Public Health Legislation
The chosen legislation is the Protection of Human Issues Act, which establishes the foundation for preserving study participants. The policy is the ordinary rule because it is codified by all entities that support, conduct, or oversee the investigation of actual victims. 2017 (Protection of Human Subjects). The Belmont Report, which outlined the essential ethical criteria for respecting human subjects, significantly impacted current law. The Nuremberg Code, which includes ethnic and legal norms established by final decisions of US courts concerning the prosecution of Nazi doctors, is the first set of principles and limitations intended to protect participants. Many points in the Code are fundamental principles governing human research ethics. Following the release of litigation studies in the United States, it was demonstrated that the virtues of each scientist could not be sufficiently dependent on protecting research topics. Government organizations and agencies amended their regulations on existing human subjects, as the Belmont report encouraged them to do while adhering to their various legislative authorities and producing a piece that was as uniform as possible (Groman & Grady, 2018).
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Subsections of the rule specify additional safeguards required when investigating vulnerable groups, and they impose criteria in addition to those established by the ‘Common Rule.’ It acknowledges that some demographic groups are more susceptible to negative influences or pressure than others. Children, pregnant women, convicts, the intellectually or mentally impaired, and those who are academically or financially disadvantaged are among the vulnerable groups under the law. Subpart B also safeguards pregnant women, neonates, and humans participating in research. Other securities are provided in Subpart C for research involving convicts. Subpart D, on the other hand, provides additional safeguards for minors participating in research projects (Protection of Human Subjects, 2017). According to the article, the term “vulnerable” or “vulnerability” focuses too much on the person and leads to a lack of attention to the social factors that define human existence, limiting broad methods that can protect people with the greatest needs.
Position
Vulnerability refers to the inability to protect one’s interests or rights, whether due to inherent characteristics such as immaturity or age or external factors such as poverty, incarceration, or illness. A fundamental ethical principle in research involving human participants is to take extra precautions to protect vulnerable individuals from harm (Groman & Grady, 2018). The author believes that the term “vulnerability” used in policy should be revised or replaced because it frequently overlooks people in need and can lead to stereotyping. The term or concept is overly broad even if specific individuals are vulnerable and require additional safeguards. Giving the label vulnerable to particular communities have been criticized for implying a simple solution to a complex situation.
Individuals and groups experience various types and levels of vulnerability, and these complexities are often overlooked when a group of people is labelled fragile. The vulnerability concept leads to the stereotyping of entire groups of people, with no distinction made between the identities within the group, where there may be distinguishing characteristics that must be considered.
Stereotyping is the practice of affixing labels or characteristics to organizations and people that are difficult to remove, and this labelling can be harmful or incorrect. Because the vulnerability concept is presented in a binary format, it is difficult to distinguish between different levels of vulnerability. Some people in vulnerable communities may have it worse than others. As a result, the statutory definition of vulnerability is rigid and unyielding. According to Bracken-Roche, Bell, Macdonald, and Racine (2017), vulnerable people are at a measurable increased risk of wrongdoing. Such explanations emphasize this. Environmental and individual variables must be considered when assessing susceptibility because overemphasising personal characteristics may obscure essential aspects of the setting or study procedure. The vulnerability has been criticized as an ineffective method of protecting individuals from potential research risks. It disregards people’s morally significant characteristics. The phrase can refer to pregnant women, toddlers, intellectually challenged people, or lawbreakers. Such groupings of people have been deemed inaccurate and potentially condescending, with the potential to perpetuate stigma.
Paying attention to patients’ circumstances and histories has been highlighted as critical to providing excellent, appropriate treatment in clinical settings. According to several research sources, discrimination in healthcare situations limits the treatment of people of colour and disadvantaged communities, including the homeless, members of the LQBTQ group, and sex workers. According to researchers, other study designations that require and encourage more attention should be added to the concept of vulnerability. It was also suggested that similar types of special care should concentrate on the additional resources needed to combat the effects of social victimization on healthcare (Walker & Fox, 2018). According to this author, a marginalization framework that examines the various levels of vulnerability could help supplement the policy’s vulnerability concept.
A Call to Action
The first step in determining vulnerabilities in terms of consent, physical problems, dependency, social and economic conditions, and exploitation, according to Luna (2019), must be to effectively exploit and understand exposure in the fields of research ethics. Following the identification of the various layers, the following process may include an evaluation, which may assist researchers, ethics boards, and legislators in identifying essential characteristics. Dispositions have been developed to describe different levels of vulnerability, and the appropriate personality traits and structures should be considered during an ethical examination (Luna, 2019). The possibility of abuse, damage, and exploitation is significant because a person should not be abused, misused, or used for consideration as vulnerable. If the person has been abused, manipulated, or maltreated, he is no longer susceptible because they have already been abused or damaged. A thorough examination of the situational structure of vulnerability layers can lead to sound ethical judgments. Situations that can lead to increased vulnerability levels can vary. If there are no stimuli, vulnerabilities will never be updated, while the possibility of occurrence can always be considered. As a result, researchers, policymakers, and ethical research boards must identify stimulus circumstances that may lead to or provoke vulnerabilities when developing appropriate protective mechanisms (Luna, 2019).
