Respect for Human Vulnerability and Personal Integrity

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Unit 8

• Respect for Human Vulnerability and Personal
  Integrity

Soraj Hongladarom, Center for Ethics of Science
and Technology and Department of Philosophy,
Faculty of Arts, Chulalongkorn University
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Article 8

• In applying and advancing scientific knowledge,
  medical practice and associated technologies,
  human vulnerability should be taken into account.
  Individuals and groups of special vulnerability
  should be protected and the personal integrity of
  such individuals respected.

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Outline

• Notion of Human Vulnerability
• Respect for human vulnerability
• Different aspects
• Physical
• Social
• Cultural
• The Limited Power of Medicine
• The fight against vulnerability
• Successes and failures

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Outline (2)

• Problems with the Idea that Vulnerability is to
  be Eliminated
• Sustainable Medicine
• Dilemmas of Vulnerability
• Ethics of Care
• Notion of Personal Integrity

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Vulnerability

• The word came from Latin, vulnerabilis, meaning
  can be wounded. (vulnerare means to wound.)
• Thus the word means capable of being wounded.
• The meaning is extended to cover the state of
  being susceptible to injury in many forms thus,
  the term human vulnerability refers to the
  state of human being that is susceptible to harms
  or injuries.

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Dimensions of Vulnerability

• Physical
• Human beings are fragile creatures.
• Compare a human being with a cockroach.
• What would happen if a cockroach were of the same
  size as a human being, or a human being were of
  the same size as the cockroach? Who would be more
  vulnerable?
• Harm can come from both inside and outside.

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Dimensions

• Social
• This refers to harm and injuries that human
  beings perpetrate against one another.
• Wars, crimes, etc.
• Environmental degradation
• Differences in class, wealth, status, etc.
• Vulnerable groups such as ethnic minorities,
  disabled people, mentally unstable people, etc.

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Dimensions

• Cultural
• This concerns the fragility of particular
  traditions and conceptions of values that are
  typical for a community or local cultures.
• Examples cultures of ethnic minorities,
  vulnerable languages, local cultures versus
  globalization.

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Vulnerability and Power

• The concept of vulnerability has a lot to do with
  power.
• Physical physical power
• Social social power(this refers to the
  ability to do what one pleases in the social
  arena, thus the social elites have more power).
• Cultural Likewise, the cultural elites have
  more cultural power (they are able to impose
  their cultures onto those who have less power.)

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Vulnerability and Ethics

• In ethics, the notion of vulnerability is not
  just a neutral description of the human condition
  but instead a normative prescription to take care
  of the vulnerability that is characteristic for
  human beings. Ethics is more than respecting
  individual choices and decisions, but it aims at
  care for the other. For example the human face
  shows the vulnerability of the human person and
  at the same time appeals for help and assistance.

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• Vulnerability is also deeply connected with the
  concept of justice. Since one becomes more
  vulnerable as ones power is diminished,
  upholding social justice would require that those
  whose power is diminished should be protected
  more.
• Hence it is just that the vulnerable groups get
  enough resources to get them going, even though
  the resources they get might be more than do
  those who are less vulnerable.

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The Limited Powers of Medicine

• Even though modern medicine has created wonders,
  but it still has not been successful in many
  areas, such as fully protecting those who are
  vulnerable.
• It is not possible to eliminate all
  vulnerabilities, because vulnerability is a
  relative concept, like rich or powerful.
• What this means is that no matter how much one
  protects oneself against vulnerability, still
  further vulnerabilities are exposed.

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Limited Power

• This shows that the power of medicine is limited.
• Research and development in one area, such as
  cancer and heart diseases, creates
  vulnerabilities in other areas, such as
  infectious diseases.
• Question Who is getting the most medical care,
  the best medicine, the best care?
• If one group gets more medical resources, others
  immediately become vulnerable.

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Dilemma

• In order to protect the vulnerable, it is
  possible that the action is based on the idea
  that there is a distinction between those who are
  vulnerable and those who are not, which results
  in a form of injustice.
• That there is vulnerability in certain groups
  which is not adequately addressed is a form of
  injustice.

