The High Court continues to exercise its inherent jurisdiction to make declarations about interventions into the lives of situationally vulnerable adults with mental capacity. In light of protective responses of health care providers and the courts to decision-making situations involving capacitous vulnerable adults, this paper has two aims. The first is diagnostic. The second is normative. The first aim is to identify the harms to a capacitous vulnerable adult’s autonomy that arise on the basis of the characterisation of situational (...) vulnerability and autonomy as fundamentally opposed concepts or the failure to adequately acknowledge the conceptual relationship between them at common law. The second part of this aim is to draw upon developments in analytic feminist philosophy to illustrate how standard approaches to autonomy are ill-equipped to capture the autonomy issues of capacitous vulnerable adults when their decisions regarding care and treatment are at stake. The second (normative) aim is to develop an account of self-authorised, intersubjective autonomy on the basis of analytic feminist insights into the relational practices of recognition. This account not only attempts to capture the autonomy of capacitous vulnerable adults and account for the necessary harms to their autonomy that arise from standard common law responses to their situational vulnerability, it is also predicated on the distinctions between mental capacity, the satisfaction of conditions for informed consent and the exercise of autonomy, meaning that it is better placed to fulfil the primary aim of the inherent jurisdiction – to facilitate the autonomy of vulnerable adults with capacity. (shrink)

Research Ethics, Volume 18, Issue 4, Page 265-280, October 2022. Concerns around comprehension and recall of consent information by research participants have typically been associated with low health and research literacy levels. In genomics research, this concern is heightened as the scientific and ethical complexities of genetics research, such as biobanking, genetic susceptibility, data sharing, and incidental findings may be more difficult for potential research participants to understand. However, challenges to research participants’ comprehension of consent information may be compounded by (...) factors beyond health and research literacy levels. To identify factors that may impact research participants’ understanding and recall of consent information, we designed a qualitative study to explore whether participants enrolled in a tuberculosis genetics study in Cameroon understood the objectives of the study, the risks and benefits and certain key aspects of the study such as biobanking and data sharing. The results showed that research participants had limited understanding and/or recall of the TBGEN-Africa study goals and methods. Some participants were of the opinion that TBGEN-Africa was not a genetics study because tuberculosis is not an inheritable condition. Factors that may have hindered understanding and/or recall of study information are diagnostic misconception, and information overload and situational vulnerability. There is a need for improved practices to support research participants’ understanding of consent information in genetics studies including designing the consent process in ways that minimize psychological distress and diagnostic/therapeutic misconception. (shrink)

In this paper I present a critical analysis of the English law relating to the safeguarding of vulnerable adults, in particular how the law impacts on the sexual lives of adult women with mental disabilities. I consider the discourses of vulnerability that surround the different legal regimes and whether the emerging theoretical vulnerability literature can assist in developing more nuanced legal responses. I argue that the inherent jurisdiction and Care Act 2014 provide an opportunity to move away from (...) the focus on inherent features of vulnerability such as mental disability towards a more nuanced, situational and embodied account of what it means to safeguard ‘vulnerable adults’. This has the potential to be developed in England through the new legal framework of the Care Act and can be achieved through targeting interventions against the situational causes of vulnerability, for example the perpetrators of sexual violence. (shrink)

In his speech to the opening of the High Level section of the recent Copenhagen climate negotiations last December, Prime Minister Tillman Thomas of Grenada, speaking for AOSIS (the Alliance of Sma...

In this paper, following the taxonomy developed by Mackenzie, Rogers and Dodds of different sources and states of vulnerability, I claim that wild animals are inherently and situationally vulnerable. This is because they can experience suffering as a response to certain internal and external states and have a high exposure to, and a low capacity to cope with, harmful natural processes. From this it follows that we have a moral obligation to support and assist individuals who are occurrently vulnerable (...) and to reduce the risk of dispositional vulnerabilities becoming occurrent in the future, by endorsing some form of what I call ‘environmental enhancement’. Finally, I pay critical attention to how to prevent interventions aimed at ameliorating vulnerability from paradoxically generating pathogenic vulnerabilities. (shrink)

The goal of this paper is to propose a relational turn in healthcare professionalism, to improve the responsiveness of both healthcare professionals and organizations towards care of patients, but also professionals. To this end, it is important to stress the way in which difficult situations and vulnerability faced by professionals can have an impact on their performance of work. This article pursue two objectives. First, I focus on understanding and making visible shared vulnerability that arises in clinical settings (...) from a triple perspective: patient and family, health professionals, and institutions. Second, to address this challenge for professionalism, in this paper I articulate the term "relational centered-patient professionalism", which has two main axes. The relational approach means taking into account how the relationships among professionals, patients and institutions determine the constitution and evolution of those professional values. The focus on patient centered care is indispensable, because it is the ultimate goal pursued by the development of these professional values, and must always be at the center. (shrink)

