How Does the WHO’s Framework for Functioning, Disability and Health (ICF) Provide an Ethical Foundation for 21st Century Clinicians?

The WHO’s twenty-first century framework for health, the International Classification of Functioning, Disability and Health (the ICF), integrates many elements of people’s lives to enable people to create a unique self-portrait. ICF language illustrates the evolution of concepts like “impairment” and “disability”. In this essay we illustrate how the ICF’s approach to health ranges well beyond traditional biomedical diagnosis as the entry point for services and offers opportunities to contextualize a person with any health “impairment” in terms of their functioning, personal values and preferences, and environments. We argue that the use of the ICF makes it possible for health services to provide care that addresses Beauchamp and Childress’s four ethical principles. Justice is served by the universality of the ICF. Incorporating the voices and values of people respects individual autonomy. Codesigning approaches to care with providers facilitates achievement of beneficence (doing the right things in the context of people’s own voices and values) and avoids maleficence (doing things judged not to be in the best interests of the person). We believe that this ICF-based approach to health and health care offers a unique ethical framework.