Project

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Protecting Vulnerable Persons in Health Care

English title Protecting Vulnerable Persons in Health Care
Applicant Hurst Samia
Number 123340
Funding scheme SNSF Professorships
Research institution Institut Ethique Histoire Humanités - iEH2 Faculté de Médecine Université de Genève
Institution of higher education University of Geneva - GE
Main discipline Public Health and Health Services
Start/End 01.10.2009 - 31.12.2013
Approved amount 1'302'601.00
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All Disciplines (2)

Discipline
Public Health and Health Services
Neurophysiology and Brain Research

Keywords (5)

vulnerability; ethics; bioethics; health services; priority setting

Lay Summary (English)

Lead
Although we agree that vulnerable persons should be afforded some kind of special attention, or protection, applying such protections in clinical care is challenging for both practical and theoretical reasons. Vulnerability is a complexe concept, based on different sources and types of fragility, and on different sorts of claims in regard to which a person can be vulnerable.
Lay summary

This project brought together an interdisciplinary team and applied tools of analytic moral and political philosophy, as well as sociology, findings from the neurosciences, and clinical experience, to clarify the concept of vulnerability and the  protections required in health care. We found that vulnerability is composed of i) the reasons why an object is vulnerable; ii) the circumstances under which vulnerability manifests; and iii) the manifestations of vulnerability. Vulnerable beings are beings who have morally protected interests. Particularly vulnerable beings are those more likely to have their claims unjustly taken into consideration. Protecting particularly vulnerable persons in health care requires the identification of morally protected interests. Based on the convergence of philosophical approaches, these include negative and positive requirements for physical integrity, autonomy, freedom, social provision for basic needs, impartiality in the exercise of authority, social bases of self-respect, and communal belonging. Identifying reasons why an interest is fragile enables the design of specific protections. We explored one such reason: based on the available data, unconscious stereotypes exist among health care professionals. These professionals, however, are able to identify situations of vulnerability and some required protections in practice. Priorities among required protections can be based on the strength of claims to special protection and the degree of responsibility to provide it. This diagnostic approach to designing and prioritizing protections for vulnerable persons makes the concept of vulnerability more applicable in clinical care and public health. Our definition was integrated in the 2013 revision of the Declaration of Helsinki.