The concept of vulnerability is deployed in bioethics to, amongst other things, identify and remedy harms to participants in research, yet although nonhuman animals in experimentation seem intuitively to be vulnerable, this concept and its attendant protections are rarely applied to research animals. I want to argue, however, that this concept is applicable to nonhuman animals and that a new taxonomy of vulnerability developed in the context of human bioethics can be applied to research animals. This taxonomy does (...) useful explanatory work, helping to pinpoint the limitations of the 3Rs/welfare approach currently adopted in the context of animal experimentation. On this account, the 3Rs/welfare approach fails to deliver for nonhuman animals in experimentation because it effectively addresses only one element of their vulnerability (inherent) and paradoxically through the institution of Animal Ethics Committees intended to protect experimental animals in fact generates new vulnerabilities that exacerbate their already precarious situation. (shrink)

What makes individuals, groups, or even entire countries vulnerable? And why is vulnerability a concern in bioethics? A simple answer to both questions is that vulnerable individuals and groups are subject to exploitation, and exploitation is morally wrong. This analysis is limited to two areas. First is the context of multinational research, in which vulnerable people can be exploited even if they are not harmed, and harmed even if they are not exploited. Second is the situation of women, who (...) are made vulnerable in cultural settings or in entire countries in which they are oppressed and powerless. (edited). (shrink)

Patients in need of palliative care are often described as vulnerable. Being vulnerable can sometimes be interpreted as the opposite of being autonomous, if an autonomous person is seen as an independent, self-sufficient person who forms decisions independently of others. Such a dichotomous view can create a situation where one has experiences of vulnerability that cannot be reconciled with the central ethical principle of autonomy. The article presents a feminist ethical perspective on the conceptualisation of vulnerability in the (...) context of palliative care. It does so through the lens of the concepts of inherent and pathogenic vulnerability from the taxonomy on vulnerability suggested by Mackenzie et al. To differentiate between forms of vulnerability, is important since even though vulnerability can be regarded as a shared life condition it can be the product of practices creating harm to the patient. The article also presents an analysis of how vulnerability can be included in the interpretation of the ethical principle of autonomy, in order to be relevant in palliative care where vulnerability is salient, namely, as relational autonomy. Furthermore, two practical implications for nursing practice are suggested. Firstly, to acknowledge vulnerability as a shared life condition one needs training in order to neither be overwhelmed by one’s own vulnerability, nor become invulnerable when facing vulnerability in others. Secondly, to foster relational autonomy includes navigating between the patient exercising their autonomy within a framework of relations, and shielding the patient from paternalistic practices. Nurses could be particularly suited for this role, which includes creating an environment which is open and supportive; navigating between patient, family and staff; seeing and acknowledging the complex situation in which patient autonomy is actually played out; and promoting patient autonomy. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

The paper outlines an attempt at phenomenological description of two intermingled dimensions of human vulnerability. First, vulnerability understood as an essential dimension in the constitution of embodiment and second, vulnerability in regard to trust, as a form of emotive interpersonal disposition. In either case, vulnerability does not only refer to mere physical fragility but to the situational horizon where from emerge progressive anticipations of “possible harm”. According to this account, vulnerability appears as a practical (...) horizon of emotional awareness of risk involving not only bodily fragility but a dimension of concrete existence of individual persons, namely, the intimate affectation of being harmed, injured or deprived or a practical aim. In this context the paper claims for a second and more radical sense of vulnerability that problematize the classical account of emotive protentionality, following Anthony Steinbock´s description of moral emotions. In this regard, vulnerability of trust involves an emotional risk and fragility that opens to consideration a dimension of human existence revealing human persons in their absolute and individual concreteness. (shrink)

Vulnerability theory as developed in the Vulnerability and Human Condition Initiative is an alternative to a rights-based or social contract paradigm for thinking about foundation concepts of state responsibility. One fundamental premise of the theory is that the individuals and groups currently described as “vulnerable populations” should not be labelled vulnerable, nor should they be sequestered in discreet categories for the purposes of law and policy. This plea for their inclusion in a larger whole is not to deny (...) that discrimination, harm, and relative disadvantage arising from all sorts of circumstances and situations exist. Nor is it to suggest that particular instances of harm should not be addressed by appropriate state action. Rather, it is an argument that “vulnerability” is the wrong concept to use to define and isolate these groups, or any other specific group, from the whole of humanity. Human vulnerability is universal and constant, inherent in the human condition. Recognizing the theoretical mandates of accepting the universal, vulnerability theory presents a “vulnerable subject” as the only appropriate object of law and policy. This inclusive, universal legal subject incorporates the realities of the ontological body and its life-long dependence on social institutions and relationships, building a theory of essential social cohesion and reciprocity in which the state has the responsibility to see that these vital social institutions and relationships operate justly. (shrink)