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Vulnerability and Justice

• Since the vulnerable lack power, they suffer from
  injustice.
• In order to ensure justice, these groups need to
  be empowered.
• For the poor, this means to give them
  opportunities so that they can bring themselves
  upeducation, health care, access to essential
  medicine, clean environment.

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Ethics of Care

• In the 1970s and 80s feminist writers began to
  question the assumptions behind many of the
  traditional ethical theories. Carol Gilligans
  work in moral psychology (A Different Voice,
  1982) challenged "justice-based" approaches to
  moral discussion "...men tend to embrace an
  ethic of rights using quasi-legal terminology and
  impartial principles women tend to affirm an
  ethic of care that centers on responsiveness in
  an interconnected network of needs, care, and
  prevention of harm. Taking care of others is the
  core notion.
• Beauchamp and Childress, Principles of Bioethics
  5th Ed., p. 371.

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Ethics of Care

• "many human relationships involve persons who
  are vulnerable, dependent, ill, and frail and
  the desirable moral response is attached
  attentiveness to needs, not detached respect for
  rights
• Beauchamp and Childress, Principles of Biomedical
  Ethics, 5th edition, p. 373.

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• "The person who acts from rule-governed
  obligations without appropriately aligned
  feelings such as worry when a friend suffers
  seems to have a moral deficiency. In
  additioninsight into the needs of others and
  considerate alertness to their circumstances
  often come from the emotions more than reason."
• BC 4th ed., p. 89.

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The Vulnerable and Ethics of Care

• It is rational to care for the vulnerable and to
  be attentive to their needs.
• However, the larger issue is the conditions that
  have led them to become vulnerable in the first
  place.
• So long as these conditions are not taken care
  of, then they will continue to be vulnerable.

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Integrity

• In ethics, integrity refers to ones moral
  character. One has integrity when one does not
  compromise what one stands for or what one values
  deeply for short term, personal gains, for
  example.
• However, in health care ethics, integrity is
  usually taken to mean the whole of the life of a
  human being fundamental aspects of a human
  life that should be respected.

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Integrity

• Personal integrity refers here to respect for the
  patients understanding of his or her own life
  and illness, but also for his interests and free
  will. Each persons life has a coherence, a
  narrative whole based on important events in his
  life and by his interpretations and values. What
  is most valuable to a person is grounded in this
  narrative whole. It is this personal integrity of
  human beings that must be protected

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Problems

• But what if the narrative that constitutes a
  persons life runs in conflict with modern
  medicine? What if a persons way of life and his
  belief system prevents him from accepting any
  form of modern treatment?

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Questions

• How to tell which individual, or which group of
  individuals, is vulnerable?
• The poor? People in developing countries? Those
  with certain genetic traits?
• We are talking as if we ourselves are not in the
  vulnerable group, but how can the voices of these
  vulnerable groups be heard?

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Case Study

• In 1979 a group of prisoners filed a lawsuit
  claiming wrongful treatment as research subjects.
  They claimed that poor prison conditions,
  idleness, and high level of pay relative to other
  prison jobs rendered their participation in
  medical studies coerced and in violation of their
  constitutional rights to due process, privacy,
  and protection against cruel and unusual
  punishment.

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• The judge rejected most of the argument. In his
  opinion on the matter, he wrote, Plaintiffs have
  not proven any violations of their constitutional
  rights. Some persons may prefer that if societys
  needs require that human beings be subjects of
  non-dangerous, temporarily disabling, unpleasant
  medical experiments, such subjects should either
  be chosen by lot or at least not come solely from
  the ranks of the socially or economically
  underprivileged, including prison inmates.

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• Such preference, however, even if valid, does
  not add up to a presently established
  constitutional absolute.
• The judge held that there is no absolute bar to
  doing research with prisoners but did admit the
  need for serious oversight and regulation.

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Questions

• Do you agree with the judges decision to
  continue with doing research on the prisoners?
• How should research on vulnerable groups such as
  prisoners be conducted so that their
  vulnerability is taken into consideration?