Journal of Bioethical Inquiry

, Volume 12, Issue 3, pp 395–408 | Cite as

Respect for Human Vulnerability: The Emergence of a New Principle in Bioethics

Original Research

Abstract

Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged (1) distinguishing between different types of vulnerability, (2) criticizing the categorization of populations as vulnerable, and (3) questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of vulnerability. As a phenomenon of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously.

Keywords

Global bioethics Globalization Vulnerability Research ethics Philosophy of medicine 

References

  1. Aldwin, C., and T. Revenson. 1986. Vulnerability to economic stress. American Journal of Community Psychology 4(2): 161–175.CrossRefGoogle Scholar
  2. Ankrah, E.M. 1991. AIDS and the social side of health. Social Science & Medicine 32(9): 967–980.CrossRefGoogle Scholar
  3. Anonymous. 1980. The hospital industry’s new vulnerability to antitrust. Regulation 4(5): 12–13.Google Scholar
  4. Beauchamp, T., and J. Childress. 2012. Principles of biomedical ethics, 7th ed. New York and Oxford: Oxford University Press.Google Scholar
  5. Belmont Report. 1979. Ethical principles and guidelines for the protection of human subjects of research, Report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Federal Register 44(76): 23191–23197.Google Scholar
  6. Benaroyo, L. 2007. The notion of vulnerability in the philosophy of Emmanuel Levinas and its significance for medical ethics and aesthetics. http://www.api.or.at/aebm/download/docs/web_levinas.pdf.
  7. Blacksher, E., and J. Stone. 2002. Introduction to “vulnerability” issues. Theoretical Medicine and Bioethics 23(6): 421–424.CrossRefGoogle Scholar
  8. Botbol-Baum, M. 2000. The necessary articulation of autonomy and vulnerability. In Basic ethical principles in European bioethics and biolaw: Vol. II: Partners’ research, edited by J. D. Rendtorff, and P. Kemp, 57–64. Copenhagen and Barcelona: Centre for Ethics and Law and Institut Borja de Bioetica.Google Scholar
  9. Brown, N. 1994. Climate change and human history: Some indications from Europe, AD 400–1400. Environmental Pollution 83(1–2): 37–43.CrossRefPubMedGoogle Scholar
  10. Burggraeve, R. 1999. Violence and the vulnerable face of the other: The vision of Emmanuel Levinas on moral evil and our responsibility. Journal of Social Philosophy 30(1): 29–45.CrossRefGoogle Scholar
  11. Callahan, D. 2000. The vulnerability of the human condition. In Bioethics and biolaw: Vol. II: Four ethical principles, edited by P. Kemp, J. Rendtorff, and N. Mattson Johansen, 115–122. Copenhagen: Rhodos International Science and Art Publishers & Centre for Ethics and Law.Google Scholar
  12. CIOMS. 1982. Proposed international guidelines for biomedical research involving human subjects. In Bioethics: Issues and perspectives, edited by S. Scholle Connor, and H.L. Fuenzalida-Puelma, 220–226. Washington, DC: Pan American Health Organization.Google Scholar
  13. CIOMS. 1991. International guidelines for ethical review of epidemiological studies. http://www.cioms.ch/publications/guidelines/1991_texts_of_guidelines.htm. Accessed September 14, 2012.
  14. CIOMS. 1993. International ethical guidelines for biomedical research involving human subjects. http://www.codex.uu.se/texts/international.html. Accessed September 14, 2012.
  15. CIOMS. 2002. International ethical guidelines for biomedical research involving human subjects. http://www.cioms.ch/publications/guidelines/guidelines_nov_2002_blurb.htm. Accessed September 14, 2012.
  16. Coleman, C.H. 2009. Vulnerability as a regulatory category in human subject research. Journal of Law, Medicine & Ethics 37(1): 12–18.CrossRefGoogle Scholar
