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 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.

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.

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.

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.

The concluding chapter summarises the book’s central argument that laws, policies, and practices which privilege the birth and survival of the non-disabled fundamentally challenge the notion that people with impairments have an equal right to live in the world. It also discusses avenues for further research, before closing with some final remarks.