It is well known that Hume excluded inferior rational beings, who are incapable of resistance and weak resentment, from his concept of justice. This resulted in a critique of Hume’s theory of justice, as it would not protect those who were the most vulnerable against ill treatment. The typical answer to this critique is that Hume excluded inferior rational beings from the concept of justice, but not from that of morality, and that he considered their protection to be (...) the task of humanity. The subject of this text is the range of Hume’s humanity. What manner of protection does Hume’s humanity truly offer? Despite the conclusion that this manner of protection of the vulnerable is insufficient, Hume’s humanity contains valuable characteristics worthy of re-evaluation in modern debate — both on the limits of humanity and on the conditions and models of protecting the vulnerable. (shrink)

This volume is devoted to exploring a subject which, on the surface, might appear to be just a trending topic. In fact, it is much more than a trend. It relates to an ancient, permanent issue which directly connects with people's life and basic needs: the recognition and protection of individuals' dignity, in particular the inherent worthiness of the most vulnerable human beings. The content of this book is described well enough by its title: 'Human Dignity of the (...) Vulnerable in the Age of Rights'. Certainly, we do not claim that only the human dignity of vulnerable people should be recognized and protected. We rather argue that, since vulnerability is part of the human condition, human vulnerability is not at odds with human dignity. To put it simply, human dignity is compatible with vulnerability. A concept of human dignity which discards or denies the dignity of the vulnerable and weak is at odds with the real human condition. Even those individuals who might seem more skilled and talented are fragile, vulnerable and limited. We need to realize that human condition is not limitless. It is crucial to re-discover a sense of moderation regarding ourselves, a sense of reality concerning our own nature. Some lines of thought take the opposite view. It is sometimes argued that humankind is - or is called to be - powerful, and that the time will come when there will be no vulnerability, no fragility, no limits at all. Human beings will become like God (or what believers might think God to be). This perspective rejects human vulnerability as in intrinsic evil. Those who are frail or weak, who are not autonomous or not able to care for themselves, do not possess dignity. In this volume it is claimed that vulnerability is an inherent part of human condition, and because human dignity belongs to all individuals, laws are called to recognize and protect the rights of all of them, particularly of those who might appear to be more vulnerable and fragile. (shrink)

Volume 20, Issue 9, September 2020, Page 36-38.

Protecting the Vulnerable explores the reality of patient control and choice in health care and analyzes how decisions should be made on behalf of those deemed incapable of making decisions. The contributors, distinguished experts from the disciplines of medicine, ethics, theology, and law, look at the complex problem of autonomy and consent in health care and clinical research today from an illuminating perspective--its impact on the vulnerable members of society. The essays move from the exploration of lingering paternalism (...) in health care to the acute dilemma of treatment of and research on newborn babies. In covering both general and specific problems the collection reveals how exploitation can occur when the right of autonomy is eroded and where informed consent is illusory. Particularly vulnerable groups, such as children and people with mental handicaps, are discussed alongside cases where the vulnerability is itself an issue. Other areas covered include: `gesture' suicides, the practical problems of doctors in dealing with dependent patients, and the limits of proxy consent. All health care professionals, ethicists, policy makers, and lawyers currently engaged in the study or practice of health care ethics will find Protecting the Vulnerable to be a vital source of information for many years to come. (shrink)

The right of adults with sound mind to consent to treatment or risk their own health for the benefit of the community in a clinical trial is unequivocally recognised by the law. But what about those vulnerable by virtue of their age, nature or position in society? Experts from the fields of medicine, philosophy, theology and law, explore the ethical and legal principles which seek to reconcile the individual's right to autonomy with the need to protect vulnerable groups. (...) Discussions refer both to specific groups and specific issues. (shrink)

The right of adults with sound mind to consent to treatment or risk their own health for the benefit of the community in a clinical trial is unequivocally recognised by the law. But what about those vulnerable by virtue of their age, nature or position in society? Experts from the fields of medicine, philosophy, theology and law, explore the ethical and legal principles which seek to reconcile the individual's right to autonomy with the need to protect vulnerable groups. (...) Discussions refer both to specific groups and specific issues. (shrink)

Current regulations and guidelines identify specific subject populations as vulnerable. Regulations and guidelines generally stipulate protections with regard to the process of informed consent. Recent clinical trials suggest that satisfying the legal requirements for additional safeguards may not protect subjects to the extent we may desire. We present proposed guidelines for the protection of decisionally impaired subjects throughout the course of the trial.

