The Principle of Respect for Human Vulnerability

The UNESCO"s International Bioethics Committe (IBC) published its report on The principle of Respect for Human Vulnerability. The document is a result of a five year work of the IBC, beginning with its 15th session in 2008 dealing with questions connected to Article 8 of the Universal Declaration on Bioethics and Human Rights which states as follows: "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."

Here are the introductory remarks by Stefano Semplici, chairperson of the IBC:

Article 8 of the Universal Declaration on Bioethics and Human Rights (2005) enshrines the principle of respect for human vulnerability and personal integrity as a bioethical value of universal concern to the Member States of UNESCO. The specific purpose of Article 8 is to address special vulnerabilities that occur, whether as a consequence of personal disability, environmental burdens or social injustice, in the contexts of healthcare, research and the application of emerging technologies in the biomedical sciences. This Report is the result of three years of reflection by the International Bioethics Committee of UNESCO (IBC).

We are definitely all equally entitled to meet our basic needs related to our health and well-being, but we are certainly not all equally and permanently able to meet all those basic needs of ours.

Over the course of its reflections, the Committee has investigated the multiple ethical implications of this very basic inequality among human beings which is particularly highlighted and exacerbated in the context of advances in the fields of biomedical sciences. As a matter of fact, these advances have opened the way for many new and powerful capacities for the safeguarding of human welfare, but they have also created mechanisms of exploitation and degradation which can take advantage of natural and context-related vulnerabilities.

Vulnerability, in its first and more general sense, is an essential feature of human nature and may therefore boost awareness of a common destiny and responsibility. This Report seeks to elaborate the scope and content of Article 8 of the Declaration of 2005, focusing on special vulnerabilities and taking into account conditions that, more or less directly, impinge upon the capacity to live as free and autonomous individuals; and on the right to live in a world where significant inequalities in the capacity to meet everyone’s basic needs are adequately addressed.

In writing this report, which is neither exhaustive, nor prescriptive, the ethicists, geneticists, biologists, lawyers, philosophers, psychiatrists, neurologists and immunologists composing the IBC aimed at paving the way for a broader reflexion and indicating possible lines of action not only for States, but also for individuals, groups, communities, institutions and corporations, public as well as private.

They specifically call on all concerned stakeholders to exercise great vigilance in protecting those who are especially vulnerable. Nearly every country of the world is the home of one or the other type of vulnerable groups: countries in which proper antiretroviral therapies are for various reasons not being provided to a majority of HIV/AIDS infected people; countries in which poor patients are refused healthcare because they lack insurance coverage; countries in which people are involved in clinical trials without respecting the principle of free and informed consent, just for the sake of profit. Unfortunately, the list is easy to extend.

Special Vulnerabilities of Women and Girls

Gender-related vulnerabilities and in particular the special vulnerabilities of women and girls have always been in the forefront of the Committee’s reflections throughout its work on this publication. Females, both children and women, are given special attention in the Report. Seven of the eighteen cases proposed for discussion specifically refer to the treatment of women in healthcare delivery,research and the applications of new biotechnologies. Female cases are prominent as they are particularly exposed to the whole range of the social, cultural, economic, educational and political determinants of vulnerability. This is also highlighted in one of the concluding paragraphs of the Report:

“A further important example of special vulnerabilities can be provided using the example of the position of women. In some cultures, female children are uniquely vulnerable to the risk of being unwanted, uncared for, abused and rejected. Female children may also find their interest in bodily integrity gravely threatened, including especially their right to be free from sexual assault and exploitation. Adult women may find themselves transferred from the patronage of their father to the patronage of their husband, thereby denying them the personal authority to make important life and healthcare decisions on their own behalf. As women live longer in many parts of the world, elderly women might find themselves abandoned by their families, subject to inadequate healthcare, and disregarded by society. Migrant women and women affected by war are especially vulnerable to abuse and are often disenfranchised from engaging in conflict resolution and reconciliation.”

Special Vulnerabilities in Africa

Human vulnerabilities that are present in developed countries are often exacerbated in developing countries, due to a wide range of factors, including extreme poverty. This is especially visible in the case of developing countries of sub-Saharan Africa. The Committee has consistently maintained this concern within its reflection on Article 8. This is particularly evident with the mention of three specific cases from Africa, even though the general practice is to remove specific regional or national references. Other cases highlight vulnerabilities of immediate relevance to the African context, while the remaining cases are applicable to fast emerging situations on the continent. In essence, all the possible remedies elaborated within the Report, from providing vulnerable populations with adequate health education and access to available therapies, to striving against poverty and strictly limiting the use of potentially discriminating incentives in medical research, have universal application across both developed and developing countries, but are especially pertinent to the African context.

Ultimately, the goal of our efforts in this regard is to inspire and stimulate all stakeholders, not only States, to take the necessary steps to protect the interests of vulnerable populations in the context of healthcare, research and the application of emerging technologies in the biomedical sciences; and to ensure the realization and enjoyment of human rights across all strata of society.