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1 - The Alchemy of Agency: Reflections on Supported Decision-Making, the Right to Health and Health Systems as Democratic Institutions

Published online by Cambridge University Press:  20 August 2021

Michael Ashley Stein
Affiliation:
Harvard Law School
Faraaz Mahomed
Affiliation:
Wits University
Vikram Patel
Affiliation:
Harvard Medical School
Charlene Sunkel
Affiliation:
Global Mental Health Peer Network
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Summary

There has been little interdisciplinary discussion between the global health and disability rights fields regarding the relevance of article 12 of the Convention on the Rights of Persons with Disabilities (CRPD) to States parties’ obligations to respect, protect and fulfill the right to health under international law. While disability rights advocacy has focused largely on coerced treatment and abuses in facilities, the global health and development communities’ attention has been focused on unmet need for mental health care. This chapter argues that conceptualizing health in terms of rights, just as disability, requires upending aspects of the biomedical and conventional public health paradigms. In turn, once the incompatibility of health and disability rights is dispelled, implementing supported decision-making (SDM) for persons with psychosocial disability reveals important aspects needed for constructing health systems as inclusive democratic social institutions more broadly. SDM and substituted decision-making should not be seen as dichotomous options when a crisis arises, but rather in terms of a range of options available for a range of disabilities, which is supported by the financing and organization of the health system.

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Publisher: Cambridge University Press
Print publication year: 2021

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