In recent decades, developing and middle-income countries around the globe have adopted path-breaking reforms to their social protection systems. Latin America has been a pioneer region, expanding the state’s commitment on behalf of low-income citizens in key policy areas in many countries. This paper undertakes two tasks. First, it documents the surprising extension of noncontributory social protection policies across many Latin American countries, highlighting how tax-financed programs have come to play a central role in a variety of settings. (...) Second, it examines citizen-level preferences that support this trend, arguing that employment vulnerability and threats to income continuity play a decisive role in shaping demand for public, rather than private, social protection. Survey data on labor-market risks and social policy preferences from eighteen countries corroborate these claims. Our findings suggest that other countries undergoing labor-market strains may experience similar demands for a “return of the state” as a guarantor of social protection in the coming years. (shrink)

Vulnerabilities often characterize the availability of immigrant populations of interest in social behavioral science, public health, and medical research. Refugees, asylum seekers, and undocumented immigrants present unique vulnerabilities relevant to protocol development as well as ethics review procedures and criteria. This paper describes vulnerable populations in relation to the Belmont Report and US federal regulations for the protection of human subjects, both of which are commonly used in international research contexts. It argues for safeguards for immigrants comparable to (...) protections for such populations as pregnant women, prisoners, and children. The paper further presents a two-part model for the review of protocols that involve immigrants. The model is intended to help identify the risks to immigrants associated with participation in research, and to suggest how researchers can responsibly frame studies and access to research participant immigrants through community-based, and/or non-governmental organizations that serve immigrants and immigrant communities. (shrink)

An issue about the privacy of the clustered groups designed by algorithms arises when attempts are made to access certain pieces of information about those groups that would likely be used to harm them. Therefore, limitations must be imposed regarding accessing such information about clustered groups. In the discourse on group privacy, it is argued that the right to privacy of such groups should be recognised to respect group privacy, protecting clustered groups against discrimination. According to this viewpoint, this right (...) places a duty on others, for example, private companies, institutions, and governments, to refrain from accessing such information. To defend the idea that the right to privacy should be recognised for clustered groups, at least two requirements must be satisfied. First, clustered group privacy must be conceived of as either a collective good or a participatory good. Since these forms of good are of the type from which no member of a group can be excluded from benefiting, the right to them is defined as a group right. Second, there must be group interests on which to base a group right. Group interests can be either the interests of those members that are a result of their being in the group or the interests of the group as a whole that transcend the interests of its members. However, this paper argues that clustered group privacy cannot be conceived of as either a collective or a participatory good because it is possible for some individuals to be excluded from benefiting from it. Furthermore, due to the lack of awareness among individuals that they are members of a clustered group and the nature of a clustered group itself, such groups cannot have the group interests necessary to establish a group right. Hence, the group right to privacy cannot be recognised for these groups, implying the group right cannot be considered a means to protect clustered groups against discrimination. Instead, this paper suggests that moral principles need to be articulated within an ethics of vulnerability to identify the moral obligations of protecting vulnerable clustered groups. The duty owed to the vulnerable should involve refraining from accessing certain information about clustered groups in specific contexts. This duty is not engendered by the right to privacy of such groups; it is the duty owed to the vulnerable. The findings highlight the need to articulate moral principles regarding privacy and data protection to protect clustered groups in contexts in which accessing information about them could constitute a reason for discriminatory targeting. (shrink)

