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Human Vulnerability & Non-discrimination
Bioethics & Health Law (BHL)-3
Drs. Uki Dwiputranto, Grad.Dip.Sc, M.Sc
• Principle of respect for human vulnerability
• Interrelationship b/w presentday scientific medicine and human vulnerability
• Concepts of discrimination and stigmatization in bioethics context
• To identify different contexts and bases of discrimination and stigmatization and
their implications
•To identify and deal with situations where exceptions to the principle can be justified
Ethymology
Vulnus
Vulnerability
Wound
Susceptibility to being wounded
Prinsip dari respect for human vulnerability memberikan perhatian/ kepedulian terhadap adanya potensi kerapuhan/ kelemahan (fragility) pada manusia.
Sebagai suatu kesatuan yang menyeluruh, fungsi (pada manusia) dapat dengan mudah terganggu/ kacau sehingga kesehatannya bahkan keberadaannya dapat berada pada posisi terancam.
Prinsip ini terkait dengan prinsip integritas personal.
- the so-called developing countries tended to understand it in a broad sense, as noun/condition, applied to every field of human activity; vulnerability is to be acknowledged and respected.
- western countries tended to understand it in a narrow sense, as adjective/situation, applied to human experimentation/clinical trials; vulnerability is to be overcome by the persons empowerment,strengthening autonomy;
Several Aspects of Vulnerability :1. Biological or corporeal vulnerability; this concerns the fragility of
the human organism originating from:- natural threats are coming from our biology: ageing, susceptibility to illness and disease, and death- environmental and other natural and man-made threats: famine, earthquake, hurricanes, pollution and environmental disasters
2. Social vulnerability; this concerns the fragility of the human capacity for creating coherence in one’s life and for sharing goods and services.- social threats stemming from war and crime, prejudice and discrimination, cruelty and indifference- persons also become vulnerable due to hospitalization and institutionalization- social circumstances and conditions
3. Cultural vulnerability; this concerns the fragility of particular traditions and conceptions of values that are typical for a community or local cultures.
Poverty
What is poverty ……?
Poverty is multidimensional:
• Low income• Poor access to resources and skills• Vulnerability• Insecurity• Voicelessness, disempowerment Gender Race Ethnicity
Poverty and health: the links
The vicious circle:
• Ill health leads to poverty
• Poverty leads to ill health
The virtuous circle:
• Good health is linked to higher income
and welfare
• Higher income is linked to good health
Vulnus
Vulnerability
Wound
Susceptibility to being wounded
Bioethics becomes
morally relevant
Not just a neutral description of
the human condition but instead
a normative prescription to take
care of the vulnerability that is
characteristic for human beings.
The fight against vulnerabilityA comon idea: vulnerability of the human condition should be eliminated or reduced.
Science & technological innovations should be used to overcome the natural threats.
Medical research should be focused on eliminating the biological threats to the human body.
Contingent,
NOT inherent
Successful Failure
• Life expectancy and health have improved.
• Poverty and starvation reduced.
• Life expectancy is decreasing in many
countries.
• Many people die from common disease.
• Poverty is still widespread.
Vulnerability
Should be eliminated.
Problems
• Culture.
• Economics.
• Medical progress.
The Dilemmas :
Require a balance b/w eliminating and accepting human vulnerability.
• Disability. It is viewed as abnormal “vulnerable”. At the same time they should not be stigmatized by being treated as abnormal.
• Death. (: ambivalent). In palliative care, death is understood as being part of life; in others death is still treated as the enemy.
• Depression. The use of certain antidepressant drug is recommended, but it is regarded as for unhappiness and sadness.
Human suffering and misery
Human vulnerability
Challange
We must at the same time struggle to keep suffering to a minimum and also accept it as part of life.
Human vulnerability cannot be merely regarded as an enemy to be eliminated.
Too much emphasis on eradication has led to evil in the name of some supposed good (e.g. eugenic movement)
Care ethics
• The challenge of human vulnerability is that it can never be entirely eliminated from human life. Instead, it should inspire new approaches in bioethics.
• The human condition requires solidarity; human beings all share common vulnerabilities.
• Human vulnerability also leads to an ethics of care. Because it is a shared characteristic, it is also a source of concern for others as well as awareness that we rely on others. It is the basis for the duty to care for those threatened by biological, social and cultural threats as well as by the power of medicine itself.
Expected practical achievements :
• Human experimentation,
• Medical practice,
• Health care and biomedical research policies.
