The regulation of embryo testing, selection, and gene editing, as part of assisted reproduction, is the focus of Chapter 3. The chapter argues that restricting or prohibiting the transfer of embryos with impairments during assisted reproduction is incompatible with disability rights. It also argues that if embryos can have their impairments removed through gene editing, then preventing the creation of disabled embryos would be incompatible with regulating assisted reproduction in a disability-inclusive manner.

There is an established body of research providing clear evidence that certain types of media reporting of suicide, such as sensationalist reporting of celebrity suicides, can produce substantial negative effects. The most notable of these effects is a subsequent increase in the number of suicides. Conversely, emerging evidence also shows that suicide reporting focused on positive narratives of recovery from suicidal thoughts may confer protective benefits and lower subsequent suicide rates. This chapter provides a brief discussion of a possible theoretical mechanism for the impact of media portrayals of suicide on subsequent suicides. It also provides a brief history of research into the effects of fictional and non-fictional media portrayals of suicide, as well as portrayals and discussions of suicide in both traditional and newer media, including social media. The chapter focuses particularly on novel research findings related to suicide and the media. It concludes with a discussion of interventions that attempt to optimize the safety of media portrayals of suicide, and those that attempt to use various types of media proactively for suicide prevention purposes.

This book makes a number of theoretical contributions to the legal and political philosophy of dementia care, which have important public policy implications. This conclusion serves as both a summary of the book and a final statement of the urgency of addressing the issues raised. It must be appreciated that contemporary Western societies, including the UK, face funding and legislative barriers to achieving the just, dementia-inclusive society. Nevertheless, by identifying an ideal to aspire to, it is hoped that this book can play some role in rectifying the severe injustices people living with dementia face.

Despite negative effects on their health and social lives, many informal carers of people living with dementia claim to be acting in accordance with a moral obligation. Indeed, feelings of failure and shame are commonly reported by those who later give up their caring responsibilities, suggesting a widespread belief that professional dementia care, whether delivered in the person’s own home or in an institutional setting, ought always to be a last resort. This chapter, however, suggests that this common intuition gets things the wrong way around. The most serious injustices engendered by present-day dementia care services are contingent on broader societal structures – they can thus be ameliorated relatively easily (if resource intensively). Informal dementia care, on the other hand, carries similar risks of injustice and is much more resistant to structural reform. While there may be moral obligations to provide informal dementia care in present-day societies, then, they arise because of the deficiencies of professional care, not the virtues of its informal counterpart.

In this chapter, clinical practice is addressed from three perspectives. First, what does good clinical practice in suicide prevention look like? Secondly, there are key matters pertaining to how we both maintain patient safety and avoid iatrogenic harm. These include: an excessive focus on risk; the way in which people can and do fall through gaps between services; the continued use of, contrary to evidence, guidance and humane clinical practice, of behavioural management approaches to self-harm and suicidality, and the risks to patients and service users of ‘group think’ and malignant alienation in clinical cultures. Finally, we will consider what needs to be done to maintain positive standards and values in clinical settings.

Carers often interfere with the choices of people living with dementia. On neo-republican and (most) relational egalitarian views, interference can be justified if it tracks a person’s interests: if it does not lead to a relationship of domination. The kind of environment-shaping interventions carers often choose to pursue, however, would be considered infantilising or objectionably paternalistic in other cases. This chapter defends what it calls the indirect-first approach to dementia care, arguing that it offers the best prospects of avoiding domination.

Disease surveillance, particularly of infectious diseases, has a long history. There are many book chapters and articles providing detailed accounts of systematically collated health information [1]. Conventionally, modern health surveillance commences with John Snow’s observations of the epidemic of cholera in London’s Soho district in 1854 [2], culminating in the iconic (but probably ineffective) removal of the handle from Broad Street pump. It is significant that although Snow did not know that the Vibrio cholerae bacterium was the causative organism, surveillance played a part in resolving the epidemic. Disease surveillance has a crucial role in evaluating and shaping responses to major public health problems, as was clearly demonstrated during the COVID-19 pandemic of 2020. Not all causes of untimely death or ill health are due to the disease of interest, but surveillance provides a firm foundation for public health interventions of all types [1].

