With aging, incidence of severe stress‐related diseases increases. However, mechanisms, underlying individual vulnerability to stress and age‐related diseases are not clear. The goal of this review is to analyze finding from the recent literature on age‐related characteristics of the hypothalamic‐pituitary‐adrenal (HPA) axis associated with stress reactivity in animals that show behavioral signs of anxiety and depression under mild stress, and in human patients with anxiety disorders and depression with emphasis on the impact of the circadian rhythm and the (...) negative feedback mechanisms involved in the stress response. One can conclude that HPA axis reaction to psycho‐emotional stress, at least acute stress, increases in the aged individuals with anxiety and depression behavior. Elevated stress reactivity is associated with disruption of the circadian rhythm and the mineralocorticoid receptor‐mediated glucocorticoid negative feedback. The disordered function of the HPA axis in individuals with anxiety and depression behavior can contribute to aging‐related pathology. (shrink)

Prosocial crowdfunding was originally conceived as a financial mechanism to assist vulnerable unbanked populations, typically excluded from formal financial markets. It subsequently grew into a billion-dollar scheme in the multi-billion-dollar crowdfunding industry. However, recent evidence claims prosocial crowdfunding may be shifting away from its goal to support the poor and underserved. Drawing on a composite social responsibility and framing theory framework, we examine the role that vulnerability plays in successfully raising funds in a prosocial crowdfunding context. We conduct multilevel (...) logistic regressions on a sample of microloans allocated to 105,727 ventures in 64 countries. Our results indicate that applying for funds through a field partner which caters to vulnerable populations may in fact have a negative effect on the entrepreneur’s request to be fully funded. Notwithstanding, framing the entrepreneur as being female or rural as key characteristics of individual vulnerability increases the project’s likelihood to be fully funded. This conflict offers noteworthy theoretical and practical implications for ethics in prosocial crowdfunding, an understudied field of research. (shrink)

Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on quality of (...) care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states. (shrink)

Vulnerability in research is often understood as a diminished ability to protect one's own interests, manifested by a compromised capacity to give informed or voluntary consent. Certain groups of people are thought to be more vulnerable than others and therefore are at risk of being exploited or mistreated in research. Accordingly, the federal regulations call for additional safeguards to protect vulnerable groups.There remains some ambiguity and contradiction, however, regarding what groups are vulnerable in research and why,3 since the available (...) codes of research ethics and regulations describe many groups as vulnerable. When so many groups are considered vulnerable, but no specification is offered as to how they are vulnerable or what particular protections are appropriate, the possibility of meaningful safeguards is diminished. In addition, current concepts of vulnerability are usually applied to whole groups of people, without distinguishing between individuals in a group who might truly have a compromised capacity to protect their own interests from those who do not. (shrink)

Individuals with limited resources are often presumed to be vulnerable in research. Concerns include the possibility of impaired decision making, susceptibility to undue inducement, and risk of exploitation. Although each of these concerns should be considered by investigators and IRBs, none justifies categorical exclusion of individuals with limited resources.

In her paper Pity and Mercy: Nietzsche’s Stoicism, Martha Nussbaum argues that Nietzsche’s philosophical project can be seen in part as an attempt to ‘bring about a revival of Stoic values of self-command and self-transformation’. She argues that, to his detriment, Nietzsche’s ‘Sovereign Individual’ epitomises a kind of stoic ideal of inner strength and self-sufficiency that ‘goes beyond Stoicism’ in its valorisation of radical self emancipation from the contingencies of life and from our own human vulnerability. Nussbaum thus (...) urges us to question whether the picture of strength in Nietzsche’s Sovereign Individual is really a picture of human strength at which we would be willing to, or at which we ought to, aim. In this paper I take up Nussbaum’s challenge, arguing that Nietzsche’s Sovereign Individual is both less stoical and provides us with a far more attractive picture of personhood than Nussbaum suggests. (shrink)

Universal vulnerability provides an alternative to a rights-based and social contract model for state responsibility by contextualizing the individual and revealing the ways in which we are all inherently and dynamically dependent on society and others throughout the life-course. Beginning from the body as an ontological concept, vulnerability theory shows the fallacy of the current obsession in legal and political theory with rationality, individual liberty, and autonomy as measures for assessing social justice. It compels us to (...) ask different questions and emphasize different principles and values than current liberal legal modes of reasoning about state responsibility. (shrink)

