Patient Vulnerability and Professional Vulnerability

The papers in this issue of the Asian Bioethics Review may be seen to have a common thread in being commentaries, directly or indirectly, on situations of vulnerability and the way in which vulnerabilities bear on the ethical issues arising. The varying situations illustrate various aspects of vulnerability.

Vulnerability has often been discussed in bioethics in terms of groups of vulnerable populations. Groups of patients or research subjects are seen to have various types of weaknesses that render them exposed to exploitation or unfair treatment. For example, children have been singled out as belonging to a vulnerable population. Thus, they need to be regarded with additional care compared to non-vulnerable populations who are capable of deciding and speaking for themselves either as patients or as subjects of biomedical research.

In this issue of the ABR, the paper by Siriwardhana et al., highlights the plight of survivors of a natural disaster. The paper mentions the threat of possible exploitation of vulnerable survivors by unscrupulous researchers. One can imagine thousands of survivors being interviewed or publicly observed several times by investigators wishing to take the opportunity to document the experiences of disaster victims not only in writing or in subsequent publications but also through audio and video recordings. Some of the audio and video accounts are also broadcast to the rest of the world as part of news accounts of a tragedy. Some of these accounts are not mindful of the dignity of victims.

In addition to the vulnerability of disaster victims, the vulnerability of researchers also needs attention. Enthusiastic as they are to pursue their calling in their field of expertise, many researchers feel the need to conduct studies in the context of a disaster. Their vulnerability lies in their predisposition to take advantage of the situation to do research while possibly glossing over some of the significant risks to subjects and their communities. This type of professional vulnerability needs to be recognised first of all by researchers themselves so they can exercise restraint. Otherwise, the vulnerability needs to be recognised by regulatory bodies so they can take necessary steps to prevent further harm to disaster victims.

The paper on perception of nursing conscience by Jalali, Hasani, and Abedsaeedi calls attention to a similar type of professional vulnerability relating to the difficulties faced by healthcare professionals in their effort to act according to their conscience. There is a stress on conscience as professionals find themselves having to be party to health care that is in conflict with their own principles, especially those that relate to respect for human dignity. As with other professional vulnerabilities, these stresses on conscience cannot be overlooked. The consequences could be significant not only for health care professionals themselves but also for the patients they have to care for. There is a need for open discussions among colleagues about their beliefs and feelings so that conflicts could be minimized, if not completely resolved.

The sexual abuse paper takes up the vulnerabilities facing a 16-year-old girl who was referred for counseling by her teacher for not performing well academically. The age-related vulnerabilities are complicated by the limited role for women in the particular child’s cultural context. While the paper proceeds by looking at the tension between patient autonomy and beneficence, it is important to see how the discussion needs to be qualified by the recognition of the patient’s vulnerabilities. Those vulnerabilities cannot be understood merely in terms of the child’s belonging to a particular age group or a particular gender but also in relation to more specific factors such as the “closed communication systems” within the family. Beyond seeing a person as having vulnerabilities identified with a particular group, it is necessary to understand more specific factors that could be unique to the person’s childhood or to the person’s being a girl. For example, talk about the child’s autonomy cannot be dissociated from the fact that even adult individual decision-making in the given cultural context is exercised in very close consultation with the family. Individual decision-making is rarely implemented in the same way as...