Despite the role of public health interventions in controlling disease transmission and protecting the public during the COVID-19 emergency, the implementation of quarantine restrictions has raised serious ethical concerns, especially in relation to the well-being of vulnerable populations. Drawing on the lived experiences of rural Chinese migrants who are subject to pandemic control, the authors highlight their inadequate capacities to manage the risks associated with the pandemic and adjust to quarantine restrictions. Informed by an ethical discourse of vulnerability, we (...) show that underpinning this group’s deficient coping strategies is a range of detrimental social structures and institutions that have developed under the persistent rural–urban divide in China. These structural constraints and pathologies expose rural migrants to serious risks and uncertainties while depriving them of the means and resources necessary to protect their own interests in the process of complying with quarantine restrictions. Understanding the plight of rural Chinese migrants as a structural problem also has implications for the global response to the COVID-19 pandemic. We further suggest a need for state intervention to mitigate structural deficiencies and empower the vulnerable during the COVID-19 era. (shrink)

Bullying often results in negative coping in victims, including an increased consumption of alcohol. Recently, however, an increase in alcohol use has also been reported among perpetrators of bullying. The factors triggering this pattern are still unclear. We investigated the role of empathy in the interaction between bullying and alcohol use in an adolescent sample (IMAGEN) at age 13.97 (±0.53) years (baseline (BL), N = 2165, 50.9% female) and age 16.51 (±0.61) years (follow-up 1 (FU1), N = 1185, 54.9% female). (...) General empathic distress served as a significant moderator of alcohol use in perpetrators (F9, 493 = 17.978, p < 0.01), which was specific for males and FU1. Male perpetrators, who are generally less sensitive to distress, might thus be more vulnerable to alcohol abuse. (shrink)

In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

Scholars and policymakers continue to struggle over the meaning of the word “vulnerable” in the context of research ethics. One major reason for the stymied discussions regarding vulnerable populations is that there is no clear distinction between accounts of research vulnerabilities that exist for certain populations and discussions of research vulnerabilities that require special regulations in the context of research ethics policies. I suggest an analytic process by which to ascertain whether particular vulnerable populations should be contenders (...) for additional regulatory protections. I apply this process to two vulnerable populations: the cognitively vulnerable and the economically vulnerable. I conclude that a subset of the cognitively vulnerable require extra protections while the economically vulnerable should be protected by implementing existing regulations more appropriately and rigorously. Unless or until the informed consent process is more adequately implemented and the distributive justice requirement of the Belmont Report is emphasized and operationalized, the economically disadvantaged will remain particularly vulnerable to the harm of exploitation in research. (shrink)

The vulnerability of participants in Substance Abuse and Mental Health Services Administration (SAMHSA) programs is a consequence of the illnesses that they are experiencing; ethical guarantees must be in place that ensure the dignity of the persons involved in such programs. Dignity is more than an individual concern; it has individual, institutional, and societal dimensions. An ethical framework is proposed that involves the interrelated vulnerabilities and needs of individuals and communities and our societal response to them. Among the issues given (...) particular attention are individual and community stigmatization, target population involvement in program planning, balance with regard to confidentiality and privacy, the place of proportionality grounded in a rich sense of community as a guiding ethical principle, and guidelines for SAMHSA programs. (shrink)

Agriculture in the Netherlands is a critical industry, in terms of both its share of available land and its importance to the Dutch economy. Cultural-technical improvements and intensification of land use have resulted in increased productivity, but have also threatened vulnerable and valuable natural habitats and landscapes. TheRelatienota, a government report issued in 1975, introduced an environmental policy implemented by regulation in 1983 and 1988. Under this policy,Relatienota areas (management areas and reserves) are established. Farmers in management areas voluntarily (...) enter private contracts (management agreements) with the government, in which they promise to tailor agricultural production to nature and landscape conservation. By compensating farmers for activities that maintain existing natural conditions, management agreements provide the incentive for extraordinary efforts to protect agricultural environments for valuable plant and animal species. Particularly sensitive natural areas, where environmental values are incompatible with economic farming, are identified as reserves, and the land is purchased for specialized management.AlthoughRelatienota policy has been implemented on a limited number of hectares, it is an important component of the efforts in the Netherlands to protect and preserve vulnerable natural areas. As a model of negotiated cooperation between government, farmers, and nature protection interests, its success may encourage other nations in the Economic Community to use private contracts to further societal goals. (shrink)