One of liberalism’s core commitments is to safeguarding individuals’ autonomy. And a central aspect of liberal social justice is the commitment to protecting the vulnerable. Taken together, and combined with an understanding of autonomy as an acquired set of capacities to lead one’s own life, these commitments suggest that liberal societies should be especially concerned to address vulnerabilities of individuals regarding the development and maintenance of their autonomy. In this chapter, we develop an account of what it would mean for (...) a society to take seriously the obligation to reduce individuals’ autonomy-related vulnerabilities to an acceptable minimum. In particular, we argue that standard liberal accounts underestimate the scope of this obligation because they fail to appreciate various threats to autonomy. (shrink)

International migration has a female face in the beginning of the twenty-first century; since at least 1990, a total of 49 percent of international migrants have been women (UN 2008).1 Many women relocate in pursuit of goals that they can’t realize in their countries of origin, and many women move on their own to developed countries as caregivers to the very old or the very young, as nurses to attend to the sick in hospitals, and as domestic workers.2 How should (...) we regard their decisions to do so? One way of thinking about such moves is to deplore the fact that women have to move in order to attain certain goals in their lives; it would be more desirable to live in a world that would not make such moves necessary... (shrink)

In this chapter, I examine the concept of vulnerability as a complex constitutive feature of human agency and argue that it is both a constraint on and a resource for practical reasoning. When discussed as an ontological feature of human agency, vulnerability is primarily understood as an aspect of embodiment, which is problematic in different respects. First, in relation to the situatedness of human agency, vulnerability indicates that human agents are subjected to contextual contingencies. Second, in relation (...) to temporality, vulnerability indicates that agents act in time and under the pressure of time. They are finite and produce finite and perishable actions, even though the longlasting effects of an action may survive the action itself. Third, in relation to corporal feature of agency, vulnerability is associated to suffering and frailty, insofar as bodily needs and desires represent both springs of and hindrances to rational action. Finally, in relation to the social nature of human animals, vulnerability indicates the susceptibility to be harmed, obstructed, undercut or manipulated by other agents These varieties of vulnerability are constituive features of human agency, which cannot be removed without removing what is peculiar and specific to human agency. Theories of practical reason are primarily concerned with constitutive vulnerability as a defect, and presume to offer normative guidance by adopting an idealized account of rational agency, which corrects or merely cancels the defective features of human agency. By contrast, theories of bounded rationality understand practical reasoning instrumentally, and thus are concerned with cognitive limitations of practical rationality, in particular with partial and perspectival information. However, the notion of “partial information” is inadequate to capture the complexities and significance of vulnerability, even in its restricted cognitive sense, which has to do with the agent’s situatedness. On the view I propose, instead, vulnerability is declined as a constitutive constraint on practical reasoning. Susceptibility to time constraints makes sense of the agents’ engagement in action and of their distinctive deliberative perspective. Susceptibility to bodily needs and desires tracks the normative relation between motivations and reasons for action, as well as the corporal roots of the agents’ efficacy in a perceived context. Susceptibility to others makes possible to broaden the scope and the modes of individual agency, by way of inter-action and shared agency. Rather than the source of problems and issues for rational agency, I take vulnerability to name the cluster of constitutive constraints that shape practical reasoning. According to the distinctive variety of Kantian constructivism I defend, practical reason is incomplete, rather than imperfect or defective. The completion of practical reason does not aim to correct or dissolve vulnerability, but deploys vulnerability as a resource to build up autonomy. This view accounts for autonomy as a normative relation among vulnerable agents, which develops in time. (shrink)