Direct link to Lay Summary Last update: 28.02.2014

Responsible applicant and co-applicants

Employees

Publications

Publication
Clarifying vulnerability: the case of children
Hurst SA (2015), Clarifying vulnerability: the case of children, in Asian Bioethics Review, 7(2), 126-138.
Analysis of the Born in Bradford birth cohort.
Makrythanasis Periklis, Hamamy Hanan, Antonarakis Stylianos E, Mauron Alex, Hurst Samia A (2014), Analysis of the Born in Bradford birth cohort., in Lancet, 383(9912), 123-123.
Inequalities in health: concepts, measures, and ethics
Eyal N, Hurst SA, Norheim O, Wikler D (2013), Inequalities in health: concepts, measures, and ethics, Oxford University Press, Oxford.
Informed consent forms in oncology research: linguistic tools identify recurrent pitfalls
Ilic Nathalie, Auchlin Antoine, Hadengue Antoine, Wenger Alexandre, Hurst Samia (2013), Informed consent forms in oncology research: linguistic tools identify recurrent pitfalls, in AJOB Empirical Bioethics, 4(4), 39-54.
Is tracheostomy still an option in amyotrophic lateral sclerosis? Reflections of a multidisciplinary work group.
Heritier Barras Anne-Chantal, Adler Dan, Iancu Ferfoglia Ruxandra, Ricou Bara, Gasche Yvan, Leuchter Igor, Hurst Samia, Escher Monica, Pollak Pierre, Janssens Jean-Paul, CeSLA group (2013), Is tracheostomy still an option in amyotrophic lateral sclerosis? Reflections of a multidisciplinary work group., in Swiss medical weekly, 143, 13830-13830.
La qualité de la vie et la question du bien
Hurst Samia (2013), La qualité de la vie et la question du bien, in Bioethica Forum, 6(2), 72-74.
L'éthique du monde en développement?
Hurst Samia (2013), L'éthique du monde en développement?, in Bioethica Forum, 6(1), 18-20.
Views of US physicians about controlling health care costs.
Tilburt Jon C, Wynia Matthew K, Sheeler Robert D, Thorsteinsdottir Bjorg, James Katherine M, Egginton Jason S, Liebow Mark, Hurst Samia, Danis Marion, Goold Susan Dorr (2013), Views of US physicians about controlling health care costs., in JAMA : the journal of the American Medical Association, 310(4), 380-8.
In favor of PGD – the Moral Duty to Avoid Harm Argument
Martin Angela (2012), In favor of PGD – the Moral Duty to Avoid Harm Argument, in American Journal of Bioethics, 12(4), 12-13.
Interventions and persons.
Hurst Samia A (2012), Interventions and persons., in The American journal of bioethics : AJOB, 12(1), 10-1.
Tierversuche sind nützlich. Also sind sie ethisch gerechtfertigt.‘ Gedanken zu einem oft vorgebrachten Argument
Martin Angela (2012), Tierversuche sind nützlich. Also sind sie ethisch gerechtfertigt.‘ Gedanken zu einem oft vorgebrachten Argument, in Bioethica Forum, 5(1), 22-24.
What if medical graduates are right?
Hurst Samia A (2012), What if medical graduates are right?, in The American journal of bioethics : AJOB, 12(5), 37-8.
Why physicians ought to lie for their patients
Tavaglione Nicolas, Hurst Samia (2012), Why physicians ought to lie for their patients, in American Journal of Bioethics, 12(3), 4-12.
”Do not attempt resuscitation” and ”Cardio-pulmonary resuscitation” in an inpatient setting: factors influencing physicians’ decisions in Switzerland
Becerra M, Hurst SA, Junod Perron N, Cochet S, Elger B (2011), ”Do not attempt resuscitation” and ”Cardio-pulmonary resuscitation” in an inpatient setting: factors influencing physicians’ decisions in Switzerland, in Gerontology, 57(5), 414-421.
A step toward pluralist fairness.
Hurst Samia A (2011), A step toward pluralist fairness., in The American journal of bioethics : AJOB, 11(12), 46-7.
Assisted suicide is compatible with medical ethos.
Martin Angela K, Mauron Alex, Hurst Samia A (2011), Assisted suicide is compatible with medical ethos., in The American journal of bioethics : AJOB, 11(6), 55-7.
Attitudes and approaches to decision-making about anti-hypertensive treatment in elderly patients
Perret-Guillaume C, Genet C, Allali D, Herrmann F, Hurst SA., Benetos A (2011), Attitudes and approaches to decision-making about anti-hypertensive treatment in elderly patients, in J. Am Med Dir Assoc, 12(2), 121-128.
Ethics and non biomedical research with human subjects.
Hurst Samia A (2011), Ethics and non biomedical research with human subjects., in Swiss medical weekly, 141, 13285-13285.
Public health: how much evidence is needed to support our policies?
Hurst Samia A, Borisch Bettina, Mauron Alex (2011), Public health: how much evidence is needed to support our policies?, in Journal of public health policy, 32(1), 135-41.
Scaling up changes in doctors' education for rural retention: a comment on World Health Organization recommendations.
