Respect for people in situations of vulnerability: A new principle for health-care professionals and health-care organizations

To some extent all of us are vulnerable. Every human—indeed everything living—is capable of being hurt, wounded, or damaged. Some situations make us more vulnerable than others. Some situations of vulnerability bear on others' moral responsibilities.

Article 8 of the UNESCO Universal Declaration on Bioethics and Human Rights (2005) acknowledges the moral importance of taking human vulnerability into account "in applying or advancing scientific knowledge, medical practice, and associated technologies." The Declaration also states that "Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals should be respected" (2005, Article 8). The meaning and intended application of the Declaration's Article 8 was the topic of a multiyear reflection by UNESCO's International Bioethics Committee (IBC), which culminated in June 2011 in the release of the Report of IBC on the Principle of Respect for Human Vulnerability and Personal Integrity.

In its Report, the IBC regards human vulnerability as a permanent risk to the physical and mental integrity of the human (2011, Articles 6 and 41). This vulnerability is an inescapable feature of all human lives and is a risk that shapes our relationships. The IBC notes that vulnerability is generally implied when "something fundamental is at stake" (2011, Article 7). While the Report goes on to focus on the obligations that arise because of situations of special vulnerability (defined below), what is established in the explanation of basic human vulnerability is the essential link between human vulnerability and personal integrity. To acknowledge that as humans we are always vulnerable is to acknowledge that, for each of us, our physical and mental integrity are always at stake. In medical practice, the life sciences, and applications of associated technologies, the Declaration calls for us to guide our actions by consideration of this ever-present risk to every human's personal integrity.

What, then, is "special vulnerability," from the perspective of Article 8 of the Declaration, that enjoins something more (i.e., the protection of certain individuals and groups, and respect for those individuals' integrity)? It is clear from the Report that the IBC interprets "special vulnerability" as a context of vulnerability over and above the basic human vulnerability that all of us share. The IBC concludes that the "special vulnerability" in the scope of Article 8 "means that there are individuals and groups that are especially prone to violation of personal integrity or disrespect for autonomy due to exploitation, deception, coercion and disregard through the application and advancing of scientific knowledge, medical practice and associated technologies" (2011, Article 41). Fully two-thirds of the Report elaborate on what commonly causes or exacerbates the inability of humans to protect their personal integrities and provide scenarios that reflect a wide range of social, political, and environmental determinants, most of which require action at the level of states to rectify.

Feminists will recognize forms of oppression in the Committee's examples of what can limit the capacity of individuals or groups to protect themselves (over and above the general human condition that implies vulnerability). These include poverty and inequalities of social conditions, gender discrimination, deprivation of liberty, marginalization, hierarchical power relations, and the effects of wars, natural disasters, and exploitation of resources. Likewise, feminists will endorse the recurring message in the Report (perhaps not stated as boldly as herein) that governments have the major responsibility to prevent and correct situations that impinge upon 1) "people's capacity to live as free, autonomous individuals," and 2) "the right to live in a world where significant inequalities in the capacity to meet everyone's basic needs are adequately addressed" (2011, Article 4). It takes a committed, moral leadership at all levels of governments to reform the varieties of social, political, and environmental conditions that give rise to significant added vulnerability that humans face around the globe. Through its eighteen scenarios that illustrate a range of situations that give rise to special vulnerability of both individuals and groups, the IBC Report calls for action by states to provide rights, resources, education programs...