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Vulnerability: Too Vague and Too Broad?

Abstract

Imagine you are walking down a city street. It is windy and raining. Amidst the bustle you see a young woman. She sits under a railway bridge, hardly protected from the rain and holds a woolen hat containing a small number of coins. You can see that she trembles from the cold. Or imagine seeing an old woman walking in the street at dusk, clutching her bag with one hand and a walking stick with the other. A group of male youths walk behind her without overtaking, drunk and in the mood for mischief. It doesn't need an academic to say what vulnerability is. We can all see it, much more often than we care to.

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1. Macklin R. Double Standards in Medical Research in Developing Countries. Cambridge, UK: Cambridge University Press; 2004:101.

2. Macklin R. Bioethics, vulnerability and protection. Bioethics 2003;17(5–6):472–86, at 472.

3. Kipnis K. Vulnerability in research subjects: A bioethical taxonomy. In: National Bioethics Advisory Commission, eds. Report on Ethical and Policy Issues in Research Involving Human Participants, Vol. II, 2001; available at http://www.onlineethics.diamax.com/cms/8087.aspx (last accessed 27 April 2008); Ruof MC. Vulnerability, vulnerable populations and policy. Kennedy Institute of Ethics Journal 2004;14(4):411–25; Levine C, Faden RR, Grady C, Hammerschmidt D, Eckenwiler L, Sugarman J. The limitations of “vulnerability” as a protection for human research participants. The American Journal of Bioethics 2004;4(3):44–9. Rogers AC. Vulnerability, health and health care. Journal of Advanced Nursing 1997;26:65–72; Shi L. The convergence of vulnerable characteristics and health insurance in the U.S. Social Science and Medicine 2001;53(4):519–29.

4. Hurst SA. Vulnerability in research and health care; Describing the elephant in the room? Bioethics 2008;22(4):191–202 at p. 192.

5. Forster H, Emanuel E, Grady C. The 2000 revision of the Declaration of Helsinki: A step forward or more confusion? The Lancet 2001;358(9291):1449–53.

6. See note 4, Hurst 2008:192.

7. This paper does not provide an overview of the most common definitions. This has been done excellently elsewhere. See note 4, Hurst 2008.

8. Council for International Organizations of Medical Science. International Ethical Guidelines for Biomedical Research Involving Human Subjects, 2002; available at http://www.cioms.ch/frame_guidelines_nov_2002.htm (last accessed 22 April 2008).

9. Hobbes T. Leviathan. London: Penguin; 1985[1651]:183.

10. See note 9, Hobbes 1985[1651]:186.

11. Jecker NS. Protecting the vulnerable. The American Journal of Bioethics 2004;4(3):60–2.

12. It is interesting to note that the most recent definition in the academic literature by Samia Hurst, a medical doctor, focuses exclusively on our external element. “[V]ulnerability should be understood as an identifiably increased likelihood of incurring additional or greater wrong.” See note 4, Hurst 2008:195.

13. Silvers A. Historical vulnerability and special scrutiny. The American Journal of Bioethics 2004;4(3):56–7 at p. 56.

14. See note 13, Silvers 2004:56.

15. We are excluding here the possibility that people could have the means and the ability to protect themselves, but choose not to, thereby making themselves vulnerable voluntarily.

16. The World Medical Association. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects, adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, latest revision by the WMA General Assembly, Tokyo, 2004; available at http://www.wma.net/e/policy/b3.htm (last accessed 9 July 2008). The latest amendment was made by the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000.

17. Forster H, Emanuel E, Grady C. The 2000 revision of the Declaration of Helsinki: A step forward or more confusion? The Lancet 2001;358(9291):1449–53.

18. See note 4, Hurst 2008:193.

19. Resnik DB. Research subjects in developing countries and vulnerability. The American Journal of Bioethics 2004;4(3):63–4.

20. The first points look at benefits in the narrow sense, excluding justice issues, which are covered by the fourth point.

21. See note 16, The World Medical Association 2004.

This paper was prepared as part of GenBenefit, a research project funded by the European Community's Sixth Framework Programme, but reflects only the authors’ views. We are grateful to the members of the GenBenefit Group and Armin Schmidt for comments on an earlier draft.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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