  17. Cox, R.W. 2002. The political economy of a plural world: Critical reflections on power, morals and civilization. London: Routledge.CrossRefGoogle Scholar
  18. Cutler, S. 1979. Safety on the streets: Cohort changes in fear. International Journal of Aging and Human Development 10(4): 373–384.CrossRefPubMedGoogle Scholar
  19. Danis, M., and D. Patrick. 2002. Health policy, vulnerability, and vulnerable populations. In Ethical dimensions of health policy, edited by M. Danis, C. Clancy, and L. Churchill, 310–334. New York: Oxford University Press.Google Scholar
  20. DeBruin, D. 2001. Reflections on “vulnerability.” Bioethics Examiner 5(2): 1, 4, 7.Google Scholar
  21. Delor, F., and M. Hubert. 2000. Revisiting the concept of “vulnerability.” Social Science & Medicine 50(11): 1557–1570.Google Scholar
  22. Derrida, J. 2002. The animal that therefore I am (more to follow). Critical Inquiry 28(2): 369–418.CrossRefGoogle Scholar
  23. Eckenwiler, L., C. Ellis, D. Feinholz, and T. Schonfeld. 2008. Hopes for Helsinki: Reconsidering “vulnerability.” Journal of Medical Ethics 34(10): 765–766.Google Scholar
  24. Epstein, P.R. 1994. Framework for an integrated assessment of health, climate change, and ecosystem vulnerability. Annals New York Academy of Sciences 740(1): 423–435.CrossRefGoogle Scholar
  25. Fillenbaum, G.G. 1976. An examination of the vulnerability hypothesis. International Journal of Aging & Human Development 8(2): 155–160.CrossRefGoogle Scholar
  26. Flanigan, R. 2000. Vulnerability and the bioethics movement. Bioethics Forum 16(2): 13–18.Google Scholar
  27. Flaskerud, J., and B. Winslow. 1998. Conceptualizing vulnerable populations health-related research. Nursing Research 47(2): 69–78.CrossRefPubMedGoogle Scholar
  28. Forster, H.P., E. Emanuel, and C. Grady. 2001. The 2000 revision of the Declaration of Helsinki: A step forward or more confusion? The Lancet 358(9291): 1449–1453.CrossRefGoogle Scholar
  29. Fox, K. 2002. Hotep’s story: Exploring the wounds of health vulnerability in the US. Theoretical Medicine 23(6): 471–497.CrossRefGoogle Scholar
  30. Gehlen, A. 1988. Man: His nature and place in the world. New York: Columbia University Press. Originally published as Der Mensch, seine Natur und seine Stellung in der Welt (Berlin: Junker und Dünnhaupt, 1940).Google Scholar
  31. Goodin, R.E. 1985. Protecting the vulnerable: A reanalysis of our social responsibilities. Chicago and London: The University of Chicago Press.Google Scholar
  32. Gutlove, P., and G. Thompson. 2003. Human security: Expanding the scope of public health. Medicine, Conflict & Survival 19(1): 17–34.CrossRefGoogle Scholar
  33. Harrison, P. 2008. Corporeal remains: Vulnerability, proximity, and living on after the end of the world. Environment and Planning 40(2): 423–445.CrossRefGoogle Scholar
  34. Hoffmaster, B. 2006. What does vulnerability mean? The Hastings Center Report 36(2): 38–45.CrossRefPubMedGoogle Scholar
  35. Hughes, C. 1998. The primacy of ethics: Hobbes and Levinas. Continental Philosophy Review 31(1): 79–94CrossRefGoogle Scholar
  36. Hurst, S. 2008. Vulnerability in research and health care: Describing the elephant in the room? Bioethics 22(4): 191–202.CrossRefPubMedGoogle Scholar
  37. IBC (International Bioethics Committee). 2011. Report of the IBC on the principle of respect for human vulnerability and personal integrity. Paris: UNESCO, SHS/EST/CIB-17/10/CONF.501/2 Rev 2. http://unesdoc.unesco.org/images/0018/001895/189591e.pdf.
  38. Iltis, A.S. 2009. Introduction: Vulnerability in biomedical research. Journal of Law, Medicine & Ethics 37(1): 6–11.CrossRefGoogle Scholar