BackgroundVulnerability is a key concept in traditional and contemporary bioethics. In the philosophical literature, vulnerability is understood not only to be an ontological condition of humanity, but also to be a consequence of contingent factors. Within bioethics debates, vulnerable populations are defined in relation to compromised capacity to consent, increased susceptibility to harm, and/or exploitation. Although vulnerability has historically been associated with older adults, to date, no comprehensive or systematic work exists on the meaning of their vulnerability. (...) To fill this gap, we analysed the literature on aged care for the meaning, foundations, and uses of vulnerability as an ethical concept.MethodsUsing PRISMA guidelines, we conducted a systematic review of argument-based ethics literature in four major databases: PubMed, Embase®, Web of Science™, and Philosopher’s Index. These covered biomedical, philosophy, bioethical, and anthropological literature. Titles, abstracts, and full texts of identified papers were screened for relevance. The snowball technique and citation tracking were used to identify relevant publications. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the QUAGOL methodology.ResultsThirty-eight publications met our criteria and were included. Publication dates ranged from 1984 to 2020, with 17 publications appearing between 2015 and 2020. Publications originated from all five major continents, as indicated by the affiliation of the first author. Our analyses revealed that the concept of vulnerability could be distinguished in terms of basic human and situational vulnerability. Six dimensions of older adults’ vulnerability were identified: physical; psychological; relational/interpersonal; moral; sociocultural, political, and economic; and existential/spiritual. This analysis suggested three ways to relate to older adults’ vulnerability: understanding older adults’ vulnerability, taking care of vulnerable older adults, and intervening through socio-political-economic measures.ConclusionsThe way in which vulnerability was conceptualised in the included publications overlaps with distinctions used within contemporary bioethics literature. Dimensions of aged care vulnerability map onto defining features of humans, giving weight to the claim that vulnerability represents an inherent characteristic of humans. Vulnerability is mostly a value-laden concept, endowed with positive and negative connotations. Most publications focused on and promoted aged care, strengthening the idea that care is a defining practice of being human. (shrink)

ArgumentMoreau (2019) has raised concerns about the use of DNA data obtained from vulnerable populations, such as the Uighurs in China. We discuss another case, situated in Europe and with a research history dating back 100 years: genetic investigations of Roma. In our article, we focus on problems surrounding representativity in these studies. We claim that many of the circa 440 publications in our sample neglect the methodological and conceptual challenges of representativity. Moreover, authors do not account for problematic misrepresentations (...) of Roma resulting from the conceptual frameworks and sampling schemes they use. We question the representation of Roma as a “genetic isolate” and the underlying rationales, with a strong focus on sampling strategies. We discuss our results against the optimistic prognosis that the “new genetics” could help to overcome essentialist understandings of groups. (shrink)

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of (...) class='Hi'>vulnerability. The findings revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

Over the last three quarters of a century, international guidelines and regulations have undergone significant changes in how children are problematised as participants in biomedical research. While early guidelines enacted children as vulnerable subjects with diminished autonomy and in need of special protection, beginning in the early 2000s, international regulatory frameworks defined the paediatric population as vulnerable due to unaddressed public health needs. More recently, ethical recommendations have promoted the active engagement of minors as research partners. In this paper, I (...) adopt a post-structuralist approach to policy analysis to examine deep-seated assumptions and presuppositions underlying the changes in the problematisation of children as biomedical research participants over time. While biomedical research ethics focuses on the autonomy and vulnerability of minors, ethical guidelines are situated in specific sociocultural contexts, shaped, among other things, by contingent public health needs and changing conceptions of the value of research and science for society. In the process, I demonstrate the challenge of moving away from an approach that in taking adults as the model overshadows the complexity of children’s lived experiences as well as their personal, cultural, and social lives. The lack of acknowledgement of this complexity makes children vulnerable to epistemic injustice, which is particularly crucial to address in public involvement initiatives. (shrink)

Shame is frequently viewed as a destructive emotion; but it can also be understood in terms of change and growth. This essay highlights the problematic values that cause pervasive and frequent shame and the importance of resisting and changing these values. Using Confucian insights, I situate shame in an interactive process between the individual's values and that of their society, thus, being vulnerable to shame represents both one's connection to a community and an openness to others’ negative feedback. This process (...) provides an important arena where personal values interact with communal ones. The Confucian tradition, I argue, affords individuals a degree of autonomy in internalization through urging them to cultivate and maintain a keen sense of shame. My discussion also offers resources for understanding the various aspects of this interactive process—how individuals with similar experiences of shame may, through channeling their experiences, influence social values and propel moral progress. (shrink)

This volume offers novel and provocative insights into vulnerability and exclusion, two concepts crucial for the understanding of contemporary political agency. In twelve critical essays, the contributors explore the dense theoretical content, complex histories and conceptual intersection of vulnerability and exclusion. A rich array of topics are covered as the volume searches for the ways that vulnerable and excluded groups relate to each other, where the boundary between the excluded and the included arises, and what the stakes of (...) ‘invulnerability’ might be. Drawing on the works of Hegel, Helmuth Plessner and Hannah Arendt to situate the project in a solid historical context, the volume likewise tackles pressing and contemporary issues such as the state of human capital under neoliberalism, the flawed nature of democracy itself, and the vulnerability inherent in extreme precarity, extreme violence, and interdependence. The contributions come from philosophers with a range of backgrounds in social philosophy and critical social sciences, who use related conceptual tools to tackle the political challenges of the 21st century. Together, they present a ground-breaking overview of the main challenges which social exclusion presents to contemporary global societies. (shrink)