People with mental illness are treated, in research, as a ‘class’ or category who are vulnerable, without always being clear why they should be treated as such, not why an individual, rather than the class, is vulnerable. The two main reasons given are lack of competence and power imbalance. Competence issues include incapacity and legislation, assessment and the impact of the illness in decisions. Power issues cover the role of mental health legislation, coercion, protectiveness and paternalism, stigma and (...) discrimination and the ‘well’ and ‘ill’ self. These are examined within a framework of risk assessment, both to the patient and to others. Over-concern to protect the vulnerable can lead to gate-keepers preventing their inclusion in studies at various stages of the research. This denies such groups a voice in the research process. It is suggested that ethical scrutiny of research is not only to prevent harm to the vulnerable, but also to provide a framework to empower such people to take part in research. To do otherwise is to further stigmatize and marginalize them. One way forward is to look at the risk presented by different types of research, from clinical intervention trials to non-therapeutic, qualitative studies and to modify capacity and access requirements in the light of the risks presented. (shrink)

Conceptualisations of vulnerability of research participants in the international standards of ethics of research involving humans underwent a shift from a group-membership (categorical) to an individual-oriented (analytic) approach to vulnerability. However, the categorical view has not been jettisoned completely, and so its role needs to be examined or explained. It is argued in this chapter that a restricted use of the categorical approach can be justified if protection of vulnerable research participants is seen against the background of the (...) dynamics of study design, review and implementation, and if recognition and protection of participants with vulnerabilities is construed as a process in which researchers and ethics review bodies are involved rather than as a labelling device. From this perspective, the suitability of approach to conceptualisation of vulnerability depends on the kind and scope of the available information on participants. The process of study design, ethics review, and implementation involves different users of the ethics standards at different stages in the lifetime of a project: researchers and members of ethics review bodies. The concepts of individual vulnerability (in the analytic approach) and that of group-membership vulnerability (in the categorical approach) can play their protective roles complementarily in the process of identification of vulnerabilities of participants and protection of participants with vulnerabilities. (shrink)

This paper analyses the ‘responsibility to protect’ (RtoP) from a moral cosmopolitan perspective. It argues, first, that RtoP postulates a remedial responsibility on the part of those nations that have the means and capacity to effectively protect individuals against vulnerability and to provide for the means of human security. Second, the paper explains that human security implies access to human development, including access to social and economic rights. Finally, it argues that developed nations can discharge their remedial responsibilities towards those (...) who lack social and economic rights by adopting just immigration regimes, part of which can be based on temporary foreign labour programs that allow individuals access to the economic opportunities, thus providing them with means to establish economic security. The paper thus argues for an expansion of the interpretation of RtoP. (shrink)

The trend of much of recent moral philosophy has been to question the adequacy of traditional deontological and utilitarian views which place universal moral rights and duties at the center of ethical theory. Robert Goodin's book continues this trend and attempts to break new ground in ethical theory by proposing a general theory of special moral responsibilities. He argues that such responsibilities, though diverse in many ways, all derive from a common underlying moral principle, the vulnerability principle, according to which (...) moral agents acquire special responsibilities to the extent to which others are dependent upon them or are specially vulnerable in some way or ways to their choices and actions. (shrink)

