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Institute of Biomedical Ethics and History of Medicine (IBME) Clinical Ethics Unit: Research

Vulnerability in the clinical context

Although vulnerability is intensively debated in biomedical ethics (and predominantly in research ethics) the conceptualization and exploration of vulnerability in the clinical context is both multifaceted and underexplored. Based on a survey conducted with clinicians, the Clinical Ethics Unit has established a framework for assessing and addressing structural vulnerability in the clinical setting, ie. vulnerability generated by the fact that certain populations are at risk of worse-than-average treatment outcomes due to underrecognized needs. As our research shows, these needs are ascribable to cultural, religious, linguistic, social, economic and individual health-related factors. In one project, we were able to show how migration status directly influences treatment decisions (Drewniak et al., 2016). Actually, there is no specific project or grant associated with the dimension of structural vulnerability.

Among the recent publications addressing structural vulnerability figure: 

  • Moon, S., Belser, E., Burton-Jeangros, C., Mahon, P., Hummel, C., Monteverde, S., Krones, T., Dagron, S., Bensimon, C., Schaffert, B., Trechsel, A., Chiapperino, L., Kloetzer, L., Zittoun, T., Jox, R., Fischer,M., Dalle Ave, A., Kirchschlaeger, P.., Hurst, S. (2020). Continued Confinement of Those Most Vulnerable to COVID-19. Kennedy Institute of Ethics Journal. Epub ahead of print.
  • Staudacher, D., Monteverde, S., Krones, T., Odermatt, R., Werner, N.-S., Brenner, G., Bruni, K. (2020). Verletzlich, aber gleichberechtigt. Vulnerable Patient(inn)en im Akutspital - Ein Projekt der Klinischen Ethik im Universitätsspital Zürich. Krankenpflege, Soins Infirmiers, (113)2, 20-23.
  • Monteverde, S. (2020). Muslimische Seelsorge aus klinisch-ethischer Sicht. In: Schmid, H., Lang, A. (Hrsg.) Muslimische Seelsorge im Kanton Zürich. Schweizerisches Zentrum für Islam und Gesellschaft / SZIG-Paper Nr. 8, S. 28-30.
  • Drewniak D, Krones T, Sauer C, Wild V. The influence of patients' immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland. Soc Sci Med. 2016;161:64-73.
  • Submitted: Krones, T., Monteverde, S. Vulnerable populations, the Law of the Dynamics of Inverse Care, and the role of the Clinical Ethics Consultant: Experiences from Switzerland. (book chapter) will appear in: M. Kuczeswki, C. Wasson (eds.) Thorny Issues in Clinical Ethics Consultation: North American and European Perspectives.