Eyal Nir, Hurst Samia A (2011), Scaling up changes in doctors' education for rural retention: a comment on World Health Organization recommendations., in Bulletin of the World Health Organization, 89(2), 83-83.
Trustworthiness in conflict of interest.
Hurst Samia A, Mauron Alex (2011), Trustworthiness in conflict of interest., in The American journal of bioethics : AJOB, 11(1), 40-1.
Clinical indication as an ethical appraisal: the example of imaging before middle ear surgery.
Hurst Samia A (2010), Clinical indication as an ethical appraisal: the example of imaging before middle ear surgery., in ORL; journal for oto-rhino-laryngology and its related specialties, 72(3), 138-138.
The role of ethics committees and ethics consultation in allocation decisions. A four-stage process
Strech D, Hurst SA, Danis M (2010), The role of ethics committees and ethics consultation in allocation decisions. A four-stage process, in Medical Care, 48(9), 821-826.
The role of ethics committees and ethics consultation in allocation decisions: a 4-stage process.
Strech Daniel, Hurst Samia, Danis Marion (2010), The role of ethics committees and ethics consultation in allocation decisions: a 4-stage process., in Medical care, 48(9), 821-6.
What 'empirical turn in bioethics'?
Hurst Samia (2010), What 'empirical turn in bioethics'?, in Bioethics, 24(8), 439-44.
When to start antiretroviral therapy in resource-limited settings: a human rights analysis.
Ford Nathan, Calmy Alexandra, Hurst Samia (2010), When to start antiretroviral therapy in resource-limited settings: a human rights analysis., in BMC International Health and Human Rights, 10(6), online-online.
When to start antiretroviral therapy in resource-limited settings: a human rights analysis.
Ford Nathan, Calmy Alexandra, Hurst Samia (2010), When to start antiretroviral therapy in resource-limited settings: a human rights analysis., in BMC international health and human rights, 10, 6-6.
Articulating the balance of interests between humans and other animals.
Hurst Samia A, Mauron Alex (2009), Articulating the balance of interests between humans and other animals., in The American journal of bioethics : AJOB, 9(5), 17-9.
Just care: should doctors give priority to patients of low socioeconomic status?
Hurst S A (2009), Just care: should doctors give priority to patients of low socioeconomic status?, in Journal of medical ethics, 35(1), 7-11.
Pluripotent stem cells as new drugs? The example of Parkinson's disease.
Preynat-Seauve Olivier, Burkhard Pierre R, Villard Jean, Zingg Walter, Ginovart Nathalie, Feki Anis, Dubois-Dauphin Michel, Hurst Samia A, Mauron Alex, Jaconi Marisa, Krause Karl-Heinz (2009), Pluripotent stem cells as new drugs? The example of Parkinson's disease., in International journal of pharmaceutics, 381(2), 113-21.
Ethique et santé publique
Hurst Samia A, Ethique et santé publique, in Ateliers de l'éthique.
Fleshing out vulnerability
Tavaglione Nicolas, Martin Angela, Mezger Nathalie, Durieux-Paillard Sophie, François Anne, Jackson Yves, Hurst Samia, Fleshing out vulnerability, in Bioethics, In Press.
Including patients in resuscitation decisions in Switzerland: from doing more to doing better
Hurst Samia A, Becerra Maria, Perrier Arnaud, Junod Perron Noëlle, Elger Bernice, Including patients in resuscitation decisions in Switzerland: from doing more to doing better, in Journal of Medical Ethics.
Involuntary & Voluntary Invasive Brain Surgery: Ethical Issues Related to Acquired Aggressiveness
Gilbert Frédéric, Vranic Andrea, Hurst Samia A, Involuntary & Voluntary Invasive Brain Surgery: Ethical Issues Related to Acquired Aggressiveness, in Neuroethics.
Protéger les personnes vulnérables : une exigence éthique à clarifier
Hurst Samia A, Protéger les personnes vulnérables : une exigence éthique à clarifier, in Revue médicale suisse.
Resolving the conflict: clarifying ‘vulnerability’ in health care ethics
Martin Angela, Tavaglione Nicolas, Hurst Samia, Resolving the conflict: clarifying ‘vulnerability’ in health care ethics, in Kennedy Institute of Ethics Journal, In Press.
Simplicity as progress : implications for fairness in research with human participants
Hurst Samia, Simplicity as progress : implications for fairness in research with human participants, in American Journal of Bioethics, In Press.
Telling the truth : medical students’ progress with an ethical skill.
Layat Burn Carine, Hurst Samia, Ummel Marinette, Cerutti Bernard, Baroffio Anne, Telling the truth : medical students’ progress with an ethical skill., in Medical Teacher, e-pub ahead of print.
Toward Fair Rationing at the Bedside.
Danis Marion, Hurst Samia, Fleck Leonard, Forde Reidun, Slowther Anne-Marie, Toward Fair Rationing at the Bedside., Oxford University Press, Oxford.

