chevron-down Created with Sketch Beta.
    May 28, 2025

    When the System Fails: Why Disabled People Self-Accommodate

    Katherine A. Macfarlane

    Katherine A. Macfarlane,  Associate Professor of Law and Director of  Disability Law and Policy at Syracuse University College of Law, on her article “Self-Accommodation”

    What inspired you to focus on self-accommodation as a central concept in your work?

    While working on issues that affect students with disabilities in higher ed, I noticed a common misconception about why so many students do not seek out accommodations. Nondisabled people believed that disabled people simply do not know their rights, and that educating them about those rights will solve most, if not all, access issues. My experience with students with disabilities was very different—they know what the law provides but decide not to pursue accommodations or other forms of legal protection for rational reasons. I wanted to get that point across and restore some dignity to disabled peoples’ decision-making.

    How do you define “self-accommodation” differently from informal coping mechanisms or personal resilience?

    Self-accommodation functions as a direct replacement for a legally mandated process that would, if effective, result in the receipt of a reasonable accommodation. People with disabilities elect to self-accommodate when they realize that the formal accommodations process has more costs than benefits.

    Do you see self-accommodation as always problematic, or can it sometimes be empowering?

    I think it is always problematic. There is nothing empowering about being forced to design, pay for, and implement what the law requires others to provide for free.

    You argue that self-accommodation is a civil rights failure. Can you elaborate on how the legal intent of the ADA is being undermined by practices in healthcare, education, or employment sectors?

    The Americans with Disabilities Act (ADA) is an anti-discrimination law, and the failure to provide reasonable accommodations is a form of discrimination under the ADA. When the process through which reasonable accommodations are obtained becomes so punitive that people would rather forego it and take on the labor themselves, civil rights law has failed to fulfill its intended nondiscriminatory purpose.

    How do current ADA policies unintentionally incentivize or pressure individuals to self-accommodate?

    Although the ADA does not treat documentation of disability as an accommodation prerequisite, case law and agency guidance have endorsed an aggressive documentation model. Because these documentation standards that require medical proof of disability are so onerous, expensive, and disconnected to the reality of U.S. healthcare, individuals who do not want to or simply cannot obtain such documentation will choose instead to self-accommodate. These standards assume that everyone has access not only to affordable health care, but also to health care providers who will document the existence of disability. Even those who enjoy access to affordable health care may struggle to convince their providers to respond to a one-sentence MyChart inquiry—let alone fill out a multi-page reasonable accommodation form without compensation.

    In your research or case examples (e.g., students, patients, female attorneys), what were some of the most surprising forms of self-accommodation you encountered?

    I am disheartened but not surprised to learn that people will often absorb both the physical and financial burdens of creating accessible workspaces. As I describe in my article “Self-Accommodation,” when a reasonable accommodation is provided the employer orders and pays for ergonomic office furniture, which is delivered and set up by a person whose task it is to move heavy items. In contrast, self-accommodation means that the person with disabilities does all the ordering, paying, transporting, and moving—taking on all the labor and cost that the law says should be covered by the employer.

    Were there cases where institutions responded constructively when self-accommodation was disclosed?

    I am aware of employees and students who have been reprimanded for self-accommodating. Once discovered, it can be perceived as insubordination. I am not aware of positive responses to self-accommodation.

    How do power dynamics—especially in healthcare and academia—shape whether accommodations are viewed as legitimate or burdensome?

    In the workplace, power and status often dictate who must follow all the rules—including those involving legal compliance with the ADA. An accommodation that requires a doctor to mask around an immunocompromised patient is no less legally binding than an accommodation that imposes the same requirement on an office receptionist. However, powerful people have the luxury of disregarding their legal obligations when the institutions they work for value them enough to overlook noncompliance. In addition, the legal ease with which health care providers can terminate patient care also means that when a patient asks for a legal but possibly inconvenient accommodation, their care can be terminated in lieu of providing the accommodation.

    How do race, gender, or class impact who self-accommodates and how they are treated when they do?

    As I argued in my article “Disability Without Documentation,” access to affordable healthcare is determined by race, gender, and class. As a result, when the formal accommodations process requires documentation of disability, it is not open to those who lack access to health care providers who would otherwise provide medical documentation. Moreover, medical racism and sexism impact both how patients are believed and disbelieved when they report pain, and likely also impact who is able to convince a health care provider that they are disabled.

    What are the top changes that need to happen?

    Self-accommodation should be viewed as a rational response to inaccessible systems, not as the result of an information deficit that can be easily cured. Once self-accommodation is better understood, reducing reliance on it starts with improving formal accommodation processes. In employment settings, strengthening confidentiality around both the existence of disabilities and the fact that employees receive accommodations would ease disabled employees’ disclosure concerns. Excessive documentation requirements should be reduced or removed—the law does not require documentation of disability. In education, the burden is often placed on students to negotiate and administer their accommodations, even though the law requires schools to do that (often charged) work. In health care, all staff—from receptionists to patient relations representatives—should be trained in facilitating the accommodation process on behalf of patients. Finally, across employment, higher education, and health care settings, accommodations should be treated as both essential and routine, not exceptional or burdensome.

    Topic:
    The material in all ABA publications is copyrighted and may be reprinted by permission only. Request reprint permission here.