1. Vulnerable populations Clement Adebamowo

2. Vulnerable populations Vulnerable populations are those whose ability to exercise autonomous decision is restrictedVulnerable populations are those whose ability to exercise autonomous decision is restricted CIOMS defines vulnerable people as those “who are relatively or absolutely incapable of protecting their own interests because they may have insufficient power, intelligence, education, resources, strength, or other needed attributesCIOMS defines vulnerable people as those “who are relatively or absolutely incapable of protecting their own interests because they may have insufficient power, intelligence, education, resources, strength, or other needed attributes Individuals, communities, groups or countries may be vulnerableIndividuals, communities, groups or countries may be vulnerable Vulnerability may vary from situation to situationVulnerability may vary from situation to situation

3. Vulnerable populations Such populations are considered to require special protectionSuch populations are considered to require special protection Special protection here refers to measures taken to remove the obstacles restricting the subjects ability to exercise autonomous decision makerSpecial protection here refers to measures taken to remove the obstacles restricting the subjects ability to exercise autonomous decision maker There are criticisms of the concept of vulnerabilityThere are criticisms of the concept of vulnerability Too broad – all participants are vulnerableToo broad – all participants are vulnerable Too narrow – because it focuses exclusively on decision making capabilityToo narrow – because it focuses exclusively on decision making capability It stereotypes individuals who are thus categorizedIt stereotypes individuals who are thus categorized

4. Vulnerable populations DeBruin states “Vulnerability ought not to be conceived as a characteristic of groups. Rather, certain traits may render certain persons vulnerable in certain situations”DeBruin states “Vulnerability ought not to be conceived as a characteristic of groups. Rather, certain traits may render certain persons vulnerable in certain situations” In this view, putting people in the vulnerable category deprives individuals of their autonomy – this point has been made most forcefully by AIDS activistsIn this view, putting people in the vulnerable category deprives individuals of their autonomy – this point has been made most forcefully by AIDS activists People may be vulnerable in one way and not anotherPeople may be vulnerable in one way and not another

5. Taxonomy of vulnerability Cognitive vulnerability – based on limited ability to understand informationCognitive vulnerability – based on limited ability to understand information Juridic vulnerability – relates to those under legal authority of someoneJuridic vulnerability – relates to those under legal authority of someone Deferential vulnerability – vulnerability due to customary obedience to medical or other authorityDeferential vulnerability – vulnerability due to customary obedience to medical or other authority Medical vulnerability – individuals who have illness for which there is no treatmentMedical vulnerability – individuals who have illness for which there is no treatment Allocational vulnerability – due to educational deprivation and povertyAllocational vulnerability – due to educational deprivation and poverty Infrastructural vulnerability – due to limits of the research settingInfrastructural vulnerability – due to limits of the research setting

6. Challenges to vulnerability In the past vulnerable populations were excluded from researchIn the past vulnerable populations were excluded from research Except from research that is directly related to that populationExcept from research that is directly related to that population This position has now been reversedThis position has now been reversed

7. Vulnerable populations ChildrenChildren PrisonersPrisoners Pregnant womenPregnant women Physically challengedPhysically challenged Psychologically challengedPsychologically challenged Economically, socially, politically, educationally disadvantaged groupsEconomically, socially, politically, educationally disadvantaged groups

8. Characteristics of vulnerable populations Undue susceptibility to harm – e.g. pregnant womenUndue susceptibility to harm – e.g. pregnant women Incapability to provide informed consent – childrenIncapability to provide informed consent – children Diminished autonomy so that voluntariness is suspect – prisonersDiminished autonomy so that voluntariness is suspect – prisoners

9. Protections invoked for vulnerable populations Vulnerable populations may only be involved in research where their participation is essentialVulnerable populations may only be involved in research where their participation is essential In those unable to give consent, the consent of a proxy decision maker is obtainedIn those unable to give consent, the consent of a proxy decision maker is obtained Amount of non-therapeutic risk to which the participants will be exposed is minimal or a minor increase over minimal riskAmount of non-therapeutic risk to which the participants will be exposed is minimal or a minor increase over minimal risk