Institutional Ableism and The Social Determination of Health A Bioethical Analysis of Healthcare Exclusion of Persons With Disabilities in Peru

Abstract

Objective

Healthcare exclusion of persons with disabilities is often explained in terms of isolated barriers or individual clinical needs. This article offers a different perspective by examining institutional ableism as a process that mediates between social structures, ways of life, and concrete experiences of care. Through a theoretical reflection grounded in conceptual, normative, and empirical sources, it brings together the social determination of health, models of disability, the human rights approach, and bioethics. The analysis shows how infrastructure, procedures, communication, territorial organization, information systems, and professional practices can turn particular physical, sensory, intellectual, and psychosocial capacities into implicit requirements for access. It argues that inclusive healthcare requires moving beyond merely formal equality, guaranteeing comprehensive accessibility and reasonable accommodations, recognizing autonomy with support, and ensuring the meaningful participation of persons with disabilities. Its central contribution is a critical framework for understanding and transforming healthcare exclusion in Peru.