Vulnerability is an important concern of moral philosophy, political philosophy and many discussions in applied ethics. Yet the concept itself—what it is and why it is morally salient—is under-theorized. _Vulnerability, Autonomy, and Applied Ethics _brings together theorists working on conceptualizing vulnerability as an action-guiding principle in these discussions, as well as bioethicists, medical ethicists and public policy theorists working on instances of vulnerability in specific contexts. This volume offers new and innovative work by Joel Anderson, Carla Bagnoli, (...) Samia Hurst, Catriona Mackenzie and Christine Straehle, who together provide a discussion of the concept of vulnerability from the perspective of individual autonomy. The exchanges among authors will help show the heuristic value of vulnerability that is being developed in the context of liberal political theory and moral philosophy. The book also illustrates how applying the concept of vulnerability to some of the most pressing moral questions in applied ethics can assist us in making moral judgments. This highly innovative and interdisciplinary approach will help those grappling with questions of vulnerability in medical ethics—both theorists and practitioners—by providing principles along which to decide hard cases. (shrink)

The differential activation hypothesis (DAH; Teasdale, 1988) proposes that individuals who are vulnerable to depression can be distinguished from non-vulnerable individuals by the degree to which negative thoughts and maladaptive cognitive processes are activated during sad mood. While retrieval of negative autobiographical memories is noted as one such process, the model does not articulate a role for deficits in recalling positive memories. Two studies were conducted to compare the autobiographical memory characteristics of never-depressed and formerly depressed individuals following a sad (...) mood induction. In Study 1, features of negative memories of never-depressed and formerly depressed individuals did not differ, either in neutral or sad mood. For positive memories, groups did not differ in neutral mood, but following a sad mood induction, formerly depressed individuals rated their positive memories as less vivid than their never-depressed counterparts. Study 2 examined positive autobiographical memory features more comprehensively and replicated the finding that in a sad mood formerly depressed individuals recalled less vivid positive memories than never-depressed controls. These findings suggest that the phenomenological features of positive memories could represent an important factor in depressive vulnerability, and, more broadly, that depression may be associated with a deficit in the processing of positive material. (shrink)

One of the defining features of the capability approach to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that (...) liberal accounts of vulnerability concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability. (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)

The concept of vulnerability is widely used in bioethics, particularly in research ethics and public health ethics. The traditional approach construes vulnerability as inherent in individuals or the groups to which they belong and views vulnerability as requiring special protections. Florencia Luna and other bioethicists continue to challenge traditional ways of conceptualizing and applying the term. Luna began proposing a layered approach to this concept and recently extended this proposal to offer two new concepts to analyze the (...) concept of vulnerability, namely understanding external conditions that trigger vulnerability and layers of vulnerability with cascading effects. Luna's conception of vulnerability is useful, which we demonstrate by applying her layered view and the new analyses in multiple contexts. We begin by outlining Luna's view and we use vignettes from healthcare involving transgender patients, the care of patients in psychiatric contexts, and research involving prisoners to illustrate how each part of Luna's concept elucidates important moral issues. (shrink)

The concept of vulnerability has long played a central role in discussions of research ethics. In addition to its rhetorical use, vulnerability has become a term of art in U.S. and international research regulations and guidelines, many of which contain specific provisions applicable to research with vulnerable subjects. Yet, despite the frequency with which the term vulnerability is used, little consensus exists on what it actually means in the context of human subject protection or, more importantly, on (...) how a finding of vulnerability should affect the process of research ethics review.The Common Rule, the centerpiece of the U.S. human subject protection regulations, uses the word vulnerable three times. First, it provides that institutional review boards that regularly review research involving a vulnerable category of subjects should consider including one or more individuals who are knowledgeable about and experienced in working with these subjects. (shrink)

