The concept of vulnerability is broad and covers a wide variety of fields, areas of research and analysis. This blog post discusses the concept of vulnerability in bioethics.
The dictionary definition of ‘vulnerability’ is that it is both, a noun originating from the Latin vulnus (wound), and an adjective ‘vulnerable’. The word vulnerable is used to describe something that is “susceptible to physical or emotional attack or damage”, however, when applied in different contexts the word has a variety of implications. For example, in conversations surrounding climate change, the term vulnerability can be defined as the tendency for an entity to suffer damage due to environmental causes. In economics, it can relate to a countries’ capacity to maintain financial reserves to pay its external debt.
Despite these differences, the variations in the concept of vulnerability appear to revolve around its etymology in that it correlates with the conditions of exposure or susceptibility to wounding.
An interesting paper by Cunha and Garrafa (2016) examined the concept of vulnerability from different perspectives across five regional approaches to bioethics from the United States, Europe, Latin America, Africa to Asia.
Vulnerability in the Bioethics of United States Origin
The most common perspective of bioethics from the United States focus on the relationship of vulnerability with the principle of autonomy. A vulnerable person is one who is incapable of making decisions regarding their interests. This appears to be intertwined with the moral conflicts and political associations of a history favouring the individual and one’s freedom and autonomy over values and interests of a more collective nature. Even when there have been strong debates around this topic area such as the vulnerability of racial minorities, the economically disadvantaged and the very sick and institutionalised, the debate appears to return to issues surrounding autonomy and consent. In response to this, there has been a suggestion that the development of a wide-ranging theory of vulnerability is required. This then would consider both the intrinsic vulnerability of certain groups, for example women, and the social and cultural determinants that make women even more vulnerable than others. However, this approach has not been accepted as the mainstream perspective of bioethics in the United States.
Vulnerability in the Bioethics of European Origin
Although there are similarities to the concept of vulnerability between the U.S. and Europe, it has been proposed that there are distinct differences. The influence of two European philosophers; Emmanuel Levinas and Hans Jonas have made this impact. According to Levinas, vulnerability is the foundation of subjectivity and of ethics itself, this is because of the existence of a “first person” who will depend on the non-violent encounter of the other. In this way, individuals are vulnerable in the most basic and fundamental way. According to Jonas, vulnerability is an attribute of all living things that can die. The European Bioethical community (Basic Ethical Principles in European Bioethics and Biolaw) drew up at four principles that would be fundamental regarding the topics bioethics and biolaw. These were autonomy, dignity, integrity, and vulnerability. It is argued that vulnerability should be understood as “ontologically prior” to the other principles, in so far as it expresses an attribute that precedes any other norm.
Vulnerability in the Bioethics of Latin American Origin
Within Latin America, the concept of vulnerability in bioethics evolved around the 1970s. This may be as a result of conflicts that occurred in Latin America where the United States were directly involved, thus leading the subject of bioethics to become politically and socially intertwined rather than a purely academic discipline. This shift reflected bioethics that was deeply grounded with the social and collective inequalities that were prevalent at the time, including poverty, inequality, social and environmental exploitation. The view of vulnerability expanded to encompass various forms of exclusion of population groups in relation to events or benefits that may be occurring within the worldwide process of development. Discussion centred around the adjective ‘vulnerable’ to mean ‘weaker subject or issue’ or ‘the point through which someone can be attacked, harmed or wounded’. This shaped the concept of vulnerability toward a human frailty, a lack of protection and helplessness or even abandonment.
Further, the concept of vulnerability became a topic that was spatiotemporally involved when using the words ‘potential’ or ‘actual’ capacity to be affected through the terms ‘vulnerated’ and ‘vulneration’. The concept of vulnerability could be seen as the potential of something that could be wounded, rather than actually wounded. A vulnerated state is one in which an act has taken place. Seen in another way, all living beings are susceptible to being wounded (vulnerability), but only those that have actually been wounded are vulnerated.