Collaboration

Group / person Country
Types of collaboration
Harvard University United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
National Institutes of Health United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
University of Michigan United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Australasian Association of Philosophy Annual Conference Talk given at a conference Wronging Animals without Harming Them? A Philosophical Investigation 01.07.2013 Brisbane, Australia Martin Angela;
CAVE Animals and Vulnerability Symposium and Workshop Talk given at a conference Mind the Vulnerable Research Subject – A Case against Animal Experimentation? 01.07.2013 Sydney, Australia Martin Angela;
Society for Applied Philosophy Annual Conference Talk given at a conference Vulnerability in Health Care – Resolving the Conflict 01.06.2013 Zurich, Switzerland Tavaglione Nicolas; Fitzgerald Chloé; Hurst Samia; Martin Angela;
Society for Applied Philosophy Annual Conference Talk given at a conference Identifying the Most Vulnerable Patients 01.06.2013 Zurich, Switzerland Tavaglione Nicolas; Martin Angela; Hurst Samia;
Society for Applied Philosophy Annula Conference Talk given at a conference 'Implicit biases in health professionals and what they imply for the vulnerability of patients 01.06.2013 Zurich, Switzerland Fitzgerald Chloé;
Implicit Bias, Philosophy and Psychology Conference Talk given at a conference Taking responsibility for our implicit biases 01.04.2013 Sheffield, Great Britain and Northern Ireland Fitzgerald Chloé;
Putting Dual-Process Theories to the Test - Insights from Philosophy, Psychology and Neuroscience Talk given at a conference Commentary on Elisabeth Norman's presentation, 'Identifying fringe consciousness in implicit learning' 01.02.2013 Bielefeld, Germany Fitzgerald Chloé;
Swiss research seminar in biomedical ethics Talk given at a conference Mind the Vulnerable Research Subject – A Case Against Animal Experimentation ? 08.11.2012 Bigorio, Ticino, Switzerland Martin Angela; Hurst Samia;
Philosophical Association of Geneva Talk given at a conference Peut-on faire du tort aux animaux sans leur nuire? 01.11.2012 Geneva, Switzerland Martin Angela;
STCO symposium on personalized medicine Talk given at a conference Ethical research in personalized medicine : a challenge 14.06.2012 Zurich, Switzerland Hurst Samia;
European Association of Centers of Medical Ethics Talk given at a conference A clinical room with a view 01.06.2012 Bristol, Great Britain and Northern Ireland Hurst Samia;
International Association of Bioethics World Congress Talk given at a conference The Swiss Experience with Suicide Assistance 01.06.2012 Rotterdam, Netherlands Hurst Samia;
International Association of Bioethics World Congress Talk given at a conference Vulnerability and Priority Setting 01.06.2012 Rotterdam, Netherlands Tavaglione Nicolas; Hurst Samia;
International Association of Bioethics World Congress Talk given at a conference Vulnerability and research ethics 01.06.2012 Rotterdam, Netherlands Tavaglione Nicolas; Hurst Samia; Martin Angela;
Minding Animals Poster The Vulnerability of Animals and its Implications for Morality 01.06.2012 Utrecht, Netherlands Martin Angela;
International Association of Bioethics World Congress Talk given at a conference Articulating the discipline of empirical ethics 01.06.2012 Rotterdam, Netherlands Hurst Samia;
Francophone Society for Analytic Philosophy– SOPHA Talk given at a conference Some Thoughts on Vulnerability in Health Care 01.05.2012 Paris, France Martin Angela;
Swiss National Science Foundation Workshop on Methods in Philosophy Individual talk Defining Vulnerability – Methodological Challenges 01.01.2012 Zurich, Switzerland Martin Angela;
Swiss research seminar in biomedical ethics Talk given at a conference Why physicians ought to lie for their patients 08.11.2011 Bigorio, Switzerland Hurst Samia; Tavaglione Nicolas;
American Society for Bioethics and the Humanities Talk given at a conference Force feeding a hunger striker: how should a case like this be handled in the United States? 01.10.2011 Minneapolis, United States of America Hurst Samia;
American Society for Bioethics and the Humanities Talk given at a conference Defining vulnerable persons in health care 01.10.2011 Minneapolis, United States of America Hurst Samia; Martin Angela; Tavaglione Nicolas;
Swiss research seminar in biomedical ethics Talk given at a conference "The concept of „vulnerability“ in bioethics" 08.10.2010 Bigorio, Ticino, Switzerland Tavaglione Nicolas; Martin Angela; Hurst Samia;
Conférence Annuelle de la Société Canadienne de Science Politique Talk given at a conference Why Physicians Ought to Lie for their Patients 02.06.2010 Montreal, Canada Tavaglione Nicolas; Hurst Samia;