Application of the principle of vulnerability at this
level of human experimentation does not make
autonomy secondary, nor renders consent less
important, but brings to light that these principles
not only fail to protect the individuals from every
expression of vulnerability but also can be used as
“deresponsibilizers” by those who, in this
relationship, detain more power.
Application of the principle of vulnerability at this
level of medical practice does not diminish the
responsibility of the individuals in their
autonomous choices, but brings to light that the
principle of autonomy is not abstract but situated
in a context, and that the circumstances
surrounding the decision do influence it, thus
obligating those who hold more power (society,
institutions, state) to protect the individuals from
potential abuse by the system.
Application of the principle of vulnerability at this
level of health care and research policies
requires
institutions and states to be aware that not
always
biomedical progress and/or the reinforcement of
the
power of those so-called vulnerable result in
diminishing and/or suppressing vulnerability but,
on
the contrary, they can create and/or aggravate
vulnerabilities.
Discriminare(to distiguish between) Discrimination
To make a distinction b/w people on the basis of class or
category w/o regarding to individual merit.
Against the ethical theory of egalitarian
based on sosial equality
Distinction b/w people based just on individual merit (e.g.
personal achievement, skill or ability) are NOTconsidered
discriminatory.
BUT, the distinctions based on race, social class or caste,
religion, gender, and ethnicity are not allowed.
Violates human dignity, human right, and
fundamental freedom
Stigmatization
a discrediting process which strikes an individual who is
considered as ‘abnormal’ or ‘deviant’. He or she is reduced to
this single characteristic in other people’s eyes or opinions for
whom this ‘label’ justifies a range of social discriminations
and even exclusion.
The social impact of stigmatization shows a number of
negative behaviours toward stigmatized people that can end in
real discrimination as regards, for example, access to social
services such as health care and education, employment and
professional advancement, income level and domestic life.
In the field of health care and
bioethics, some groups need more
protection such as infants and
elderly people, AIDS patients,
psychiatric patients and
depressed patients.
Did you know…..?
Around the world, people living with HIV and AIDS have been
segregated in schools, hospitals, and prisons; refused employment;
denied the right to marry; required to submit to HIV tests as a condition
of entry into other countries; banished by their communities; and killed
because of their HIV-positive status.
As of 2003, almost half of governments in sub-Saharan Africa had yet
to adopt legislation or court rulings specifically outlawing
discrimination against people living with HIV and AIDS.
As of 2003, only one-third of countries worldwide had adopted legal
measures specifically outlawing discrimination against populations
especially vulnerable to HIV and AIDS.
Surveys conducted in Southern Africa between 2000-2001 found that:
• Fewer than half of respondents in Botswana would buy fresh vegetables from a shopkeeper living with HIV or AIDS.
• One-third of respondents from Lesotho felt that a female teacher who is HIV-positive but not sick should not be
allowed to continue teaching in school.
• Approximately one-third of respondents from Namibia were secretive about a family member’s HIV status.
Facts
Surveys conducted in Central Asia between 2000-2002 found that:
• Only 8% of respondents in Tajikistan would buy fresh vegetables from a shopkeeper living with HIV or AIDS.
• 15% of respondents from Tajikistan felt that a female teacher who is HIV-positive but not sick should not be allowed
to continue teaching in school.
• In Usbekistan, 30% of male respondents and 46% of female respondents were secretive about their family
member’s HIV status.
In a study conducted in an eastern Chinese coastal
city, half of participants believed that punishment
was an appropriate response towards those living
with HIV, over half (56%) were unwilling to be
friends with HIV-positive people, and 73% thought
that those living with HIV should be isolated.
The good news
• In South Africa, the Constitutional Court held the government in
violation of the constitution for failing to provide nevirapine to
pregnant women to prevent mother-to-child transmission of HIV
• In Serbia in 2007, a woman with HIV was awarded damages from
the European Court of Human Rights after she was banned from
seeing her child
• In 2007, the Mexican Supreme Court ruled it was unconstitutional
to ban members from the military on the grounds of their HIV
status.
Litigation on behalf of people living with and affected by HIV has resulted in tangible court victories in numerous countries:
Sex workers, injecting drug users,
and other marginalized groups
People living with HIV and AIDS
HIV / AIDS
(The circle of stigmatization and marginalization)
(The cycle of stigma, discrimination and human right violation)
DiscriminationViolation of human right
Which legitimate Which causes
Which leads to
Stigma
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