David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Bioethics 22 (4):191–202 (2008)
Despite broad agreement that the vulnerable have a claim to special protection, defining vulnerable persons or populations has proved more difficult than we would like. This is a theoretical as well as a practical problem, as it hinders both convincing justifications for this claim and the practical application of required protections. In this paper, I review consent-based, harm-based, and comprehensive definitions of vulnerability in healthcare and research with human subjects. Although current definitions are subject to critique, their underlying assumptions may be complementary. I propose that we should define vulnerability in research and healthcare as an identifiably increased likelihood of incurring additional or greater wrong. In order to identify the vulnerable, as well as the type of protection that they need, this definition requires that we start from the sorts of wrongs likely to occur and from identifiable increments in the likelihood, or to the likely degree, that these wrongs will occur. It is limited but appropriately so, as it only applies to special protection, not to any protection to which we have a valid claim. Using this definition would clarify that the normative force of claims for special protection does not rest with vulnerability itself, but with pre-existing claims when these are more likely to be denied. Such a clarification could help those who carry responsibility for the protection of vulnerable populations, such as Institutional Review Boards, to define the sort of protection required in a more targeted and effective manner.
|Keywords||clinical ethics research ethics vulnerable populations patient selection|
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Citations of this work BETA
Philippe Calain, Nathalie Fiore, Marc Poncin & Samia A. Hurst (2009). Research Ethics and International Epidemic Response: The Case of Ebola and Marburg Hemorrhagic Fevers. Public Health Ethics 2 (1):7-29.
Ruth Macklin (2012). A Global Ethics Approach to Vulnerability. International Journal of Feminist Approaches to Bioethics 5 (2):64-81.
Verina Wild (2012). How Are Pregnant Women Vulnerable Research Participants? International Journal of Feminist Approaches to Bioethics 5 (2):82-104.
Agomoni Ganguli Mitra & Nikola Biller-Andorno (2013). Vulnerability and Exploitation in a Globalized World. International Journal of Feminist Approaches to Bioethics 6 (1):91-102.
Nicolas Tavaglione & Samia A. Hurst (2012). Why Physicians Ought to Lie for Their Patients. American Journal of Bioethics 12 (3):4-12.
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