  39. Jaggar, A.M. 2002. Vulnerable women and neo-liberal globalization: Debt burdens undermine women’s health in the global South. Theoretical Medicine 23(6): 425–440.CrossRefGoogle Scholar
  40. Jotkowitz, A. 2004. Vulnerability from a global medicine perspective. The American Journal of Bioethics 4(3): 62–63.CrossRefPubMedGoogle Scholar
  41. Justo, L. 2004. Participatory research: A way to reduce vulnerability. The American Journal of Bioethics 4(3): 67–68.CrossRefPubMedGoogle Scholar
  42. Kahn, K., and J.H. Bryant. 1994. The vulnerable in developed and developing countries—a conceptual approach. In Poverty, vulnerability, the value of human life, and the emergence of bioethics, edited by Z. Bankowski, and J.H. Bryant, 57–63. Geneva: CIOMS.Google Scholar
  43. Kahn, A.S., D.L. Swerdlow, and D.D. Juranek. 2001. Precautions against biological and chemical terrorism directed at food and water supplies. Public Health Reports 116(1): 3–14.CrossRefGoogle Scholar
  44. Kipnis, K. 2001. Vulnerability in research subjects: A bioethical taxonomy. In Ethical and policy issues in research involving human research participants, edited by the National Bioethics Advisory Commission, G1–G13. Bethesda, MD: National Bioethics Advisory Commission.Google Scholar
  45. Kipnis, K. 2003. Seven vulnerabilities in the pediatric research subject. Theoretical Medicine and Bioethics 24(2): 107–120.CrossRefPubMedGoogle Scholar
  46. Kipnis, K. 2004. The limitations of “limitations.” The American Journal of Bioethics 4(3): 70–72.Google Scholar
  47. Kirby, P. 2006. Vulnerability and violence: The impact of globalisation. London and Ann Arbor, MI: Pluto Press.Google Scholar
  48. Kirby, P. 2010. Vulnerability and globalization: The social impact of vulnerability. In Handbook of globalization studies, edited by B. Turner, 113–134. London: Routledge.Google Scholar
  49. Kottow, M.H. 2003. The vulnerable and the susceptible. Bioethics 17(5–6): 460–471.CrossRefPubMedGoogle Scholar
  50. Kottow, M.H. 2004. Vulnerability: What kind of principle is it? Medicine, Health Care and Philosophy 7(3): 281–287.CrossRefGoogle Scholar
  51. Levinas, E. 2009. Otherwise than being or beyond essence. Pittsburgh, PA: Duquesne University Press. Originally published as Autrement qu’ȇtre ou Au-delà de l’essence (La Haye: Martinus Nijhoff, 1974).Google Scholar
  52. Levine, R.J. 1981. Ethics and regulation of clinical research. Baltimore and Munich: Urban & Schwarzenberg.Google Scholar
  53. Levine, R.J., and K. Lebacqz. 1979. Some ethical considerations in clinical trials. Clinical Pharmacology and Therapeutics 25(5/2): 728–741.Google Scholar
  54. Levine, C., R. Faden, C. Grady, D. Hammerschmidt, L. Eckenwiler, and J. Sugarman. 2004. The limitations of “vulnerability” as a protection for human research participants. The American Journal of Bioethics 4(3): 44–49.CrossRefPubMedGoogle Scholar
  55. Lewis, J. 1990. The vulnerability of small-island states to sea level rise: The need for holistic strategies. Disasters 14(3): 241–249.CrossRefPubMedGoogle Scholar
  56. Luna, F. 2006. Bioethics and vulnerability: A Latin American view. Amsterdam and New York: Rodopi.Google Scholar
  57. Luna, F. 2009. Elucidating the concept of vulnerability: Layers not labels. The International Journal of Feminist Approaches to Bioethics 2(1): 121–139.CrossRefGoogle Scholar
  58. Mackenzie, C., W. Rogers, and S. Dodds, eds. 2014. Vulnerability: New essays in ethics and feminist philosophy. Oxford and New York: Oxford University Press.Google Scholar
  59. Macklin, R. 2003. Bioethics, vulnerability and protection. Bioethics 17(5–6): 472–486.CrossRefPubMedGoogle Scholar
  60. Martin, A.K., N. Tavaglione, and S. Hurst. 2014. Resolving the conflict: Clarifying “vulnerability” in health care ethics. Kennedy Institute of Ethics Journal 24(1): 51–72.CrossRefPubMedGoogle Scholar