The so-called European principles of bioethicsare a welcome enrichment of principlistbioethics. Nevertheless, vulnerability, dignityand integrity can perhaps be moreaccurately understood as anthropologicaldescriptions of the human condition. Theymay inspire a normative language, but they donot contain it primarily lest a naturalisticfallacy be committed. These anthropologicalfeatures strongly suggest the need todevelop deontic arguments in support of theprotection such essential attributes ofhumanity require. Protection is to beuniversalized, since all human beings sharevulnerability, integrity and dignity, thusfundamenting a mandate requiring justice andrespect for fundamental (...) human rights.Being a feature of all humanity, vulnerabilityis improperly extended to designatedestitute individuals and populations. Rather,they are in a state of fallen vulnerability,for they already are harmed in some way, andhave become deprived of their range ofcapabilities. These individuals are destituteand are no longer in command of theirfundamental human rights. They have lost thestatus of unharmed vulnerability;identifying them as susceptible – vulnerated andno longer only vulnerable – stresses thepoint that bioethics demands specific socialaction to palliate or remove their distress.When harm does occur – in the form of disease,for example –, individuals are no longervulnerable – for they have ceased to be intact–, they become susceptible to additionaldeprivations and sickness; integrity isdemeaned and dignity is offended, leading tostates of dysfunction that require specificremedial social practices, aimed at treatingand removing injuries.The main point this paper addresses is thatvulnerability – as well as dignity and integrity – are descriptive characteristics ofhuman beings qua humans, which are not normative in themselves, but fundamental enoughto inspire bioethical requirements of protection and respect for human rights in thewake of social justice. A clear distinction must be made in regard to human beings who areinjured by poverty, sickness, discriminating deprivations or suffer otherdestitutions, having ceased to be only vulnerable for they are no longer intact. Theseindividuals and populations require more than protection, their needs must be met byspecific care and remedial measures to be identified and instigated by bioethics quaapplied ethics. (shrink)

There has been an exponential rise in use of the term vulnerability across a number of political and policy arenas, including child protection, sexual offences, poverty, development, care for the elderly, patient autonomy, globalisation, war, public health and ecology. Yet despite its increasing deployment, the exact meaning and parameters of this concept remain somewhat elusive. In this article, we explore the interaction of two very different strategies—one in which vulnerability is relied upon by those seeking improved social justice (...) as a mechanism by which to identify, problematise and compel state responses to a universal condition of precarious dependency, and the other in which it is used as a category of neo-liberal governance which legitimates state encroachment whilst constructing ‘vulnerable’ individuals as ‘risk-managers’ who must behave ‘responsibly’ in the face of disadvantage. We suggest that the co-existence of these divergent approaches highlights the fluidity and malleability of the concept of vulnerability. Using sex work as a specific case study, we explore the ways in which vulnerability bears multiple meanings, and has been used in recent times in the furtherance of moralistic and regressive agendas, which collude with, rather than challenge, state power. Without seeking to reject the label or normative import of vulnerability, we call, therefore, for a more circumspect approach to its usage, and a more critical evaluation of recent claims which hail it as a mechanism, preferable to the conventional use of equality paradigms, by which to secure progressive feminist outcomes. (shrink)

Cognitive reappraisal is one of the core treatment components of cognitive behavioral therapy and is the gold standard treatment for major depressive disorders. Accumulating evidence indicates that cognitive reappraisal could function as a protective factor of cognitive vulnerability to depression. However, the neural mechanism by which CR training reduces cognitive vulnerability to depression is unclear. There is ample evidence that the prefrontal–amygdala circuit is involved in CR. This study proposes a novel cognitive bias model of CR training which (...) hypothesizes that CR training may improve the generation ability of CR with altered prefrontal–amygdala functional activation/connectivity, thus reducing negative cognitive bias and alleviating depressive symptoms. This study aims to explore whether there is abnormal CR strategy generation ability in individuals who are cognitively vulnerable to depression; test the hypothesis that CR training alleviates depressive symptoms through the mediators of cognitive bias ; explore the neural mechanism by which CR training may enhance the ability of CR strategy generation; and examine the short- and long-term effects of CR training on the reduction in depressive symptoms in individuals who are cognitively vulnerable to depression following intervention and 6 months later. The study is promising, providing theoretical and practical evidence for the early intervention of depression-vulnerable individuals. (shrink)

Human beings are essentially vulnerable in the view that their existence qua humans is not given but construed. This vulnerability receives basic protection from the State, expressed in the form of the universal rights all citizens are meant to enjoy. In addition, many individuals fall prey to destitution and deprivation, requiring social action aimed at recognising the specific harms they suffer and providing remedial assistance to palliate or remove their plights.Citizens receive protection against their biologic vulnerability by means (...) of an in rem right to health [care], which is more an attitude of protection than a specific programme. When individuals become susceptible, that is, biologically weak or diseased, they also increase their predisposition to additional harm, and require social actions to treat their demeaned condition. Such assistance takes the form of positive healthcare rights.Research on human beings has been slow to observe that the subjects recruited are susceptible, especially so if research is done in less developed countries. By mislabelling them as vulnerable – a characteristic they share with all humans – sponsors avoid registering the deprivation these people suffer, and the ethical obligation to offer them remedial help.The distinction between vulnerability and susceptibility also marks the difference between being intact but fragile – vulnerable – and being injured and predisposed to compound additional harm – susceptible. Awareness of this difference should give additional force to the rejection of double standards in research ethics. (shrink)

