance, the employment results in the field of sciences and engineering show that only (7%) of
the students with intellectual disability complete their university studies for financial facilities were provided for them but no welcoming atmosphere was prepared for them (Izzo, 2012). Black, Weinberg & Brodwin (2015) study shows that students with intellectual disability who are enrolled at higher education institutions find many difficulties that hinder their educational process. These include students with visual impairment who do not find suitable educational resources for their disability, those with hearing impairment whose lectures primarily depend on the hearing sense, students who use wheel chairs inside classes that lack facilities that help them move in, students with (ASD), those with serious physical-motor disabilities who cannot do manual tests or which require hand-writing, those with learning disabilities who do not receive any services inside their universities, or unintentional other barriers like unsuitable accommodations or delayed alternative study books.
Diversity creates challenges and opportunities which surpass the dormitories of each group of students with disabilities; many faculties cannot provide the educational requirements of these students because they could not prepare a suitable educational atmosphere for them. In addition, the traditional type of faculty staff personals, which lack the needed experience to design programs and interactive teaching methods that suit all student's category, is the most prevalent. No official training, concerning meeting the needs of these students, is provided; as a result, various study findings documented the staff doubts whether it is just to provide these students with specific services inside universities. They claim that this may be fair enough concerning what is known as hidden or unapparent disability, such as learning disabilities, ASD, or hyperactivity), but it differs with disabilities like auditory and visual impairment or intellectual disability ... etc) (Griful-Freixenet et al., 2017). The findings of Francis, Duke, Fujita & Sutton (2019)study which was carried on (8) students with intellectual disability enrolled in the university showed that they are lacking empowerment, that the faculty staff need more information about disability, how to carry out suitable modifications, using technological devices, as well as the need of normal students and their families to understand them in order to be empowered in the university and the society. Over the past two decades, some researchers interested in the field of special education posed some questions concerning testing students with intellectual disability. These are:
- Will there be any changes/modifications in the structure of tests and the skills that will be assessed?
- Are the grades got in different tests prepared in a standardized way that differs from those obtained in non- standardized tests?
- Can there be any modifications to tests given to normal students in order to fit those with intellectual disability?
- Does the examiner have the ability to prepare tests that suit students with intellectual disability?
- Are both the disability guide and the educational policy to modify procedural tests valid and stable enough to be trusted? (Goegan, Radil& Daniels, 2018).
Researchers and specialists believe that there is a number of requirements to educate these persons in universities. These include:
- Structuring and supporting the technological infrastructure and accessing digital texts to combat the barriers of printed texts for students with intellectual disability. Technological compatibility is, thus, the key to fight these limitations; the technological environment helps providing special aiding programs such as converting texts to speech, enabling computers to read the digital texts, and providing needed sources to both tutors and students.
- Receiving managerial support is considered a major component in the success of higher education programs for students with disability.
- Providing staff members with sufficient time to be trained on general learning designing; they have to be allowed to attend workshops, develop educational curricula, cooperate in designing lessons, and to be trained on using needed programming applications.
- Reconsidering the roles of staff members, which require new and different responsibilities on which they have not been trained before.
- Designing cooperative courses in which staff members, special education experts and technology specialists help each other to carry out needed adaptations and have a look at their contents to surpass the probable barriers that can hinder teaching and learning.
- Giving a special interest to the role of parents and the society as agents of change; parents of students with disabilities have always been over-viewing the issues that assisted taking care of them. In many cases, the issue of a single student with disability has been the way to change prevailing systems (Hatley, 2011).
Based on the aforementioned, it is clear that there is a considerable dilemma concerning enrolling students with disabilities in higher-education institutes, which relate to the extent of equipping them with the suitable infrastructure, the presence of trained personals, as well as the ability of staff members to understand their needs, their capacity to modify curricula and educational courses, their efficacy in using technological and teaching methods that suit all students, besides handling the problems related to assessing them in a just and equal way.
CONCLUSION
What is previously mentioned clarifies that the issues dealt with in this paper are still controversial among scientists, researchers and experts. They still need more research and study to reach reliable in-depth solutions. It is also disclosed that these problems have a direct impact on the lives of individuals with disability in health, social, educational, marital, familial, and work aspects; societies have to issue laws and legislations compatible with the culture in order to surpass these problems, which will have beneficial effects on the community at large. The stance related to vaccinations has to be clear; whether they are really beneficial or causing harm as well as considering the materials used as well as the criteria of using them should also be identified. Societies have to state their stance concerning sterilization in accordance with religious beliefs as well as the society traditions, in a way which provides the person with disability to self-determine his destiny and to fulfill his legal rights represented in marriage, parenting and motherhood. The role of families has to be consulting; they should not impose their decision on the person with disability. Special criteria related to the treatment of persons with disability with stem cells therapy as well as regulating its use and identifying its source in accordance with religious beliefs and the benefit of these people need to be implemented as they represent a promising future in their treatment.
Special interests have to be given to the issue of using medical drugs, especially that the findings of some research papers asserted their efficacy in curing persons with disability from some disorders and minimizing the severity of some symptoms and that the probability of using them increasingly in the future was also shown. A comprehensive vision to combat the problems related to enrolling students with disability in higher education institutes as well as finding solutions to them as well as dealing with them in a standardized way which guarantees the right of these persons and prohibiting their indulgence in unsuitable educational processes that do not correlate with their capacities have to be executed.
Finally, an integrative perspective towards these issues which fulfill the benefit of the society on one side and that of persons with disability form another has to be adopted, in a way which does not oppose religion and society culture and traditions.
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