Suppose that someone has a serious illness. The illness will likely lead to significant disabilities, and may even cause death. Existing treatments are unsatisfactory. The patient learns about a clinical trial, in which some allegedly promising new treatment for that illness is being tested.Such seriously ill patients for whom existing treatments are unsatisfactory have sometimes been categorized as medically vulnerable in the literature. Should these patients indeed be considered vulnerable subjects and be provided with special protections? And if (...) the answer is yes, then what are those special protections? This article explores the possible answers to these questions.The federal regulations for the protection of research subjects have several provisions addressing the concept of vulnerability. The three subparts Subparts B, C, and D deal with specific categories of vulnerable subjects, but do relatively little to address broader issues relating to vulnerability that might apply to a category such as the medically vulnerable. The Common Rule is the only section containing general discussions of vulnerability. (shrink)

Outsourcing clinical trials sponsored by pharmaceutical companies from industrialized countries to low- -income countries – summarized as transnational biomedical research – has lead to many concerns about ethical standards. Whether study participants are particularly vulnerable is one of those concerns. However, the concept of vulnerability is still vague and varies in its definition. Despite the fact that important international ethical guidelines such as the Declaration of Helsinki by the World Medical Association or the Ethical Guidelines for Biomedical Research Involving (...) Human Subjects by the Council of International Organizations of Medical Sciences refer to vulnerability as ethical principle, each of their approaches are different. To overcome these shortcomings, we analyze and unite different approaches of vulnerability and develop practical criteria in order to operationalize the concept especially for the context of TBR. These criteria refer to the context of a study as well as the characteristics and the current living situation of study participants. Based on a case study of an HIV-vaccine-trial conducted in India we demonstrate how those criteria can be applied in a retrospective way to identify potential ethical conflicts. The criteria can also indicate a prospective function for ethical pre-assessment. For this, we provide an outlook for three major topics: 1. Vulnerability as a normative concept: Different ways of protection; 2. The relevance of transparency and 3. Vulnerability as an instrument to increase decision participation of human subjects. (shrink)

The first part of this paper examines the practice of informed treatment decisions in the protective medical system in China today. The second part examines how health care professionals in China perceive and carry out their responsibilities when relaying information to vulnerable patients, based on the findings of an empirical study that I had undertaken to examine the moral experience of nurses in practice situations. In the Chinese medical ethics tradition, refinement [jing] in skills and sincerity [cheng] in relating (...) to patients are two cardinal virtues that health care professionals are required to possess. This notion of absolute sincerity carries a strong sense of parental protectiveness. The empirical findings reveal that most nurses are ambivalent about telling the truth to patients. Truth-telling would become an insincere act if a patient were to lose hope and confidence in life after learning of his or her disease. In this system of protective medical care, it is arguable as to whose interests are being protected: the patient, the family or the hospital. I would suggest that the interests of the hospital and the family members who legitimately represent the patient's interests are being honoured, but at the expense of the patient's right to know. (shrink)

The COVID-19 disease has caused thousands of deaths worldwide and required the rapid and drastic adoption of various protective measures as main resources in the fight to reduce the spread of the disease. In the present study we aimed to identify socio cognitive factors that may influence adherence to protective measures toward COVID-19 in a Spanish sample. This longitudinal study analyzes the predictive value of perceived severity and vulnerability of infection, self-efficacy, direct exposure to the virus, and instrumental focused coping (...) style for adhering to infection protection behaviors during the first months of the COVID-19 pandemic. It also tests sex and age differences in these factors and changes over time. A two-wave longitudinal study was conducted in March and April 2020 starting the day after a strict national lockdown was decreed in Spain. A path analysis was used to test direct and indirect effects between vulnerability and the adherence to protective behaviors. Results suggest that individuals' perceived severity and vulnerability to COVID-19 and instrumental coping strategies are related to the use of more protective behaviors. This coping strategy mediates the effect of perceived vulnerability on engaging in protective behaviors, and this effect depends on direct exposure to COVID-19 and perceived self-efficacy moderators. Results suggest that recognizing one's own abilities to engage in instrumental actions may facilitate adherence to protective measures in people who had not been directly exposed to COVID-19. Therefore, adopting instrumental coping strategies to manage an individual's perceived vulnerability to infection may positively impact the adherence to protective behaviors, especially during the onset of an unexpected threat and when there is no prior direct experience with the situation. (shrink)

When seriously ill patients for whom existing treatments are inadequate are invited to participate in clinical trials that offer a new treatment, should those persons be considered “vulnerable”? And if so, what additional protections should they be accorded? This article attempts to provide some answers.