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)

How can social institutions complicate and worsen vulnerabilities of particular individuals or groups? We begin by explicating how certain diagnoses within mental health and medicine operate as interactive kinds of labels and how such labels can create institutional barriers that hinder one's capacity to achieve wellbeing. Interactive-kind modeling is a conceptual tool that elucidates the ways in which labeling can signal to others how the labeled person ought to be treated, how such labeling comes about and is perceived, and how (...) it compounds vulnerabilities. We argue that this shift in standpoint helps us recognize and mitigate compounded vulnerabilities. (shrink)

This article challenges a prominent claim in moral philosophy: that autonomy is a personal ideal, according to which individuals are authors of their own lives. This claim is philosophically dubious and ethically pernicious, having excluded women from positions of rational authority. A reading of Ibsen's A Doll's House illustrates how this conception of the ideal of autonomy misrepresents the reality of individuals' lived experiences and imposes a gendered identity which subordinates women to a masculine narcissism. In Ibsen's play the woman, (...) as a doll confined to home, remains dependent on an autonomous man. It would seem that men in modern philosophy could see only their own image as rational agents reflected in their ethics; but, in fact, this position is self-defeating. The recognition of our contingencies and so, vulnerability, motivated Kant himself to try to make the moral realm secure with something necessarily common to all human beings: our capacity to reason. The unwitting upshot of Kant's ethics has been the restriction of reason to a purely formal function; but this autonomy of reason undermines itself in being unable to guide the writing of the rational agent's own life. I propose instead to preserve the capacities of moral rationality, while urging the incorporation of ethical practices previously devalued by their association with vulnerability, such as attention, affection and relationality. My philosophical challenge is, first, to develop an internal critique of ethics which exposes its authoritative imposition of a gender identity and, next, to propose a revised conception of autonomy, namely, not just writing our own story, but reading the stories in which we find ourselves. (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)

The study of the neuroscience and genomics of mental illness are increasingly intertwined. This is mostly due to the translation of medical technologies into psychiatry and to technological convergence. This article focuses on psychosis. I argue that the convergence of neuroscience and genomics in the context of psychosis is morally problematic, and that ethics scholarship should go beyond the identification of a number of ethical, legal, and social issues. My argument is composed of two strands. First, I argue that we (...) should respond to technological convergence by developing an integrated, patient-centred approach focused on the assessment of individual vulnerabilities. Responding to technological convergence requires that we integrate insights from several areas of ethics, translate bioethical principles into the mental health context, and proactively try to anticipate future ethical concerns. Second, I argue that a nuanced understanding of the concept of vulnerability might help us to accomplish this task. I borrow Florencia Luna’s notion of ‘layers of vulnerability’ to show how potential harms or wrongs to individuals who experience psychosis can be conceptualised as stemming from different sources, or layers, of vulnerability. I argue that a layered notion of vulnerability might serve as a common ground to achieve the ethical integration needed to ensure that biomedical innovation can truly benefit, and not harm, individuals who suffer from psychosis. (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)

Most recent thinking about thevulnerability of research subjects uses a``subpopulation'' focus. So conceived, theproblem is to work out special standards forprisoners, pregnant women, the mentally ill,children, and similar groups. In contrast, an``analytical'' approach would identifycharacteristics that are criteria forvulnerability. Using these criteria, one couldsupport a judgment that certain individuals arevulnerable and identify needed accommodationsif they are to serve as research subjects.Seven such characteristics can be evident inchildren: they commonly lack the capacity tomake mature decisions; they are subject to theauthority of (...) others; they (and their parents)may be deferential in ways that can maskunderlying dissent; their rights and interestsmay be socially undervalued; they may haveacute medical conditions requiring immediatedecisions not consistent with informed consent;they may have serious medical conditions thatcannot be effectively treated; and they (andtheir parents) may lack important sociallydistributed goods. Each of thesevulnerabilities can call for special care inthe design and implementation of researchprotocols. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations (...) of Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