  61. McGilloway, F.A. 1976. Dependency and vulnerability in the nurse/patient situation. Journal of Advanced Nursing 1(3): 229–236.CrossRefPubMedGoogle Scholar
  62. Morawa, A. 2003. Vulnerability as a concept in international human rights law. Journal of International Relations and Development 6(2): 139–155.Google Scholar
  63. Morin, E. 2005. Introduction à la pensée complexe. Paris: Points.Google Scholar
  64. National Bioethics Advisory Commission (NBAC). 2001. Ethical and policy issues in research involving human participants: Vol. 1: Reports and recommendations of the National Bioethics Advisory Commission. Bethesda, MD: National Bioethics Advisory Commission.Google Scholar
  65. Nortvedt, P. 2003. Subjectivity and vulnerability: Reflections on the foundation of ethical sensibility. Nursing Philosophy 4(3): 222–230.CrossRefPubMedGoogle Scholar
  66. O’Neill, O. 1996. Towards justice and virtue. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  67. Patrão Neves, M. 2009. Article 8: Respect for human vulnerability and personal integrity. In The UNESCO Universal Declaration on Bioethics and Human Rights: Background, principles and application, edited by H. ten Have and M.S. Jean, 155–164. Paris: UNESCO Publishing.Google Scholar
  68. Pellegrino, E.D., and D.C. Thomasma. 1981. A philosophical basis of medical practice: Toward a philosophy and ethic of the healing professions. New York and Oxford: Oxford University Press.Google Scholar
  69. Ramsay, L.E., M.J. Tidd, J.K. Butler, and G.R. Venning. 1977. Ethical review in the pharmaceutical industry. British Journal of Clinical Pharmacology 4(1): 73–76.PubMedCentralCrossRefPubMedGoogle Scholar
  70. Reich, W. 2005. The power of a single idea. In Bioetica ou bioeticas na evolução das sociedades, edited by M. Patrão Neves and M. Lima, 380–382. Coimbra: Grafica de Coimbra.Google Scholar
  71. Rendtorff, J.D. 2002. Basic ethical principles in European bioethics and biolaw: Autonomy, dignity, integrity and vulnerability—towards a foundation of bioethics and biolaw. Medicine, Health Care and Philosophy 5(3): 235–244.CrossRefGoogle Scholar
  72. Resnik, D.B. 2004. Research subjects in developing nations and vulnerability. The American Journal of Bioethics 4(3): 63–64.CrossRefPubMedGoogle Scholar
  73. Ricoeur, P. 2007. Reflections on the just. Chicago and London: University of Chicago Press. Originally published as Le juste, I (Paris: Esprit, 2001).Google Scholar
  74. Ruof, M.C. 2004. Vulnerability, vulnerable populations, and policy. Kennedy Institute of Ethics Journal 14(4): 411–425.CrossRefPubMedGoogle Scholar
  75. Scholte, J.A. 2000. Globalization: A critical introduction. Basingstoke: Palgrave.Google Scholar
  76. Schramm, F., and M. Braz. 2008. Bioethics of protection: A proposal for the moral problems of developing countries? Journal International de Bioéthique 19(1–2): 73–86.CrossRefPubMedGoogle Scholar
  77. Schroeder, D., and E. Gefenas. 2009. Vulnerability: Too vague and too broad? Cambridge Quarterly of Healthcare Ethics 18(2): 113–121.CrossRefPubMedGoogle Scholar
  78. Sebastian, J.G. 1985. Homelessness: A state of vulnerability. Family & Community Health 8(3): 11–24.CrossRefGoogle Scholar
  79. Shainess, N. 1979. Vulnerability to violence: Masochism as process. American Journal of Psychotherapy 33(2): 174–189.PubMedGoogle Scholar
  80. Shivas, T. 2004. Contextualizing the vulnerability standard. The American Journal of Bioethics 4(3): 84–86.CrossRefPubMedGoogle Scholar
  81. Silvers, A. 2004. Historical vulnerability and special scrutiny: Precautions against discrimination in medical research. The American Journal of Bioethics 4(3): 56–57.CrossRefPubMedGoogle Scholar
