The arguments of this book are intended to tackle the social injustices faced by people living with dementia, yet reflecting on the author’s social position reveals a tension. As the author is not a member of the social group this book concerns, they are engaging in an act of speaking for others: a practice that has received significant criticism, given the risks of contributing to oppression and stigma through misrepresentation. With this concern in mind, this chapter engages in a reflective exercise about the content of the book, highlighting ways in which the author’s social position may have negatively influenced its content and setting out the steps the author has taken to try to address this.

In both philosophical research and public discourse around dementia, issues of power and social status receive insufficient attention. The Introduction sets out how this book is aimed at filling this gap.

In medical ethics, there is a well-established debate about the authority of advance directives over people living with dementia, a dispute often cast as a clash between two principles: respecting autonomy and beneficence toward patients. This chapter, in highlighting underexplored issues of power and social status, argues that there need be only one principle in substitute decision-making: determining authenticity. This principle favours a substituted judgment standard in all cases and instructs decision-makers to determine what the patient would authentically prefer to happen – based not merely on the patient’s decisions but also on their present settled dispositions. Adhering to this principle entails that, in a significant range of cases, an advance directive can (and indeed ought to) be overruled.

Postvention describes the support offered after suicide bereavement to mitigate the risk of suicide in those affected by the loss. In this chapter we describe the international epidemiological evidence about the impact of suicide on relatives, friends, and other close contacts of the deceased. This includes an elevated risk of depression and suicide, and other adverse physical health and social outcomes. We describe the practice of postvention as it applies to recommended responses to suicide in clinical and community settings, and the evidence to support this. Whilst there is a lack of evidence to support the effectiveness of postvention in preventing suicide specifically, there is evidence that it improves the mental health and social outcomes likely to mediate suicide risk. Clinicians who encounter suicide-bereaved individuals should be aware of resources available to people affected by suicide loss, described here, including digital resources in the public domain.

The introductory chapter outlines the book’s central premise: disabled people have as much right to live in the world as the non-disabled. It introduces the human rights and critical disability studies methods used to interrogate the problem of disability discrimination throughout the life cycle, especially at the beginning and end of life. Along with providing an overview, the introductory chapter argues that the book is particularly needed because disability equal rights struggles remain marginal in mainstream bioethics and law.

Suicide is a global phenomenon, with implications for HICs and LMICs alike, bec,ause of interconnectedness. Social injustice increases societies’ suicide risk and it is easily and frequently exported. Suicide is preventable but not always individually. Suicide prediction is difficult or impossible, so those measures that effect everyone work best. Hence assuring good quality, timely mental health coverage for the whole population is important. Those with the least resources must be targeted, as they are at greatest risk..

Suicide prevention requires a systematic approach to develop a framework that brings together different elements of a prevention strategy, including surveillance, mental health service access, restriction of lethal means, and public awareness campaigns. Originating with Finland's pioneering efforts in the 1980s, such strategies have since expanded worldwide, driven by the World Health Organization's call for action and alignment with the Sustainable Development Goals. It is imperative that these programmes/strategies are evidence-based, informed by local research, continuously monitored and regularly evaluated for effectiveness. By developing suicide prevention programmes/strategies, governments around the world show their commitment to mitigating preventable deaths, underscoring the need for sustained funding, leadership, and research-driven implementation.

This chapter provides an overview of suicidal behaviours and suicide prevention strategies among minority groups, including refugees, migrants, asylum seekers, and internally displaced persons (IDPs). The chapter highlights the interplay of cultural and gender diversity in shaping suicidal behaviours and emphasizes the need for tailored interventions that address the specific challenges faced by these populations. It reviews the existing literature on the prevalence of suicide among minority groups in both high-income countries (HICs) and low- and middle-income countries (LMICs), examining the role of cultural factors, gender-based violence, and mental health issues. The chapter also discusses suicide prevention strategies in humanitarian settings, such as community engagement, gatekeeper training, cultural adaptation of interventions, and the importance of integrating mental health services into primary healthcare services. The chapter highlights evidence-based practices recommended by research, the Inter-Agency Standing Committee (IASC), and the World Health Organization (WHO). The conclusion underscores the need of a comprehensive, culturally sensitive approach and calls for further research, increased investment in mental health infrastructure, and the development of gender-sensitive strategies to reduce the burden of suicide among minority groups in humanitarian contexts.

Chapter 6 examines the regulation of access to controlled and prohibited substances for symptomatic relief and palliative care. It argues that restrictive drug control policies, especially uniform drug prohibition, are incompatible with disability rights because they are discriminatory against disabled people in pain. The chapter concludes that permitting a wider range of controlled substances to be accessed by people with impairments, especially those eligible for assisted dying, strengthens their right to live in the world by giving them greater options to live with their conditions.

The refusal and withdrawal of life-sustaining treatment and care by, and on behalf of, people with impairments are the focus of Chapter 4. The chapter argues that greater attention must be given to the socio-economic contexts in which these non-treatment decisions are made. It also argues that the selective non-treatment of disabled infants and the non-consensual withholding and withdrawal of life-sustaining care from people with disorders of consciousness are incompatible with disability rights. The chapter concludes that disabled people, and their health care proxies, should not simply have rights to refuse or withdraw life-sustaining interventions, they must also have rights to request life support.

Chapter 2 focuses on the regulation of selective abortion following prenatal screening and testing. It argues that disability-selective abortion bans may appear to be compatible with disability rights but that such bans are ultimately misguided because they fail to recognise the socio-economic context in which reproductive decisions are made by prospective parents. The chapter concludes that disability-inclusive abortion laws would not legally entrench differential time limits for pregnancy termination based on foetal impairment: if disabled foetuses can be aborted until birth, then the same should apply to non-disabled foetuses.

The scope of this chapter is to provide an overview of the relationship of substance use disorders (SUD) and suicidal behaviour. The epidemiology of substance use disorders and suicidal behaviour is extensively and critically reviewed in general and clinical populations. The mediating mechanisms for this association are examined.

The findings strongly indicate that SUD is a robust risk factor for suicidal behaviour: It is remarkable that the contribution of SUD to suicidal behaviour is universal except for few variations in the association of SUD with suicidal behaviour between high-income and low-income and middle-income countries.