Community-level interventions are a key part of suicide prevention. The effectiveness of these strategies vary and objective measurement of the efficacy of these interventions are often challenging. Evidence shows that preventing access to means of suicide in the community, and ongoing education and awareness among primary care healthcare professionals about mental illness and suicide, both are effective, universal-level preventive strategies. Increasing awareness and mental health literacy among young people in schools shows promise, though most evidence is from high-income countries. Trials have demonstrated that brief follow-up contact interventions (BCI), such as sending postcards, text messages or a follow-up phone call, are effective in reducing suicidal ideation and repetition of suicide attempts.

Suicide is a leading cause of death for young people (variously defined as those aged up to 24-29 years) worldwide. Non-fatal self-harm, which we define as including all intentional acts of self-poisoning (e.g., intentional drug overdoses, ingestion of products not intended for human consumption) or self-injury (e.g., self-cutting) regardless of degree of suicidal intent or other types of motivation is more common. In this chapter, we do not distinguish between attempted suicide and non-fatal self-injury as there is a high degree of co-occurrence between the two behaviours, particularly in young people.

The framework set out in this book reconceptualises the problem of dementia care as a problem of power and social exclusion. At every stage, the goal should be to empower recipients of care to meet their own needs and participate fully in social life as equals, necessitating restrictions on the power of carers and radical changes to our cultural assumptions about and depictions of dementia. Though few would disagree that Western dementia care services are in need of reform, the book’s emphasis on social equality means that the depth and character of the proposed reforms differ significantly from many of those under public discussion. Indeed, as demonstrated in this chapter, significant changes would be needed to the way the UK treats people living with dementia under the law in order to support the reforms recommended in this book.

Chapter 5 focuses on the regulation of physician-assisted suicide and euthanasia, or medically assisted dying. The chapter considers whether restricting access to assisted dying to people with impairments amounts to disability discrimination. It contends that any ‘right to die’ should apply no more to people with impairments, including those with life-threatening conditions, than to others. The chapter concludes that impairment-based eligibility for assisted dying legally entrenches ableism and that only disability-neutral assisted dying laws would be compatible with disability rights.

Pre-approval access rights to potentially life-preserving experimental treatment is the focus of Chapter 7. The chapter considers whether people with life-threatening conditions should have a right to access possibly life-saving experimental treatments, as embodied in right to try laws. It argues that, despite their significant shortcomings, right to try laws bolster disability rights by seeking to advance the right to life and survival of people with life-threatening conditions beyond medically assisted dying.

Secure dementia units (SDUs) rely on a degree of coercive control that might strike many of us as intuitively unjust. This chapter, however, cautions against the idea that justice demands their elimination. Setting out the limits of community care models, it makes the case for the limited use of suitably reformed SDUs. While they ought not to be the first choice for meeting the care needs of people living with dementia, the chapter defends the view that these institutions are essential to the social care infrastructure of a just society.

On a standard relational egalitarian framework, social justice is achieved through eliminating intolerable inequalities of power and social status. From this point of view, injustice is not simply a matter of what institutions or individuals do but of how they do it. If they fail to challenge, reinforce, or create paradigm social injustices such as domination, stigma, and oppression, citizens remain socially unequal whatever their distributive positions. As this chapter demonstrates, the case of dementia clearly illustrates the value of this approach, as purely distributive views cannot fully capture the severity nor the character of the injustices those that live with this condition face.

Suicide and suicide attempts ravage societies and are now considered a top priority on the Global Health Agenda. In Ghana, lack of systematic reporting and recording hamper genuine efforts to prevent the problem. Among the many factors militating against progress in this direction is the strong taboo associated with suicidal behaviours in general and the criminalisation of suicide attempts in particular [1].