Biology Reference
In-Depth Information
definitions have two features. First, there is an emphasis on the external element of
vulnerability, namely the presence of a potential harm. Second, the potential harm
is usually identified as either physical or emotional. However, in the research con-
text, as we will see below, the definition requires either a wider understanding of
harm, which
includes
violations of rights to well-being, autonomy and justice, or
an acknowledgement of such violations
in addition to
harm.
In research ethics, one finds a notable definition of 'vulnerability' in the
International Ethical Guidelines for Biomedical Research Involving Human Subjects
of the Council for International Organizations of Medical Science (CIOMS
2002
).
'Vulnerability' refers to a substantial incapacity to protect one's own interests owing to
such impediments as lack of capability to give informed consent, lack of alternative means
of obtaining medical care or other expensive necessities, or being a junior or subordinate
member of a hierarchical group (CIOMS 2002).
The commentary on this guideline provides a corresponding description of vul-
nerable persons.
Vulnerable persons are those who are relatively (or absolutely) incapable of protecting their
own interests. More formally, they may have insufficient power, intelligence, education,
resources, strength, or other needed attributes to protect their own interests (CIOMS 2002).
In contrast to the generic dictionary definition, the CIOMS description empha-
sizes what we might call the internal aspects of vulnerability, which may prevent
some from protecting their interests as research participants. A complete definition
of vulnerability needs to combine both the internal and the external aspects. This
distinction between the two aspects is useful because it reminds us that vulner-
ability - and, by implication, harm - can be lessened or prevented on two fronts:
reducing or eliminating the cause of the potential harm, and helping the vulner-
able protect themselves. For example, where people are vulnerable to malaria, one
could either fight the mosquitoes carrying the parasite or provide the vulnerable
population with mosquito nets, repellents and medication, and with health care if
they get infected. Ideally one would, of course, do both.
Before developing our definition further, let us point out another useful distinc-
tion: there is a difference between stating the meaning of a concept and setting out
the criteria for its use. We might be clear about what vulnerability means, but still
unsure about whether it applies to specific cases. The CIOMS formulation pro-
vides first a definition of 'vulnerability', namely a substantial inability to protect
one's interests, and goes on to list some of the criteria for using the concept. So,
according to the criteria, we can describe someone who cannot give informed con-
sent, or who is a junior member in a relevant hierarchical group,
3
as vulnerable,
but these are just some criteria for the use of the term 'vulnerability' and do not
form part of its definition.
A first definition of 'vulnerability' could combine the external element of the
dictionary definition and the internal element of the CIOMS definition.
3
The examples cited are medical and nursing students, subordinate hospital and laboratory per-
sonnel, employees of pharmaceutical companies, and members of the armed forces or police.