Legislation for dementia care needs to be continually rethought, if the rights of older persons and other persons with dementia are to be addressed properly. We propose a theoretical framework for understanding vulnerability and dependency, which enables us to problematize the currently prevailing legal conception of adults as always able — irrespective of health or age — to act autonomously in their everyday lives. Such an approach gives rise to difficult dilemmas when persons with dementia are forced to make (...) decisions on their own about basic living conditions, such as housing and care, without decision-making support. In Sweden, for example, such matters are frequently left to the person him- or herself to decide, often without any assistance from social workers, and with family members serving as caregivers of last resort.Using vulnerability theory as the framework for our discussion, we argue that policymakers should not apply a group-oriented approach (based on factors like age, legal status, or mental capacity) to persons suffering from dementia. The needs of such individuals are as complex and varied as they themselves are. We discuss our findings from an interdisciplinary (law/social work) research project in which we examine the dilemma that social workers face when they are required, under the terms of the Swedish Social Services Act, to determine whether persons with dementia are to be granted support.We argue further that a cross-disciplinary approach — in which vulnerability theory furnishes the framework — opens up for new ways of understanding and developing social welfare law and practice. This, we believe, can help us better address the rights, interests, and needs of people with dementia, of their families, and of professionals in the social welfare system. Finally, many of the problems faced by ageing societies in general can be understood on the basis of such an approach. (shrink)

This article suggests that those individuals typically acknowledged as vulnerable during public health crises, such as pandemics, are often-times doubly so. I suggest that individuals can be vulnerable in a person-affecting way as well as in a personhood-affecting way. I suggest that the former notion of vulnerability coincides with many existing accounts of vulnerability and that subsequently, many of the more standard arguments for moral and justice-based obligations to minimize such vulnerability, hold. I also suggest that the (...) latter notion of vulnerability adds another layer of vulnerability to those that we typically view to be at risk. I argue that personhood-vulnerability constitutes a novel interpretation of vulnerability than expands our ideas of the kinds of harm that emerge during public health crises. (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)

The vulnerability of the human world is an edited book that collects papers reflecting on the problem of well-being, health, and vulnerability in our current society. The ‘human world’ to which we refer points to the anthropological, environmental, and ecological issues in relation to health and well-being that we propose to discuss. It addresses the need for a critical anthropological concept that overcomes the biases of modern anthropocentrism while addressing the specific responsibility of humans in contemporary world crisis. (...) We do not try to give a final definition for what vulnerability is, but we problematize the notion of well-being as a standard of non-vulnerability that is often imposed on human beings; often well-being becomes a measure within which human beings should fit to not be vulnerable. Consequently, well-being has been implicitly defined as the opposite of vulnerability – especially when vulnerability is conceived as a risk or a threat to oneself or the community, rather than a potential source of growth and transformation. For this reason, we believe that well-being is more the title of a problem rather than its solution. This paradigm initiates, indeed, a “positive” conception of health that aims to push the boundaries of human finitude such as suffering, illness and the recognition of mortality. Usually, we assume that well-being is the final goal of our choices and the gist of a decent life, but we spend more time striving for well-being than asking ourselves what being well means for us, as individuals and societies. This paradox may generate emotional frustration which often worsens our condition rather than helps it reach its optimum. Moreover, it may generate and increase inequalities between people and countries who may suffer from the discrepancies in their access to healthcare or vaccination. Therefore, it also raises questions about collective justice and interdependence. Indeed, the concept of well-being seems to block a critical and epistemological appraisal of the concept of “health,” conflating thereby the impression of being “well,” which is normed by sociological, cultural and moral standards with the lived reality of what it means to be healthy – which itself needs to be questioned in light of the scientific paradigms that built human biology and environmental approaches over the past decades. (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)