Latin American bioethicists brought forward political differences between vulnerability as an ontological condition and vulnerability as a contingent situation. Susceptibility, in this context, was characterised as the socially produced circumstances that threatened groups required justified protective action by the state. Social vulnerability emerged, which was taken to mean the limits of self-determination and increased exposure to risk created by a situation of social exclusion. There was a certain degree of push back when using the concept of vulnerability to characterise abstract subjects without clearly delineating the subjects themselves. In the main, this was in relation to the ‘colonial’ pattern of power that has structured the world system since the beginning of the modern era, through white, European-American, Christian, heterosexual men. It became apparent that the Latin American bioethical conception of vulnerability was strongly related to the social dimension of vulnerability, where socioeconomic differences among populations are highlighted with connections to the political and ethical control of humans.
Vulnerability in the Bioethics of African Origin
African bioethics researchers have been critical of institutionalised University centred studies in light of continued reference to Western bioethics. Among African bioethics literature there is reference to traditional medicine, proverbs, songs, mythology, folklore and religious rites. In particular, philosophical approaches to life such as Ubuntu, a tradition within African thinking that includes a set of values and thoughts which are distinct and contrast from Western approaches. The late Archbishop Desmond Tutu described Ubuntu to mean ‘I am because we are’. He went on to explain;
“ We believe that a person is a person through other persons. That my humanity is caught up, bound up, inextricably, with yours. When I dehumanise you, I dehumanise myself. The solitary human being is a contradiction in terms. Therefore, you seek to work for the common good because your humanity comes into its own in community, in belonging.”
Beauchamp and Childress (2001) developed four principles within Western bioethics—autonomy, non-maleficence, beneficence and justice. In contrast to this, African bioethics replace justice with harmony and also replace respect for individuals for autonomy. Vulnerability, therefore, exists within communal and collective forms of humanity rather than the individual autonomous person.
Vulnerability in the Bioethics of Asian Origin
Due to Asia’s vast size and diversity in respect to culture and religion, Asia benefits from a rich and varied tradition of bioethics. For example, Buddhist and Taoist bioethics emphasise the role of compassion, empathy, hope, and wisdom. Similar to African bioethics, there exists an emphasis on the role of family, community, and religious traditions. The complex context of cultural, territorial and religious diversity of Asia makes it challenging to construct a single theoretical and normative foundation for the bioethics of that region. Vulnerability, therefore, becomes consistent with African bioethics in that it is a context dependent concept oriented towards openness towards others with a shared sense of collaborative support bound by culture and religious form of practices.
Summary
As noted, in bioethics originating from the United States, vulnerability is usually correlated with incapacity to provide consent or to exercise autonomy, whereas in European bioethics the focus is mostly on the condition of intrinsic frailty of all living beings. From the Latin American perspective, discussions are characterised by a political focus aimed at identifying the ways in which vulnerability develops and exploits communities. What is evident is that these perspectives do not contradict each other and may actually complement each other in that they focus on different instances of vulnerability. For example, the individual dimension is highlighted in American bioethics, whereas the ontological dimension is clear in European bioethics and the political dimension strongly is evident in Latin American bioethics. African and Asian bioethical perspectives shed light on a shared and community-based concept of vulnerability despite regional, geographical, spiritual and religious differences.
A universal definition for the principle of vulnerability is not clear, and efforts toward this appear unwarranted. Attempts at trying to resolve any conflicts involving the concept of vulnerability within the field of bioethics will not be achieved through negotiated geographical definitions. However, it might be beneficial to identify and address the reasons, agents, and processes that maintain the unequal distribution of wounds among different individuals and groups across the world.
References
Cunha, T., & Garrafa, V. (2016). Vulnerability: A Key Principle for Global Bioethics? Cambridge Quarterly of Healthcare Ethics, 25(2), 197-208. doi:10.1017/S096318011500050X
Beauchamp TL, Childress JF (2001) Principles of biomedical ethics. 5th. New York: Oxford University Press.
Perspectives on Physiotherapy 