(Conference proceedings 2014) This presentation (International Development Ethics Association, July 2014) considers economic vulnerability, exploring the risk of deprivation of necessary resources due to a complex and rarely discussed vulnerability that arises from hope. Pierre Bourdieu’s sociological account of French petit-bourgeois aspiration in The Social Structures of the Economy has recently inspired Wendy Olsen to introduce the term “aspiration paradox” to characterize cases wherein “a borrower's status aspirations may contribute to a situation in which their borrowings exceed their (...) capacity to repay,” leaving the individual much the worse, due to an aspiration to betterment. If such financial opportunities were not made available to these people – if some were denied loans due to a careful assessment of their vulnerability – would they be better off? We should seriously consider that they might be. I will hazard the straightforwardly paternalistic suggestion that limiting access to lending to those who are vulnerable to their aspirations can be a just policy. Because aspiration paradox is a cross-cultural phenomenon, and because lending frequently involves asymmetries in mathematical education between borrowers and lenders, I hope to elude at least some of the charges of colonialism that have gained a stronger purchase on adaptive preference arguments. (shrink)

The article addresses issues at the nexus of physician industrial action, moral agency, and responsibility. There are situations in which we find ourselves best placed to offer aid to those who may be in vulnerable positions, a behavior that is consistent with our everyday moral intuitions. In both our interpersonal relationships and social life, we make frequent judgments about whether to praise or blame someone for their actions when we determine that they should have acted to help a vulnerable person. (...) While the average person is unlikely to confront these kinds of situations often, those in the medical professions, physicians especially, may confront these and similar situations regularly. Therefore, when physicians withhold their services for whatever reason in support of industrial action, it raises issues of moral responsibility to patients who may be in a vulnerable position. Using theories of moral responsibility, vulnerability, and ethics, this paper explores the moral implications of physician industrial action. We explore issues of vulnerability of patients, as well as the moral responsibility and moral agency of doctors to patients. Determining when a person is vulnerable, and when an individual becomes a moral agent, worthy of praise or blame for an act or non-action, is at the core of the framework. Notwithstanding the right of physicians to act in their self-interest, we argue that vulnerability leads to moral obligations, that physicians are moral agents, and the imperatives of their obligations to patients clear, even if limited by certain conditions. We suggest that both doctors and governments have a collective responsibility to prevent harm to patients and present the theoretical and practical implications of the paper. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

Outsourcing clinical trials sponsored by pharmaceutical companies from industrialized countries to low- -income countries – summarized as transnational biomedical research – has lead to many concerns about ethical standards. Whether study participants are particularly vulnerable is one of those concerns. However, the concept of vulnerability is still vague and varies in its definition. Despite the fact that important international ethical guidelines such as the Declaration of Helsinki by the World Medical Association or the Ethical Guidelines for Biomedical Research Involving (...) Human Subjects by the Council of International Organizations of Medical Sciences refer to vulnerability as ethical principle, each of their approaches are different. To overcome these shortcomings, we analyze and unite different approaches of vulnerability and develop practical criteria in order to operationalize the concept especially for the context of TBR. These criteria refer to the context of a study as well as the characteristics and the current living situation of study participants. Based on a case study of an HIV-vaccine-trial conducted in India we demonstrate how those criteria can be applied in a retrospective way to identify potential ethical conflicts. The criteria can also indicate a prospective function for ethical pre-assessment. For this, we provide an outlook for three major topics: 1. Vulnerability as a normative concept: Different ways of protection; 2. The relevance of transparency and 3. Vulnerability as an instrument to increase decision participation of human subjects. (shrink)

Despite the diversity of ageing, society and academics often describe and label older persons as a vulnerable group. As the term vulnerability is frequently interchangeably used with frailty, dependence, or loss of autonomy, a connection between older age and deficits is promoted. Concerning this, the question arises to what extent it may be helpful to refer to older persons as vulnerable specifically in the context of health care. After analyzing different notions of vulnerability, I argue that it is (...) illegitimate to conclude that older age is related to increased vulnerability. Much more, identifying older adults as a vulnerable group is closely related to ageism and can be associated with paternalistic benevolence and a tendency to overprotection, especially within health care. Additionally, even though older adults are more often in situations of increased vulnerability due to their potentially higher need for health care, I argue further that older adults mainly become a vulnerable group due to ageism. In this way, it can be concluded that the vulnerability of older adults does not originate in certain attributes of the group, but arises from a characteristic of society and, in turn, health personnel, namely ageism. Labeling older adults as vulnerable therefore is only helpful, when it is used to raise awareness of the widespread ageism in society, in this context, especially in the setting of health care, and the negative consequences thereof for older adults. (shrink)

Background: Empathy and moral courage are important virtues in nursing and nursing ethics. Hence, it is of great importance that nursing students and nurses develop their ability to empathize and their willingness to demonstrate moral courage. Research aim: The aim of this article is to explore third-year undergraduate nursing students’ perceptions and experiences in developing empathy and moral courage. Research design: This study employed a longitudinal qualitative design based on individual interviews. Participants and research context: Seven undergraduate nursing students were (...) interviewed during or immediately following their final clinical placement. Ethical considerations: The Norwegian Social Science Data Services (NSD) approved the study. Participants were informed that their participation was voluntary and were assured confidentiality. They were informed that they could withdraw from the study at any time, without providing reasons. Findings: Affective empathy seemed to be strong among third-year undergraduate nursing students. However, they tried to handle the situations in a ‘professional’ way, and to balance their emotions. At the same time, they expressed how difficult it can be to show moral courage when confronted with poor patient care. In addition, they spoke about a lack of role models during clinical practice and supervision. Conclusions: Undergraduate nursing students are in a vulnerable position throughout their journey to become professional and to develop empathy and moral courage. The professional socialisation and forming of professional empathy and moral courage among nursing students, may be seen as a complex interaction of formal and hidden curriculum, where role models play an important role. We argue that the main theme ‘Vulnerable students – a journey towards professional empathy and moral courage’ may cover the longitudinal project as a whole. This vulnerability is something both teachers and supervisors should be aware of when following up with students in their clinical placements. (shrink)