Drawing from a wide array of disciplinary perspectives and geographical contexts, this volume offers new insights for critically engaging with the problem of vulnerability. The essays here contained take the move from the COVID-19 pandemic, in order to explore the inherent vulnerability of individuals, but also of social, economic and political systems, and probe the descriptive and prescriptive import of the concept.Each chapter provides a self-contained perspective on vulnerability, as well as a specific methodological framework for questioning (...) its meaning. Taken together, the chapters combine into a multi-disciplinary toolkit for approaching the various forms and structures of vulnerability, with a special attention to the intersectional factors shaping the individual experience of it: from gender to age, from disability to mental illness, from hospitalisation to incarceration. The book explores the theoretical richness and complexity of the concept and proposes new analytical approaches to it, before illustrating its multifariousness through empirically grounded case studies. The closing section engages with “the future of vulnerability”, as a hermeneutic, epistemological, and critical-normative perspective to be deployed beyond the domain of global crises and emergencies.The volume is primarily intended as a reference for scholars in the human, social and health sciences. The accessible structure and plain language of the chapters make it also a valuable didactic resource for graduate courses in philosophy, the social sciences and public health. (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)

The contemporary emphasis on vulnerability and interdependence stresses the ethical necessity of a critical care concept to undermine the individualistic paradigm of autonomy and the modern understanding of well-being regarding individual self-achievement and world mastery. This paper analyzes how the philosophical investigation of vulnerability has led to an existential, social, and ethical reflection that brought to light a fundamental interdependence among living beings. This chapter examines the nature of this interdependence and the type of relations involved in (...) these dynamics. The author argues that caring for the living involves a holistic approach of the human being that considers not only the plurality of her interpersonal relations but also her relation to the environment and her relation to her ‘self’ as a person with rights and responsibility. Moreover, speaking of interdependence also implies examining the philosophical understanding of our modern concepts of nature and culture along the lines of a philosophical critique of the immunity paradigm and cultural biology anew. Drawing on phenomenological ethics, this chapter shows that the concept of responsibility that stems from this renewed understanding of interdependence implies an ethics based on responsiveness and responsibility that articulates the dignity of human beings as persons with the care for the living they demonstrate in the ‘forms of life’ they inhabit with others. It bears consequences for contemporary issues in bioethics, such as caring for vulnerable people or determining the moral standing of our relations. (shrink)

In this essay I present an overview of the problem of climate change, with attention to issues of interest to feminists, such as the differential responsibilities of nations and the disproportionate “vulnerabilities” of females, people of color, and the economically disadvantaged in relation to climate change. I agree with others that justice requires governments, corporations, and individuals to take full responsibility for histories of pollution, and for present and future greenhouse gas emissions. Nonetheless I worry that an overemphasis on household (...) and personal-sphere fossil fuel emissions distracts from attention to higher-level corporate and governmental responsibilities for addressing the problem of climate change. I argue that more attention should be placed on the higher-level responsibilities of corporations and governments, and I discuss how individuals might more effectively take responsibility for addressing global climate change, especially when corporations and governments refuse to do so. (shrink)

This article proposes a novel defense of vaccine mandates: such policies are justifiable because they protect the capabilities of individuals who cannot cultivate individual immunity against infection. We begin by considering a nearby argument that has recently enjoyed popularity, which claims individuals have an enforceable obligation to get vaccinated because they have benefited from community protection (often referred to as ‘herd immunity’), and thus they ought to do their fair share in sustaining that public good by getting vaccinated. We (...) object, however, that this kind of argument misstates the ethical basis for vaccine mandates because community protection primarily protects unvaccinated people. We contend that the duty to vaccinate is not fundamentally an obligation to make a fair contribution to a public good from which vaccinated people benefit, but a duty to protect the wellbeing of otherwise vulnerable third parties. We flesh out our view by drawing on Martha Nussbaum's capabilities approach. (shrink)

Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged distinguishing between different types of vulnerability, criticizing the categorization of populations as vulnerable, and questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of (...) vulnerability. As a phenomenon of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously. (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)

