Many will have heard of the debate between the social model of disability and the medical model of disability. These two polarised viewpoints make up the first and second ways of inclusion. The first way – the medical model – assumes that anyone who is not perfectly healthy nor perfectly able should meet a defined medical condition in order to received assistance. This medical condition is their disability. The second way – the social model – assumes that anyone who is not perfectly healthy nor perfectly able has an impairment, which is only a disability if it is not accommodated for by others as if they accepted it there would be no impairment. There is a third way also – the recovery model – this assumes that anyone who is not perfectly healthy or perfectly able must be helped by others to overcome the impairment that comes from an identifiable medical condition so that they are not disabled by it. None of these ways are satisfactory to me, so by using the Fourth Way process I think it is possible to take the best of the first and second ways and eliminate the third. The fourth way – the pluralist model – would assume that anyone who is not perfectly healthy or perfectly able is a human being with a distinct personality derived from those imperfections. In some environments those imperfections will be advantageous and in others they will be impairments. Under this model both the person with the medical condition and the people around them have to weigh up factors around whether the environment needs to change to the person or the person needs to change their environment. This is best decided with the ‘reasonable adjustment’ instrument. If it is reasonably possible to change the environment to accommodate the persons impairment then it should be done, but if it is not reasonably possible then that person will have to decide whether they want to stay in the environment and mitigate that impairment with support, or whether they want to go to an environment where that medical condition gives them a strength so they have no impairment.