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The failure of public policy to adequately address the issue of the common humanity of individuals with disabilities has resulted in the substitution of human services and human service environments and programs for real life and high purpose. Individuals with disabilities have become human service subjects within a system of long-term supports that has no expectations that common life goals based on universal human aspirations can add great depth to the notion of addressing the health and welfare of individuals with disabilities.

Individuals with psychiatric disabilities represent the largest category of persons with disabilities in the United States. No other category of disability is treat so disparately and remains so inadequately funded that it can truly be said that no coherent national finance policy exists for this population.

All people – including those with disabilities and older Americans -- share common human aspirations for freedom, dignity and equality. People with disabilities and older Americans want and deserve what we all take for granted as American citizens. They want the power and authority to decide where and with whom they live. They want control over the services they receive. They want an opportunity to work and have private income. And they deserve the supports that will break down the barriers that exclude them from participating in community life.

Every year since 2006, United Cerebral Palsy (UCP)–an international advocate, educating and providing support services for children and adults with a spectrum of disabilities through an affiliate network–produces The Case for Inclusion, an annual ranking of how well state Medicaid programs serve Americans with intellectual and developmental disabilities (ID/DD). Individuals with ID/DD, including the aging, want and deserve the same freedoms and quality of life as all Americans.

The mutilation of this girl named Ashley should come as no surprise. By now the entire disability community is familiar with what happened to Ashley, the justification on the grounds of convenience for the parents/caretakers and the defense of these procedures on the basis of diminished citizenship by Peter Singer in the NY Times. Part of the outrage that some of us feel is simply that others are not outraged at all. This should give us pause. The uncomfortable question I would like to pose is simply this: to what extent are we complicit in this lack of outrage from the media and the general public?

This paper discusses emerging issues in the area of quality and quality assurances as they relate et both self-directed and self-determination efforts now spreading all disability populations.

All people – including those with disabilities -- share common human aspirations for freedom, dignity and equality. However, various disability populations have unique histories, utilize diverse language to define their collective goals and are often categorized by funding streams and professional definitions of disability that separate and divide. The publicly funding long-term support system of the future must be informed and guided by the lived experiences of people with disabilities themselves.

To date quality assurance systems have ignored almost every critical component of quality that all individuals would chose as necessary for a minimally adequate quality life. In addition the unspoken “bargain” made with many individuals who need support is to require all or most of their everyday freedoms to be surrendered in return for support. This raises a core public policy question: can we ever have quality in a system that does not support freedom?