The paper discusses some of the implications of regulatory innovation in the area of advanced biological therapies and personalised medicine. Benefits, risks and trade-offs are highlighted.

Vulnerability is one of the least examined concepts in research ethics. Vulnerability was linked in the Belmont Report to questions of justice in the selection of subjects. Regulations and policy documents regarding the ethical conduct of research have focused on vulnerability in terms of limitations of the capacity to provide informed consent. Other interpretations of vulnerability have emphasized unequal power relationships between politically and economically disadvantaged groups and investigators or sponsors. So many groups are now considered to be vulnerable (...) in the context of research, particularly international research, that the concept has lost force. In addition, classifying groups as vulnerable not only stereotypes them, but also may not reliably protect many individuals from harm. Certain individuals require ongoing protections of the kind already established in law and regulation, but attention must also be focused on characteristics of the research protocol and environment that present ethical challenges. (shrink)

BPA Production and Associated Health Risks Bisphenol A is a chemical agent found in many everyday products, including canned goods and plastic food containers. BPA exposure is linked to a variety of adverse health effects, such as obesity and diabetes. To protect the public's health — especially the health of vulnerable fetuses, infants, children, and pregnant women — BPA regulations should encompass products intended specifically for these populations. Even with tremendous public outcry against the use of BPA, current federal (...) restrictions do not reach far enough. The U.S. Food and Drug Administration recently banned the use of BPA in children's sippy cups and baby bottles, but failed to address its inclusion in canned infant formula or plastic tableware.BPA production began in the 1950s to make epoxy resins and was later employed to create polycarbonate plastic products. (shrink)

The recent alleged doping case of the figure skater Kamila Valieva at the Winter Olympic Games in Beijing 2022 dramatically raised the issue of the protection of minors in anti-doping policy. We firstly present the literature on doping in relation to minors. Secondly, we present WADA’s Protected Person (PP) concept and its implications. Thirdly, we analyse the WADA Code’s purpose and the vulnerability of minors under the Code, and fourthly, we identify the real threats from which minors should be (...) protected by analysing the ineffective PP concept, and showing how it cannot be a real protection. We explain how preventing one threat can generate another, thus converting minor athletes from victims into suspects. We conclude by stressing the necessity for further research, and we indicate our future research direction, towards the development of a much wider concept of protection, and its application into sporting contexts. (shrink)

This article explores the activities of the Adult Shelter of the National Committee of the City of Zagreb since its foundation, from 1953 to 1978. The focus is on the consideration of the policy of taking care of vulnerable groups in social welfare institutions in the city of Zagreb, including persons with mental disorders. It seeks to illuminate the beginnings of the long-term care of the latter population in the homes for mentally ill adults, today known as homes for (...) adults. In connection to this, their social stigmatisation and tendency of placement into spatially segregated objects are discussed. The research showed that the strategies of social protection and mental health protection, despite the then-advocated idea of equality between social categories, were at the time oriented towards the protection of the majority of community from persons with mental disorders. (shrink)

Human beings are essentially vulnerable in the view that their existence qua humans is not given but construed. This vulnerability receives basic protection from the State, expressed in the form of the universal rights all citizens are meant to enjoy. In addition, many individuals fall prey to destitution and deprivation, requiring social action aimed at recognising the specific harms they suffer and providing remedial assistance to palliate or remove their plights.Citizens receive protection against their biologic vulnerability by (...) means of an in rem right to health [care], which is more an attitude of protection than a specific programme. When individuals become susceptible, that is, biologically weak or diseased, they also increase their predisposition to additional harm, and require social actions to treat their demeaned condition. Such assistance takes the form of positive healthcare rights.Research on human beings has been slow to observe that the subjects recruited are susceptible, especially so if research is done in less developed countries. By mislabelling them as vulnerable – a characteristic they share with all humans – sponsors avoid registering the deprivation these people suffer, and the ethical obligation to offer them remedial help.The distinction between vulnerability and susceptibility also marks the difference between being intact but fragile – vulnerable – and being injured and predisposed to compound additional harm – susceptible. Awareness of this difference should give additional force to the rejection of double standards in research ethics. (shrink)