Knowledge transfer events



Self-organised

Title Date Place
WHO AFRO region Ethics Review Committee training session on research ethics 01.08.2011 Brazzaville, Congo, Republic

Communication with the public

Communication Title Media Place Year
Media relations: print media, online media Criminaliser le coma éthylique? Migros Magazine Western Switzerland 2013
Media relations: radio, television Don d'organes: comment faire mieux? RTS Western Switzerland 2013
Media relations: print media, online media Don d'organes: le consentement proposé Swisstransplant news German-speaking Switzerland Western Switzerland 2013
Media relations: print media, online media En bioéthique, la définition de la vulnérabilité a été rédigée à Genève Campus Western Switzerland 2013
New media (web, blogs, podcasts, news feeds etc.) En Suisse, le suicide assité est légal TV5MONDE International 2013
Media relations: radio, television Libre-choix du sexe du bébé RTS Western Switzerland 2013
Media relations: radio, television Quand le dossier de santé devient un casier judiciaire RTS Western Switzerland 2013
Media relations: print media, online media Directives anticipées: un droit pour tous les Suisses Migros Magazine Western Switzerland 2012
New media (web, blogs, podcasts, news feeds etc.) Fin de vie: «Ne pas tomber dans la lourdeur bureaucratique» Planète Santé Western Switzerland 2012
Media relations: print media, online media Tailored tools to protect vulnerable patients EU Research International 2012
Media relations: print media, online media Genomes, race, and health EMBO Report International 2011
Media relations: radio, television Spécial santé: trop cher? Tu meurs! RTS Western Switzerland 2011
Media relations: radio, television Euthanasie: précisions RTS Western Switzerland 2010
Other activities L’alimentation forcée est contraire à la déontologie médicale Western Switzerland German-speaking Switzerland 2010
Media relations: print media, online media Nutrition forcée: la justice croit à tort pouvoir se passer de l’éthique médicale Le Temps Western Switzerland 2010
New media (web, blogs, podcasts, news feeds etc.) Resources for clinical ethics consultation Wikipedia International 2010
New media (web, blogs, podcasts, news feeds etc.) Bio-éthique Western Switzerland 2009
Media relations: print media, online media Revue Médicale Suisse - carte blanche Western Switzerland 2009

Associated projects

Number Title Start Funding scheme
149407 Understanding implicit bias in clinical care 01.10.2013 Project funding (Div. I-III)