This article discusses the possibility for vulnerable writing within feminist methodological approaches to research. Drawing upon a project that involved difficulties and tensions in conducting transnational research, including the documenting and telling of a partial narrative of an individual who set herself on fire, the article discusses what it might mean to focus more explicitly on explicating and recognising vulnerability in writing. In providing examples from working with a situated, localised analysis that engages feminist, postcolonial and queer theoretical approaches (...) to attend to the particular and everyday, I address some of the hesitations and uncertainties in undertaking research and producing knowledge, and concerns with forms of reflexive practice. At the heart of the discussion is the question of a vulnerable ethics, of how it is possible for feminist methods to represent the lives of others, especially when stories fail in the telling, both in providing adequate explanations and in the ways that trauma and suffering can remain incommunicable. Included in this are concerns as to how we as researchers are affected within the production of research. As a form of receptivity and wounding, the article argues for vulnerable writing that challenges feminist methods to remain open and receptive to what will always resist sense-making, while continuing to respond to the demand that we do justice to the lives of others. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, (...) and agency as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

In this article, I examine the legal position of those who perform caregiving work within the context of a cohabiting relationship through a novel relational vulnerability lens. I argue that the state, through privatising and devaluing caregiving labour, situates carers within an unequal and imbalanced relational framework, exposing them economic, emotional, and spatial harms. Unlike universal vulnerability, which is inherent and unavoidable, relational vulnerability can be avoided and reduced if the state were to acknowledge that humans are (...) embodied and relational rather than self-sufficient and rational. Law’s treatment of cohabiting carers reflects the state’s broader tendency to value economic self-sufficiency, while confining caregiving to the private family. I argue that the state has a duty to respond directly to relational vulnerability and should aim to make cohabiting carers resilient. Resilience must involve the provision of material resources but should also have a normative commitment to achieving autonomy and equality for those marginalised by law and state policies. (shrink)

Martha Albertson Fineman's earlier work developed a theory of inevitable and derivative dependencies as a way of problematizing the core assumptions underlying the 'autonomous' subject of liberal law and politics in the context of US equality discourse. Her 'vulnerability thesis' represents the evolution of that earlier work and situates human vulnerability as a critical heuristic for exploring alternative legal and political foundations. This book draws together major British and American scholars who present different perspectives on the concept of (...) vulnerability and Fineman's 'vulnerability thesis'. The contributors include scholars who have thought about vulnerability in different ways and contexts prior to encountering Fineman's work, as well as those for whom Fineman's work provided an introduction to thinking through a vulnerability lens. This collection demonstrates the broad and intellectually exciting potential of vulnerability as a theoretical foundation for legal and political engagements with a range of urgent contemporary challenges. Exploring ways in which vulnerability might provide a new ethical foundation for law and politics, the book will be of interest to the general reader, as well as academics and students in fields such as jurisprudence, philosophy, legal theory, political theory, feminist theory, and ethics. (shrink)

This paper draws on the ethics of care to investigate how citizens grappled with ethical tensions in the mundane practice of grocery shopping at the height of the Covid-19 pandemic. We use this case to address the broader question of what it means ‘to care’ in the context of a crisis. Based on a qualitative longitudinal cross-country interview study, we find that the pandemic transformed ordinary shopping spaces into places fraught with a sense of fear and vulnerability. Being forced (...) to face one’s own vulnerability created an opportunity for individuals to relate to one another as significant others through a sense of “response-ability”, or the capacity of people to respond to ethical demands through situated ethical reasoning. We argue for a practical ethos of care in which seemingly small decisions such as how often to go shopping and how much to buy of a particular product serve as a means to relate to both specified and generalized others—and through this, ‘care with’ society. Our study contributes to displacing the continuing prevalence of an abstract and prescriptive morality in consumption ethics with a situated and affective politics of care. This vocabulary seems better suited to reflect on the myriad of small and unheroic care acts in times of crisis and beyond. (shrink)

This article tries to show the irreducible connection between vulnerability and violence. This connection leads us back to the ethical level of experience. If vulnerability makes violence irreducible, then at least two reactions to violence are possible. On the one hand, a reaction is possible in which one attempts to negate vulnerability in order to close down the very thing within us that allows violence to enter. This negative reaction is actually the worst violence. On the other (...) hand, a reaction is possible in which one attempts to affirm vulnerability, even though its affirmation opens us to the violence that will happen. Affirming vulnerability is the least-violent reaction. If the formula for the worst violence is apocalypse without remainder, then the least violence is the maintenance of the remainder. The maintenance would happen only by not possessing the remainders, which places us in a new situation of poverty. (shrink)