Subpart B of 45 Code of Federal Regulations Part 46 (CFR) identifies the criteria according to which research involving pregnant women, human fetuses, and neonates can be conducted ethically in the United States. As such, pregnant women and fetuses fall into a category requiring “additional protections,” often referred to as “vulnerable populations.” The CFR does not define vulnerability, but merely gives examples of vulnerable groups by pointing to different categories of potential research subjects needing additional protections. In this (...) paper, I assess critically the role of this categorization of pregnant women involved in research as “vulnerable,” both as separate entities and in combination with the fetuses they carry. In particular, I do three things: (1) demonstrate that pregnant women qua pregnancy are either not “vulnerable” according to any meaningful definition of that term or that such vulnerability is irrelevant to her status as a research participant; (2) argue that while a fetus may be vulnerable in terms of dependency, this categorization does not equate to the vulnerability of the pregnant woman; and (3) suggest that any vulnerability that appends to women is precisely the result of federal regulations and dubious public perceptions about pregnant women. I conclude by demonstrating how this erroneous characterization of pregnant women as “vulnerable” and its associated protections have not only impeded vital research for pregnant women and their fetuses, but have also negatively affected the inclusion of all women in clinical research. (shrink)

This essay responds to Esther Reed's recent critique of the Responsibility to Protect (R2P) principle in this journal. It argues that Reed fundamentally misunderstands and misrepresents R2P. Her critique of R2P would have served well as a critique of the earlier concept of humanitarian intervention had it been penned in the late 1990s. But most of the problems and dangers that Reed identifies are in reality the very problems and dangers that R2P seeks to overcome, and I suggest that it (...) does overcome them quite successfully. R2P does not impose Western ideals on the rest of the world, weaken the legal restrictions on the use of force, or promote abusive interventionism. Rather, it offers a bold but carefully constructed framework that holds the promise of promoting the protection of vulnerable populations from mass atrocities. (shrink)

Recent discussion on the need to reassess research ethics standards has called into question familiar concepts such as equipoise, coercion, undue inducement, and the protection of vulnerable subjects. Reassessment of these concepts can be useful for a variety of reasons. It can eliminate conceptual murkiness, can assist in the proposal of regulations to better protect human subjects, and can elucidate ethical concerns. In this essay, I call attention here to a different, and often neglected, reason why reassessment of (...) research ethics concepts can be helpful. It can undermine the all-too-common practice of taking as a given the social and political conditions in which biomedical research takes place and can encourage the inclusion of broader questions about social justice, human flourishing, or about the importance of taking into account the social determinants of health and disease. I will focus on some recent attempts to reevaluate the concept of vulnerability in research ethics. I will argue that such attempts, by calling attention to the characteristics that can render participants vulnerable, can promote, rather than discourage, moral reflection about social and global justice concerns among bioethicists, policy makers, investigators, and members of Institutional Review Boards. (shrink)

This paper advances a new criterion of a vulnerable population in research. According to this criterion, there are consent-based and fairness-based reasons for calling a group vulnerable. The criterion is then applied to the case of people with serious illnesses. It is argued that people with serious illnesses meet this criterion for reasons related to consent. Seriously ill people have a susceptibility to “enticing offers” that hold out the prospect of removing or alleviating illness, and this susceptibility reduces (...) their ability to safeguard their own interests. This explains the inclusion of people with serious illnesses in the Belmont Report’s list of populations needing special protections, and supports the claim that vulnerability is the rule, rather than the exception, in biomedical research. (shrink)

