Vulnerable Populations, the Inverse Care Law, and the Role of Clinical Ethicists: Experiences from Switzerland

Abstract

Departing from the Swiss healthcare context and from the experience of the clinical ethics unit at a larger university hospital, this chapter discusses what “witnessing” structural vulnerability of patients actually entails for clinical ethics services from a normative point of view. It discusses the foundations and duties of clinical ethics services in addressing unmet needs of vulnerable populations and epistemic injustices, recalling the relevance of assuring universal health coverage under applicable law and uncovering the dynamics of the so-called inverse care law as three necessary conditions for realizing health equity within the clinical context. An anonymized case is presented which is particularly revelatory for situations of “aggravated” vulnerability in the hospital context. The chapter concludes with organizational ethics strategies. The authors describe how structural vulnerability can be identified and addressed within clinical ethics. In order to realize prima facie relevant ethical principles, clinical ethics consultations (CECs) have to offer open spaces that allow parties to talk transparently about ethical problems and barriers arising from dynamics of “inverting” care.