Transhumanism is a challenging movement that invites us to rethink what defines humanity, including what we value and regret the most about our existence. Vulnerability is a key concept that require thorough philosophical scrutiny concerning transhumanist proposals. Vulnerability can refer to a universal condition of human life or, rather, to the specific exposure to certain harms due to particular situations. Even if we are all vulnerable in the first sense, there are also different sources and levels of (...) class='Hi'>vulnerability depending on concrete social circumstances. Recently, Michael Hauskeller argued about a fundamental incompatibility between transhumanism and vulnerability. He understands vulnerability as an existential category, linked to woundability and mortality. This idea is akin to ontological vulnerability, but it does not notice some important features of social vulnerability. On the other side, transhumanism is a complex and non-homogeneous movement. Here we distinguish between a strong and a weak version of transhumanism. We will propose that the salience of vulnerability is only diminished in the radical one, while a moderate version can reconcile vulnerability with human enhancement. Thus, vulnerability, a concept that has recently gained much importance as an anthropological category in contemporary ethics, is not necessarily at odds with any transhumanist project. (shrink)

In recent years there has been an increasing interest in museum studies in exhibitions on what is termed Difficult Matters —such as rape and mass murder—and how such exhibitions may evoke ethical change. This raises the question about the conditions on which such exhibitions can lead to an ethical change. By developing a conceptual framework this article contributes to museum studies on Difficult Matters demonstrating how vulnerability can work as a key concept in a relational pedagogical understanding of the (...) conditions for ethical change. Inspired by feminist ethics the article suggests that there is an “ambivalent potentiality” of the concept of vulnerability and forwards a double perspective on vulnerability as condition: vulnerability is inherent to the human condition and always situational. From this point of departure vulnerability is fleshed out as a key concept in museum pedagogy via pedagogical thinkers inspired by the philosopher Emmanuel Lévinas’ ethics. Concepts like heteronomy, incarnation, Face and Saying/Said are introduced to define vulnerability and the relation between exhibition and visitor is defined as a teaching–learning relation conditioned by vulnerability. Vulnerability is defined as openness to an encounter with the Other as being different, which is conditional of an ethical transformation of existing perceptions of self, others and the world. Finally, inspired by feminist philosophy a norm critical is introduced. It is argued that displaying Difficult Matters in order to evoke an ethical transformation museum professionals need consider critically the norms of vulnerability at play in particular situations. On this basis, the concept of vulnerability can serve as a lever for discussions on the pedagogy of exhibitions on Difficult Matters and the ethical responsibility of museum professionals in public museums in this regard. (shrink)

Using an approach developed in the context of human bioethics, we argue that chimpanzees in research can be regarded as vulnerable subjects. This vulnerability is primarily due to communication barriers and situational factors—confinement and dependency—that make chimpanzees particularly susceptible to risks of harm and exploitation in experimental settings. In human research, individuals who are deemed vulnerable are accorded special protections. Using conceptual and moral resources developed in the context of research with vulnerable humans, we show how chimpanzees warrant (...) additional safeguards against harm and exploitation paralleling those for human subjects. These safeguards should include empowering third parties to act as surrogate decision makers for chimpanzees, ensuring participant “assent,” and avoiding recruitment of animal subjects based merely on convenience. (shrink)

By unpacking some of the dichotomies inherent in the concepts of vulnerability and disability, the article problematises some of the current legal approaches to disability in Finland. It argues that where used to single out population groups or individuals due to their embodied characteristics, the vulnerability paradigm can be seen to create binaries both among the persons with disabilities, and between the “vulnerable” persons with disabilities and the perception of a rational, self-standing and autonomous human being. To mitigate (...) such binaries, the article explores an agency-centred discourse of vulnerability, one that recognises the co-existence of agency and vulnerability and sees agency as dynamic and responsive to the societal support structures that surround all of us. One of the central arguments of the article is that generalised approaches do, however, not suffice to make agency a reality for all persons with disabilities. Given the extensive diversity of intra-group variations between persons with disabilities, individualised solutions are needed for agency to be possible for all. To overcome objectification and de-agencification – and to enhance agency – this diversity of situations, needs and contexts of lived-in realities of individuals also needs to be expressly reflected in the legal language in addressing disability. (shrink)

Should incarcerated persons be able to participate in medical research? While this is a much-debated question, Elizabeth Victor offers a fresh perspective on current regulatory approaches to research with prisoners. She delivers exactly what her book title promises: a reevaluation of protective frameworks based on her adaptation of the concept of vulnerability.Victor employs a definition of vulnerability that is “dynamic, capturing the particularities of an individual’s situation within a community of practices, norms, and a specific history”. However, she (...) also emphasizes that “by reinforcing vulnerability in populations, these practices create, sustain, or reinforce asymmetric power relations”, which... (shrink)