Since at least as long ago as Plato’s time, philosophers have considered the possibility that justice is at bottom a system of rules that members of society follow for mutual advantage. Some maintain that justice as mutual advantage is a fatally flawed theory of justice because it is too exclusive. Proponents of a Vulnerability Objection argue that justice as mutual advantage would deny the most vulnerable members of society any of the protections and other benefits of justice. I argue (...) that the Vulnerability Objection presupposes that in a justice-as-mutual-advantage society only those who can and do contribute to the cooperative surplus of benefits that compliance with justice creates are owed any share of these benefits. I argue that justice as mutual advantage need not include such a Contribution Requirement. I show by example that a justice-as-mutual-advantage society can extend the benefits of justice to all its members, including the vulnerable who cannot contribute. I close by arguing that if one does not presuppose a Contribution Requirement, then a justice-as-mutual-advantage society might require its members to extend the benefits of justice to humans that some maintain are not persons (for example, embryos) and to certain nonhuman creatures. I conclude that the real problem for defenders of justice as mutual advantage is that this theory of justice threatens to be too inclusive. (shrink)

This article deals with an ethics of concrete others as an appropriate ethics for the vulnerable in a globalizing world. The concept of concrete others is based on the Levinasian concept of the other in that it accepts the transcendental dimension of others; however, the concept of concrete others is different from the concept of the other because it emphasizes immanent dimensions of human beings and their multiple differences. Because of a globalizing world which makes different vulnerabilities more visible, (...) I contend that the vulnerable need to be framed as concrete others rather than the other. There are different ethics which try to address vulnerabilities of concrete others. An ethics of the multitude betrays its exclusive concern for the economic dimension of the vulnerable while it shows little attention to cultural and political vulnerabilities of others. An ethics of différance, although its emphasis is on concrete difference, betrays limitations in recognizing and addressing inequality behind diverse differences of the vulnerable. An ethics of concrete others, which emphasizes both transcendental dimension and immanent dimension of concrete others, promotes both difference and equality of concrete others through equality that is substantially conducive to protection and promotion of difference. (shrink)

Intense public interest in scientific claims about COVID-19, concerning its origins, modes of spread, evolution, and preventive and therapeutic strategies, has focused attention on the values to which scientists are assumed to be committed and the relationship between science and other public discourses. A much discussed claim, which has stimulated several inquiries and generated far-reaching political and economic consequences, has been that SARS-CoV-2 was deliberately engineered at the Wuhan Institute of Virology and then, either inadvertently or otherwise, released to the (...) public by a laboratory worker. This has been pursued despite a clear refutation, through comprehensive genomic analysis, of the hypothesis that the virus was deliberately engineered and the failure of detailed investigations to identify any evidence in support of a laboratory leak. At the same time a substantial, established body of knowledge about the many factors underlying the emergence of novel zoonotic diseases has been largely ignored—including climate change and other mechanisms of environmental destruction, tourism, patterns of trade, and cultural influences. The existence and conduct of these debates have raised questions about the vulnerability of science to manipulation for political purposes. Scientific discourses are vulnerable because: (i) claims can be made with no more than probabilistic force; (ii) alleged “facts” are always subject to interpretation, which depends on social, ethical, and epistemological assumptions; and (iii) science and scientists are not inherently committed to any single set of values and historically have served diverse, and sometimes perverse, social and political interests. In the face of this complexity, the COVID-19 experience highlights the need for processes of ethical scrutiny of the scientific enterprise and its strategic deployment. To ensure reliability of truth claims and protection from corrupting influences robust ethical discourses are required that are independent of, and at times even contrary to, those of science itself. (shrink)

Solidarity between more and less vulnerable groups is fundamental to an effective public health response to a global pandemic. Yet in the case of COVID-19, a focus on deciding who can and who cannot be protected from harm has shaped the pandemic experience and continues to determine the post-pandemic trajectory of life with SARS-CoV-2. In this paper I discuss how this has affected our understanding and acceptance of solidarity.