Institutional Review Board for Health Sciences Research (IRB-HSR)

Special Issues

Vulnerable Subjects

Special Consideration for Projects Involving Vulnerable Populations

There are a number of research populations described in the Federal regulations as "vulnerable" or that require additional consideration or protection. "Vulnerable" or "special" classes of subjects include:

pregnant women, human fetuses and neonates,



cognitively impaired persons

students and employees


economically and/or educationally disadvantaged

AIDS/HIV+ subjects.

Terminally Ill Subjects

In addition, the regulations outline specific provisions for research involving:

Vulnerable Subjects and Exempt Research

Due to the vulnerable nature of the population the exemptions in 45 CFR 46.101(b) do not apply to certain types of research involving children and prisoners, Subparts C and D.

Specifically, the exemption at 45 CFR 46.101(b)(2), for research involving survey or interview procedures or observation of public behavior, does not apply to research with children, Subpart D, except for research involving observations of public behavior when the investigator(s) do not participate in the activities being observed.

In addition, exemption from IRB review should be utilized conservatively when applied to research involving special classes of subjects who are not be defined by regulation as vulnerable.

The following section is a brief discussion regarding the "vulnerable" subject populations.

In reviewing these research projects, the IRB determines if the inclusion of the vulnerable population is adequately justified and that safeguards are implemented to minimize risks unique to each population.

During it's review the IRB must determine which of the following categories the research would involve:

Requests for approval of any research that exposes vulnerable populations to risks that do not meet one of the above criteria must be submitted to the United States Secretary of Health and Human Services for review and approval.

Special protections are essential to guide research involving vulnerable persons. In order to review projects involving the use of vulnerable populations as specified in 45CFR46, an IRB must have present at its meeting an advocate for these subjects.

The mere presence of the appearance of vulnerability should not lead to a presumption that a person is incapable of making a decision regarding participation in research and of giving valid informed consent. Yet sometimes these conditions do impair the decision-making capacity required to give a valid informed consent, raising ethical concerns about the vulnerability of persons in such conditions in research.