Going beyond the scope of psychiatric diagnoses, this study introduces the concept of human vulnerability as a means of linking the phenomenological approach—focusing on the patient’s experience—with psychotherapeutic treatment. To this end, it applies Karl Jaspers’ concept of “limit situation” to the existential vulnerability in the manifestation of mental illness and the ontological vulnerability in schizophrenia. From a psychological or empathic standpoint, vulnerability, as experienced in different cases of mental illness, refers to the condition of being (...) confronted with disturbing meaningful social encounters with others. In these social encounters, existential meanings acquire disturbing qualities for a person’s integrity, giving rise to various psychopathological phenomena. This study incorporates the practice of psychotherapy and empirical research to suggest that the experience of vulnerability is crucial not only in understanding the manifestation of mental illness but also a key element of phenomenological psychotherapeutic treatment, and it uses schizophrenia as an example. (shrink)

The COVID-19 disease has caused thousands of deaths worldwide and required the rapid and drastic adoption of various protective measures as main resources in the fight to reduce the spread of the disease. In the present study we aimed to identify socio cognitive factors that may influence adherence to protective measures toward COVID-19 in a Spanish sample. This longitudinal study analyzes the predictive value of perceived severity and vulnerability of infection, self-efficacy, direct exposure to the virus, and instrumental focused (...) coping style for adhering to infection protection behaviors during the first months of the COVID-19 pandemic. It also tests sex and age differences in these factors and changes over time. A two-wave longitudinal study was conducted in March and April 2020 starting the day after a strict national lockdown was decreed in Spain. A path analysis was used to test direct and indirect effects between vulnerability and the adherence to protective behaviors. Results suggest that individuals' perceived severity and vulnerability to COVID-19 and instrumental coping strategies are related to the use of more protective behaviors. This coping strategy mediates the effect of perceived vulnerability on engaging in protective behaviors, and this effect depends on direct exposure to COVID-19 and perceived self-efficacy moderators. Results suggest that recognizing one's own abilities to engage in instrumental actions may facilitate adherence to protective measures in people who had not been directly exposed to COVID-19. Therefore, adopting instrumental coping strategies to manage an individual's perceived vulnerability to infection may positively impact the adherence to protective behaviors, especially during the onset of an unexpected threat and when there is no prior direct experience with the situation. (shrink)

Due to impaired communication, people with aphasia are often in a vulnerable situation and face barriers in accessing health information. This article discusses the contributions ofaugmentative and alternative communication for people with aphasia in optimizing communication, improving language recovery, and mainly in providing education and increasing access to healthinformation. This can be translated into a positive impact on respect for autonomy right, well-being, quality of life, and health outcomes (further participation in the decision-making process, involvement,independence, and control of the rehabilitation (...) process). Health professionals, including nurses, must have communication skills to communicate effectively with this population and also be prepared to useaugmentative and alternative communication strategies. (shrink)

Two epidemics—Covid‐19 and opioid use disorder (OUD) —are creating short‐ and long‐term mental and physical health risks for vulnerable children and adolescents. Information about the risks to children from exposure to the coronavirus is still fragmentary, but even many healthy children are not getting appropriate health care, such as vaccinations or monitoring of developmental milestones during the Covid‐19 pandemic. Children living in poverty are at heightened risk. Youngsters who are already dealing with OUD in their families—2.2 million as of 2017—face (...) serious consequences stemming from trauma and stress. Although not officially designated by the Centers for Disease Control and Prevention as “adverse childhood experiences” (“ACEs”), these situations meet the CDC's criteria for inclusion, such as death or separation from a parent. It is important to recognize and meet the needs of all these children now and not just when the long‐term consequences become apparent. (shrink)

Scientific advances in health care have been disproportionately distributed across social strata. Disease burden is also disproportionately distributed, with marginalized groups having the highest risk of poor health outcomes. Social determinants are thought to influence health care delivery and the management of chronic diseases among marginalized groups, but the current conceptualization of social determinants lacks a critical focus on the experiences of people within their environment. The purpose of this article was to integrate the literature on marginalization and situate the (...) concept in the framework of social determinants of health. We demonstrate that social position links marginalization and social determinants of health. This perspective provides a critical lens to assess the societal power dynamics that influence the construction of the socio‐environmental factors affecting health. Linking marginalization with social determinants of health can improve our understanding of the inequities in health care delivery and the disparities in chronic disease burden among vulnerable groups. (shrink)

Resumen La ética es un saber filosófico que puede ser enfocado de distintas maneras, y una de ellas es el enfoque de la vulnerabilidad, que es un aspecto evidente de la realidad humana. Desde este punto de vista, es preciso distinguir entre la vulnerabilidad general y la vulnerabilidad contextual. Por su parte, en el caso de la vulnerabilidad contextual, es necesario distinguir entre la que es producto de opciones voluntarias y la que se produce por razones involuntarias. En el marco (...) de estas distinciones, reflexionamos sobre la situación de pandemia mun dial que estamos padeciendo y proponemos algunas medidas de carácter ético que pueden ser útiles para afrontar la crisis.Ethics is a philosophical knowledge that can be approached in different ways, and one of them is the approach to vulnerability, which is an evident aspect of human reality. From this point of view, it is necessary to distinguish between general vulnerability and contextual vulnerability. In the case of contextual vulnerability, it is necessary to distinguish between that which is the product of voluntary choices and that which occurs for involuntary reasons. Within the framework of these distinctions, we reflect on the global pandemic situation that we are suffering from and propose some ethical measures that may be useful in facing the crisis. (shrink)