Abstract

Although we agree that vulnerable persons should be afforded some kind of special attention, or protection, applying this to clinical care is challenging for both practical and theoretical reasons. In discussions regarding equity-based considerations in health care, protecting vulnerability could offer some minimal criterion, enabling us to distinguish between “nice to have” aspirational equity and “need to have” equity which should be a real goal in clinical practice. Exploring this possibility through the angle of vulnerability as a claim to special protection seems a promising way to account for such a minimal criterion. However, making this distinction is not easy, as vulnerability is itself a multiple concept, based on different sources and types of fragility, and on different sorts of claims in regard to which a person can be vulnerable. The present project aims to apply tools of analytic moral and political philosophy, as well as sociology, and findings from the neurosciences, to the development of decision processes aimed to target protection of vulnerable persons at the micro-level of health care. More precisely, we will outline how vulnerability in health care can be defined analytically, what characteristics are likely to make individuals more or less vulnerable, and conduct normative analysis of how resource allocation could be conducted more fairly when the claims of different vulnerable persons must be balanced against each other. Three stages are planned. Through interdisciplinary collaborations, we will: A) outline how vulnerability in health care can be defined analytically, define sources of claims for protection of the vulnerable, how convincing they are, and what effect their validity may have on fairness in resource allocation decisions; B) explore whether, and how, claims for protection can be weighed against one another in situations of resource allocation, starting from scenarios of deep scarcity such as those encountered in humanitarian medicine or the uninsured in industrialized countries; C) describe characteristics identified by moral psychology and the neurosciences which may have an impact on vulnerability in clinical care, and identify which patients are indeed described as vulnerable by clinicians in examples of situations where they face scarce resources and allocation decision. A special focus will be placed on outlining the possible application of findings to decisions in clinical practice and health policy. We propose to articulate two conceptual, and one empirical sub-project. Subproject A - conceptual analysis: In this phase, we plan to outline how vulnerability in health care can be defined analytically using tools of moral philosophy and confronting conclusions with clinical cases. These issues will be explored by a doctoral student in philosophy, under co-supervision by the candidate and a philosopher.Subproject B - normative exploration: In this phase, we plan to explore whether, and how, claims for protection can be weighed against one another in situations of scarce resources. These issues will be analysed under the candidate’s supervision in an interdisciplinary group composed of a post-doctoral fellow in political philosophy, the candidate, and a research group including practitioners in international health, humanitarian medicine, and caring for uninsured populations and addicted patients in an industrialized setting.Subproject C - description of obstacles: In this phase, we plan to 1) identify which patients are indeed described as vulnerable by clinicians, based on a secondary analysis of available interview transcripts, and 2) describe characteristics identified by moral psychology and the neurosciences which may have an impact on vulnerability in clinical care, through a commented review of the literature. The first part will be conducted by an assistant in sociology, under co-supervision by the candidate and a sociologist. The second part will be conducted by a post-doctoral fellow in psychology or neuroethics, under the candidate’s supervision and with feedback from an expert in the neurosciences. This project follows on work done by the candidate in the areas of resource allocation, bedside rationing, vulnerability, ethical issues in humanitarian medicine, and neuroethics. The research team will include the SNSF professor, a post-doc in political philosophy, a post-doc in neuroethics or psychology, a doctoral candidate in philosophy, and a research assistant in sociology. The research group will include collaborations with members of the WHO unit in Ethics, Trade and Human Rights, Médecins Sans Frontières, the International Committee of the Red Cross, the Geneva University Hospital unit for international health, and community care mobile unit, as well as with the Centre for cognitive neurosciences, Departments of sociology and political sciences, and the Department of philosophy. Members of the research team will attend relevant meetings of the Centre for Affective Sciences at the University of Geneva. The project thus takes advantage of Geneva’s position on the international stage, which also has also resulted in a focus on international health and a particular development of services for vulnerable populations in the Geneva University Hospitals.
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