Shame in the deep sense of fear of exposure of human vulnerability (and not in the narrower sense of individual transgression or fault) has been identified as one mood or disposition of philosophical thinking. Philosophical imaginary, disciplinary identity and misogynistic vocabulary testify to a collective, underlying, unprocessed shame inherent to the (Western) philosophical tradition like Le Doeuff (1989), Butler (2004) and Murphy (2012) have pointed out. One aspect of collective philosophical shame has to do with disgust of or (...) denial of embodiment insofar as it poses a threat to ideals of sovereignty and rationality (Nussbaum 2006). Embodiment reveals finitude, being dependent and exposed to others (Sartre 1984; Merleau-Ponty 2012; Landweer 1999; Zahavi 2014), and ultimately points to human vulnerability as rooted in an experience of fear of shame (Gilson 2016). If the inability to process shame of embodiment has resulted in disembodied notions of the human being that may lead to defensiveness, aggression or violence, how can a constructive processing of shame based on an embodied notion of the human being result in a way of philosophical thinking that is more vulnerable? And how can philosophical thinking that has its point of departure in vulnerability, neither in the sense of the victim nor the hero but as a self-conscious emotion, lead to philosophical dialogues that can unsettle vicious cycles of shaming and blaming and are productive for deepening philosophical reflection? Susan Brison’s (2002) work on sexual violence will finally be discussed as an example of such a philosophy. (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)

ABSTRACT This paper offers an account of institutional testimonial justice and describes one way that it breaks down, which we call institutional opacity. An institution is opaque when it becomes resistant to epistemic evaluation and understanding by its agents and users. When one cannot understand the inner workings of an institution, it becomes difficult to know how to comport oneself testimonially. We offer an account of an institutional ethos to explain what it means for an institution to be testimonially just; (...) we then describe how an ethos of institutional testimonial justice can break down when the institution becomes opaque. An opaque institution is especially problematic for individuals and groups already rendered epistemically vulnerable during their interactions with that institution, which we call epistemically vulnerabilised individuals. We articulate the features of an encounter between an epistemically vulnerabilised individual and an opaque institution. We end by tracing ameliorative strategies that could help repair a deteriorated institutional ethos of testimonial justice. (shrink)

The vulnerability of participants in Substance Abuse and Mental Health Services Administration (SAMHSA) programs is a consequence of the illnesses that they are experiencing; ethical guarantees must be in place that ensure the dignity of the persons involved in such programs. Dignity is more than an individual concern; it has individual, institutional, and societal dimensions. An ethical framework is proposed that involves the interrelated vulnerabilities and needs of individuals and communities and our societal response to them. Among (...) the issues given particular attention are individual and community stigmatization, target population involvement in program planning, balance with regard to confidentiality and privacy, the place of proportionality grounded in a rich sense of community as a guiding ethical principle, and guidelines for SAMHSA programs. (shrink)

We present the perspective of a Bioethics Consultation Service operating in an urban hospital in Dayton, Ohio, USA, as it adapted to treating Sars-CoV-2 patients throughout 2020. Since the first case of COVID-19 was reported in Ohio on 9 March 2020, until 1 January 2021, the Bioethics Consultation Service was consulted 60 times, a 22.5% increase from the same period of 2019. The most common diagnoses requiring consultation included end-stage renal disease requiring dialysis, out-of-hospital cardiac arrest, and sepsis. Only 10% (...) of consultations were for patients hospitalized with COVID-19. This is a qualitative analysis of the cases we saw and a discussion of factors that affected our service while adapting to COVID-19 standards of care. (shrink)

Vulnerability is one of the least examined concepts in research ethics. Vulnerability was linked in the Belmont Report to questions of justice in the selection of subjects. Regulations and policy documents regarding the ethical conduct of research have focused on vulnerability in terms of limitations of the capacity to provide informed consent. Other interpretations of vulnerability have emphasized unequal power relationships between politically and economically disadvantaged groups and investigators or sponsors. So many groups are now considered (...) to be vulnerable in the context of research, particularly international research, that the concept has lost force. In addition, classifying groups as vulnerable not only stereotypes them, but also may not reliably protect many individuals from harm. Certain individuals require ongoing protections of the kind already established in law and regulation, but attention must also be focused on characteristics of the research protocol and environment that present ethical challenges. (shrink)