Much of the debate around temporary foreign worker programs in recent years has focused on full or partial access to rights, and, in particular, on the extent to which liberal democratic states may be justified in restricting rights of membership to those who come and work on their territory. Many accounts of the situation of temporary foreign workers assume that a full set of rights will remedy moral inequities that they suffer in their new homes. I aim to show two (...) things: first, and based on experiences reported by former Live-in-Caregivers in Canada who now have access to the full set of citizenship rights, and German citizens who are descendants of Kurdish guestworkers in Germany, I have proposed that even after gaining citizenship, many of them experience social stigma and a sense of exclusion. Second, I have argued that this neglects a basic need that individuals have, which is to have access to relational resources within society in order to be protected against social deprivation. This need is seemingly immune to be effectively protected through the known catalogue of social, civic and political rights. Instead, I argue that social deprivation needs to be analyzed through the lens of institutional vulnerability to yield an analysis of the moral obligations of liberal democratic states. (shrink)

Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.

This paper is concerned with child poverty from an ethical perspective and applies the normative concept of vulnerability for this purpose. The first part of the paper will briefly outline children’s particular vulnerability and distinguish important aspects of this. Then the concept will be applied to child poverty and it will be shown that child poverty is a corrosive situational vulnerability, with many severe consequences. In this part of the paper normative reasoning and empirical literature will (...) be brought together. Then, the next section will establish why this increased vulnerability of poor children and the harm to their well-being and well-becoming, which they suffer for this reason, are of ethical concern. It will be discussed that child poverty is a structural problem based on social, political and economic factors. The concluding section will then briefly outline why it is imperative to protect children from the vulnerabilities associated with poverty. (shrink)

Significant numbers of people believe that victims of violent crime are blameworthy in so far as they imprudently place themselves in dangerous situations. This belief is maintained and fuelled by ongoing social commentary. In this paper I describe a recent violent criminal case, as a foil against which I attempt to extract and refine the argument based on prudence that seems to support this belief. I then offer a moral critique of what goes wrong when this argument, continually repeated as (...) social commentary, is left unchallenged. The effect of failing to challenge this repeated argument is the view, held by many, that the vulnerable are imprudent; indeed, they are believed negatively responsible (partly or wholly) for the violence wrought upon their person. My central claim is that public declarations of blame are morally problematic partly because they focus responsibility away from perpetrators, and partly because they harm vulnerable citizens who, as a result of internalising such public blame, suffer unnecessary constraints on their liberty. (shrink)

Vulnerability acts as a touchstone in this issue as we find our contributors reflecting on its intersection with gender and sexuality in different ways. Saeidzadeh draws out the significance of misrecognition in her consideration of responses to transsexuality in Iran, while Doonan highlights the potential pitfalls of relying on situational vulnerability in her critique of anti-trafficking legal discourse in the US. Lindsey considers the legal potential of situational vulnerability as a tool to address the ‘persistent (...) failure to take action against abuse’ in the UK. Durojaye and Oluduro contribute to the recent revitalisation in asking ‘the woman question’ by drawing on African law and literature to flesh out the development of a gender-sensitive, substantive equality approach from the jurisprudence of the African Commission on Human and Peoples’ Rights as it addresses vulnerability to violence. The reviewers continue this international conversation as they address recent contributions on sexuality, family formation and social security. (shrink)

An influential approach to engineering ethics is based on codes of ethics and the application of moral principles by individual practitioners. However, to better understand the ethical problems of complex technological systems and the moral reasoning involved in such contexts, we need other tools as well. In this article, we consider the role of imagination and develop a concept of distributed responsibility in order to capture a broader range of human abilities and dimensions of moral responsibility. We show that in (...) the case of Snorre A, a near-disaster with an oil and gas production installation, imagination played a crucial and morally relevant role in how the crew coped with the crisis. For example, we discuss the role of scenarios and images in the moral reasoning and discussion of the platform crew in coping with the crisis. Moreover, we argue that responsibility for increased system vulnerability, turning an undesired event into a near-disaster, should not be ascribed exclusively, for example to individual engineers alone, but should be understood as distributed between various actors, levels and times. We conclude that both managers and engineers need imagination to transcend their disciplinary perspectives in order to improve the robustness of their organisations and to be better prepared for crisis situations. We recommend that education and training programmes should be transformed accordingly. (shrink)

The demographic dynamics has favoured that in the last years has produced an important social change, a fundamental variable is the entry of immigrant population, in case of neighbourhoods that already they were finding in a process of social and urban development degradation, this situation has favoured the origin of certain social conflicts. This work presents some information that describe how there have been formed this process, the more out-standing factors of incident and the risks for the pacific conviviality of (...) the former and new neighbours. (shrink)

Despite the attempts to promote the inclusion of pregnant women into clinical research, this group is still widely excluded. An analysis of the “vulnerability of pregnant women” that questions deeply internalized stereotypes is necessary for finding the right balance in the protection of pregnant women as research participants. Criticism of the traditional account of vulnerability will lead to an alternative that focuses on situations rather than groups and on the obligations of responsible parties. The paper adds to the (...) current general discussion of vulnerability and at the same time addresses the specific problem of drug treatment during pregnancy. (shrink)