Protecting Vulnerable Persons in Health Care

We usually agree that vulnerable persons should be given some kind of special protection. Despite this agreement, however, applying such protections in health care is challenging for both practical and theoretical reasons. This project aims to make develop decision processes to help protect vulnerable persons in day to day health care. When we discuss fairness in clinical care, protecting vulnerability could enable us to distinguish between 'nice to have' aspirational equity, and the sort of 'need to have' equity which should be a real goal in clinical practice. This, however, is not straightforward because vulnerability itself is a multiple concept, based on different sources and types of fragility, and on different sorts of claims regarding which a person can be vulnerable. We are quite good at recognizing many individual instances of vulnerability; however we probably do not recognize them all and we have no applicable unified concept of what vulnerability actually is. This project aims to define vulnerability more clearly, to make this concept more workable in protecting the vulnerable in health care, and in measuring remaining needs for protection. Input from several disciplines are needed for this: conceptual tools from moral and political philosophy and sociology, findings from the neurosciences, and experience from general and humanitarian medicine. Through collaborations across these disciplines and with international organizations, we aim to: A) outline how vulnerability in health care can be defined consistently; B) explore how claims for protection can be weighed against one another in scenarios of deep scarcity such as those encountered in treating uninsured populations, or in humanitarian medicine; C) describe characteristics identified by the neurosciences which could affect vulnerability in clinical care, and identify which patients are indeed described as vulnerable by clinicians. A special focus will be placed on outlining the possible application of findings to decisions in clinical practice and health policy. A workable definition of vulnerability in health care has implications for measurements in public health, but also more generally where issues of allocation and protection arise in health care. It could help move discussions on issues such as patient responsibility, or the breadth of health care coverage. A framework to weigh conflicting claims for protection could bring forward policy questions in international health. Better awareness of how our reasoning could worsen vulnerable persons' situations would be immediately useful to clinicians, and would also help to shape ethics curricula in clinical training.

This project is funded by the Swiss National Science Foundation (grant PP00P3_123340)