vulnerability & non discrimination

28
Human Vulnerability & Non-discrimination Bioethics & Health Law (BHL)-3 Drs. Uki Dwiputranto, Grad.Dip.Sc, M.Sc

Upload: apsopela-sandivera

Post on 24-Oct-2015

35 views

Category:

Documents


2 download

DESCRIPTION

doc 1

TRANSCRIPT

Page 1: Vulnerability & Non Discrimination

Human Vulnerability & Non-discrimination

Bioethics & Health Law (BHL)-3

Drs. Uki Dwiputranto, Grad.Dip.Sc, M.Sc

Page 2: Vulnerability & Non Discrimination

• 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

Page 3: Vulnerability & Non Discrimination

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.

Page 4: Vulnerability & Non Discrimination

- 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;

Page 5: Vulnerability & Non Discrimination

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.

Page 6: Vulnerability & Non Discrimination

Poverty

What is poverty ……?

Poverty is multidimensional:

• Low income• Poor access to resources and skills• Vulnerability• Insecurity• Voicelessness, disempowerment Gender Race Ethnicity

Page 7: Vulnerability & Non Discrimination

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

Page 8: Vulnerability & Non Discrimination
Page 9: Vulnerability & Non Discrimination
Page 10: Vulnerability & Non Discrimination
Page 11: Vulnerability & Non Discrimination

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.

Page 12: Vulnerability & Non Discrimination

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

Page 13: Vulnerability & Non Discrimination

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.

Page 14: Vulnerability & Non Discrimination

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.

Page 15: Vulnerability & Non Discrimination

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)

Page 16: Vulnerability & Non Discrimination

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.

Page 17: Vulnerability & Non Discrimination

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.

Page 18: Vulnerability & Non Discrimination

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.

Page 19: Vulnerability & Non Discrimination

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.

Page 20: Vulnerability & Non Discrimination

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

Page 21: Vulnerability & Non Discrimination

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.

Page 22: Vulnerability & Non Discrimination

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.

Page 23: Vulnerability & Non Discrimination

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.

Page 24: Vulnerability & Non Discrimination

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

Page 25: Vulnerability & Non Discrimination

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.

Page 26: Vulnerability & Non Discrimination

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:

Page 27: Vulnerability & Non Discrimination

Sex workers, injecting drug users,

and other marginalized groups

People living with HIV and AIDS

HIV / AIDS

(The circle of stigmatization and marginalization)

Page 28: Vulnerability & Non Discrimination

(The cycle of stigma, discrimination and human right violation)

DiscriminationViolation of human right

Which legitimate Which causes

Which leads to

Stigma