One important feature is that vulnerability layers can have a cascading effect. Pathogenic faults are the risk generated or increased by social and political conditions, continuous interactions with negative or unfavourable consequences, or inherent or situational faults (Durocher, Chung, Rochon & Hunt, 2018). These vulnerabilities can be defined by their origin and impact. These vulnerabilities are formed initially due to morally defective social and interpersonal connections, and the consequences of these vulnerabilities result in adverse outcomes for a chained series of events. Following the preceding stages, the various sensitivity layers should be evaluated to classify and prioritize the vulnerabilities. The misconceptions, harms, and dangers associated with the multiple layers must be considered, including the possibility of dependence, exploitation, and abusive physical and psychosocial practices.
It is possible to consider the dispositional fabric of vulnerabilities and the stimuli and circumstances that may activate them. The stimulus circumstances are generally linked with the context of susceptibility, current situation, and possible occurrence.
High-probability stimulus events should be monitored because they update vulnerabilities and cause actual harm. Following the ranking and identification of the stimulus circumstances, the first duty should be to avoid aggravating or intensifying the exposure of the groups or people through governmental policies or procedural interventions. Another duty is the removal of vulnerability layers. Cascadian layers are visible in public health because they include prejudice or socioeconomic factors that policy can mitigate or eliminate (Luna, 2019). Where eradication or removal is not feasible, the ultimate duty may entail a combination of measures to reduce vulnerabilities, such as safeguards and the creation and empowerment of autonomy.
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References
Bracken-Roche, D., Bell, E., Macdonald, M. E., & Racine, E. (2017). The concept of ‘vulnerability in research ethics: an in-depth analysis of policies and guidelines. Health research policy and systems, 15(1), 8.
Durocher, E., Chung, R., Rochon, C., & Hunt, M. (2018). Understanding and addressing vulnerability following the 2010 Haiti earthquake: applying a feminist lens to examine perspectives of Haitian and expatriate health care providers and decision-makers. Journal of human rights practice, 8(2), 219-238.
Groman, M., & Grady, C. (2018). Exploring the Concept of Vulnerability in the Work of the US Presidential Commission for the Study of Bioethical Issues. Asian Bioethics Review, 7(2), 214-229.
Luna, F. (2019). Identifying and evaluating layers of vulnerability–a way forward developing world bioethics, 19(2), 86–95.
US Department of Health and Human Services. (2017). Protection of Human Subjects.
Code of Federal Regulations, Title 45, Part 46 (45 CFR 46), 2009. Part 46.102 (d).
Walker, A. K., & Fox, E. L. (2018). Why Marginalization, Not Vulnerability, Can Best Identify People in Need of Special Medical and Nutrition Care. AMA Journal of Ethics, 20(10), E941.
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Question 
Week 7: System Level Interventions, Legislation, & Policy & Environmental Health
Legislation Discussion:
1. Identify a bill in your state House or State. Give the bill number and the chief author of the bill.
2. Brief description of the bill.
Public Health Legislation
3. Identify your personal or professional interest in this bill and state why you would or would not encourage your representative to support this bill.
4. What could you do to advocate for this position?
Local Environmental Health Issue Discussion:
1. identify a public health issue in your community using one of the following resources. I encourage you to use one of the first three resources, but you can use online resources if you need to.
- Interview with local official
- Local newspaper article
- Contact the local environmental group
- Online resources or others you may find.
2. Identify the county and state in which you live.
3. What are current local efforts being undertaken to address this issue?
4. Citing course resources, what is the significance of the role of public health nursing in environmental issues? Identify a public health nursing intervention that could be taken locally to address this particular concern (refer to MDH Intervention Wheel).
5. What Healthy People 2030 objective/goal would be addressed with this intervention?
When responding to your peers, compare your community with their community and suggest another public health nursing intervention that could be taken or identify an agency (other than public health) that could assist the community in addressing the issue.
Climate Change:
1. Identify a recent (within the past five years) national or global environmental health outcome due to climate change.
2. What potential/actual causes of climate change contributed to this environmental health outcome?
3. What were the consequences of climate change on health, the environment, and how we live? Give specific/actual examples related to your particular environmental health outcome.
4. What role may public health nurses take to address the needs of individuals and families at the time of your specified environmental health concern?
5. What are two specific actions/roles public health nurses can take to mitigate the long-term impact of climate change on health, healthcare, and the environment? What organizations may public health nurses join or collaborate with to address future environmental concerns related to climate change?