  82. Snarr, D., N. Brown, and E. Leonard. 1979. Permanent post-disaster housing in Honduras: Aspects of vulnerability to future disasters. Disasters 3(3): 287–292.CrossRefPubMedGoogle Scholar
  83. Solbakk, J. H. 2011. Vulnerability: A futile or useful principle in healthcare ethics? In The SAGE handbook of health care ethics: Core and emerging issues, edited by R. Chadwick, H. ten Have, and E.M. Meslin, 228–238. London: Sage.CrossRefGoogle Scholar
  84. Solbakk, J.H., and S. Vidal. 2012. Research ethics, clinical. In Encyclopedia of applied ethics, 2nd ed., vol. 3, edited by R. Chadwick, 775–785. San Diego: Academic.CrossRefGoogle Scholar
  85. Steady, F.C. 1982. African women, industrialization and another development: A global perspective. Development Dialogue 1–2: 51–64.PubMedGoogle Scholar
  86. Stone, J. 2002. Race and healthcare disparities: Overcoming vulnerability. Theoretical Medicine 23(6): 499–518.CrossRefGoogle Scholar
  87. Taylor, C. 1985. Human agency and language: Philosophical papers I. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  88. ten Have, H. 2012. Potter’s notion of bioethics. Kennedy Institute of Ethics Journal 22(1): 59–82.CrossRefPubMedGoogle Scholar
  89. ten Have, H. 2014. The principle of vulnerability in the UNESCO Declaration on Bioethics and Human Rights. In The principle of human vulnerability in bioethics: Religious perspectives, edited by J. Tham, G. Miranda, and A. Garcia, 15–28. Dordrecht: Springer.Google Scholar
  90. Thomasma, D.C. 2000. The vulnerability of the sick. Bioethics Forum 16(2): 5–12.Google Scholar
  91. United Nations. 2003. Report on the world social situation: Social vulnerability: Sources and challenges. New York: United Nations Department of Economic and Social Affairs.Google Scholar
  92. United Nations Development Program (UNDP). 1999. Human development report 1999. New York: Oxford University Press.Google Scholar
  93. United Nations Educational, Scientific and Cultural Organization (UNESCO). 2005. Universal declaration on bioethics and human rights. http://unesdoc.unesco.org/images/0014/001461/146180e.pdf. Accessed September 14, 2012.
  94. Vörösmarty, C.J., P. Green, J. Salisbury, and R.B. Lammers. 2000. Global water resources: Vulnerability from climate change and population growth. Science 289(5477): 284–288.CrossRefPubMedGoogle Scholar
  95. Watts, M.J., and H.G. Bohle. 1993. The space of vulnerability: The causal structure of hunger and famine. Progress in Human Geography 17(1): 43–67.CrossRefGoogle Scholar
  96. Weijer, C. 1999. Research involving the vulnerable sick. Accountability in Research 7(1): 21–36.CrossRefPubMedGoogle Scholar
  97. Whelan, D. 1998. Human rights approaches to an expanded response to address women’s vulnerability to HIV/AIDS. Health and Human Rights 3(1): 20–36.CrossRefPubMedGoogle Scholar
  98. WMA (World Medical Association). 2000. Declaration of Helsinki, 5th revision. http://ohsr.od.nih.gov/guidelines/helsinki.html. Accessed September 14, 2012.
  99. WMA (World Medical Association). 2008. Declaration of Helsinki, 6th revision. http://www.wma.net/en/30publications/10policies/b3/index.html.pdf?print-media-type&footer-right=[page]/[toPage]. Accessed September 14, 2012.
  100. Zaidi, A. 1988. Poverty and disease: Need for structural change. Social Science & Medicine 27(2): 119–127.CrossRefGoogle Scholar
  101. Zion, D., L. Gillam, and B. Loff, 2000. The Declaration of Helsinki, CIOMS and the ethics of research on vulnerable populations. Nature Medicine 6(6): 615–617.CrossRefPubMedGoogle Scholar

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2015

Authors and Affiliations

  1. 1.Center for Healthcare EthicsDuquesne UniversityPittsburghUSA

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