Diet directly affects children’s physical and mental development. Nonetheless, how food insecurity and household food consumption impact the cognitive performance of children at risk of social exclusion remains poorly understood. In this regard, children in Guatemala face various hazards, mainly related to the socioeconomic difficulties that thousands of families have in the country. The main objective of this study was to analyze the differences in cognitive performance considering food insecurity and household food consumption in a sample of rural and urban (...) Guatemalan children and adolescents at risk of social exclusion. Child cognitive performance was assessed in 134 children and adolescents from rural and urban settings. Language, attention, and executive functions were assessed using neuropsychological tasks. Differences in cognitive performance in each level of food insecurity and household diet consumption were compared using the Mann–Whitney U test. A stepwise multivariate regression analysis was conducted to determine which factors may influence cognitive scores. The results showed that rural and urban groups did not differ in terms of food insecurity. However, considering just rural areas, differences were found between groups with food security and insecurity in attention and executive function tasks. Moreover, differences were found in food consumption for certain groups of food. Regarding regressions, protein food consumption, which is related to having a more balanced diet, was a relevant factor in executive performance. Contrary to what we expected, performance in attentional tasks was not related to the consumption of any food group. These findings could help politicians and decision-makers to select actions focused on improving diet balance and food security in families at risk of social exclusion. It is necessary to carry out more specific studies on the factors related to diet that affect the cognitive development of minors at risk of social exclusion. In addition, it is necessary to study the implementation of alternative interventions that include low-cost nutrients, thus ensuring that minors have access to a more balanced diet. (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)

There is a consensus that the effects of medical brain drain, especially in the Sub-Saharan African countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue—while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In the first (...) step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves would hold responsibilities to assist with respect to vital needs of their compatriots. These are fair reciprocity, duty to support vital institutions, and attending to the unintended harmful consequences of one’s actions. While the first two are explained and also largely discussed in the literature, the third requires an explication on how and on which basis skilled workers would have a responsibility as such. In this article, I offer a vulnerability approach with its dependency aspect that may account for why the health workers in underserved contexts would have a responsibility to attend to the unintended side effects of their actions that may lead to a vital risk of harm for the population. I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility. (shrink)

ABSTRACT When hope is discussed in bioethics’ literature, it is most often in the context of ‘false hopes’ and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of imagination in (...) hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified. (shrink)

ABSTRACT When hope is discussed in bioethics’ literature, it is most often in the context of ‘false hopes’ and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of imagination in (...) hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified. (shrink)

This paper provides an empirical and conceptual account on seeing machine learning models as part of a sociotechnical system to identify relevant vulnerabilities emerging in the context of use. As ML is increasingly adopted in socially sensitive and safety-critical domains, many ML applications end up not delivering on their promises, and contributing to new forms of algorithmic harm. There is still a lack of empirical insights as well as conceptual tools and frameworks to properly understand and design for the impact (...) of ML models in their sociotechnical context. In this paper, we follow a design science research approach to work towards such insights and tools. We center our study in the financial industry, where we first empirically map recently emerging MLOps practices to govern ML applications, and corroborate our insights with recent literature. We then perform an integrative literature research to identify a long list of vulnerabilities that emerge in the sociotechnical context of ML applications, and we theorize these along eight dimensions. We then perform semi-structured interviews in two real-world use cases and across a broad set of relevant actors and organizations, to validate the conceptual dimensions and identify challenges to address sociotechnical vulnerabilities in the design and governance of ML-based systems. The paper proposes a set of guidelines to proactively and integrally address both the dimensions of sociotechnical vulnerability, as well as the challenges identified in the empirical use case research, in the organization of MLOps practices. (shrink)

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long‐term benefits of such research, and seemingly minimal risk, a strong claim could be made that all non‐acute psychiatric inpatients, including forensic and involuntary patients, should be included in such research, provided they have capacity to consent. There are tensions, however, regarding the ethics of (...) recruiting psychiatric inpatients into such studies. In this paper our intention is to elucidate the source of these tensions from the perspective of research ethics committee interests and decision‐making. We begin by defining inpatient status and outline some of the assumptions surrounding the structures of inpatient care. We then introduce contemporary conceptions of vulnerability, including Florencia Luna’s account of vulnerability which we use as a framework for our analysis. While psychiatric inpatients could be subject to consent‐related vulnerabilities, we suggest that a particular kind of exploitation‐related vulnerability comes to the fore in the context of our case study. Moreover, a subset of these ethical concerns takes on particular weight in the context of genetic research in low‐ and middle‐income countries. At the same time, the automatic exclusion of inpatients from research elicits justice‐related vulnerabilities. (shrink)

Despite advances in theory, often driven by feminist ethicists, research ethics struggles in practice to adequately account for and respond to the agency and autonomy of people considered vulnerable in the research context. We argue that shifts within feminist research ethics scholarship to better characterise and respond to autonomy and agency can be bolstered by further grounding in discourses from the social sciences, in work that confirms the complex nature of human agency in contexts of structural and other (...) sources of vulnerability. We discuss some of the core concepts and critiques emerging from the literature on women and children's agency in under‐resourced settings, highlighting calls to move from individualistic to relational models of agency, and to recognise the ambiguous, value‐laden, and heterogeneous nature of the concept. We then draw out what these conceptual shifts might mean for research ethics obligations and guidance, illustrating our analysis using a case vignette based on research ethics work conducted in South Africa. We conclude that if research practices are to be supportive of agency, it will be crucial to scrutinise the moral judgements which underpin accounts of agency, derive more situated definitions of and responses to agency, and enable people and participants to influence these based on their own experiences and self‐perceptions. (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)

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)

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)

Social epistemologists should be well-equipped to explain and evaluate the growing vulnerabilities associated with filter bubbles, echo chambers, and group polarization in social media. However, almost all social epistemology has been built for social contexts that involve merely a speaker-hearer dyad. Filter bubbles, echo chambers, and group polarization all presuppose much larger and more complex network structures. In this paper, we lay the groundwork for a properly social epistemology that gives the role and structure of networks their due. In (...) particular, we formally define epistemic constructs that quantify the structural epistemic position of each node within an interconnected network. We argue for the epistemic value of a structure that we call the (m,k)-observer. We then present empirical evidence that (m,k)-observers are rare in social media discussions of controversial topics, which suggests that people suffer from serious problems of epistemic vulnerability. We conclude by arguing that social epistemologists and computer scientists should work together to develop minimal interventions that improve the structure of epistemic networks. (shrink)

Vulnerabilities often characterize the availability of immigrant populations of interest in social behavioral science, public health, and medical research. Refugees, asylum seekers, and undocumented immigrants present unique vulnerabilities relevant to protocol development as well as ethics review procedures and criteria. This paper describes vulnerable populations in relation to the Belmont Report and US federal regulations for the protection of human subjects, both of which are commonly used in international research contexts. It argues for safeguards for immigrants comparable to (...) protections for such populations as pregnant women, prisoners, and children. The paper further presents a two-part model for the review of protocols that involve immigrants. The model is intended to help identify the risks to immigrants associated with participation in research, and to suggest how researchers can responsibly frame studies and access to research participant immigrants through community-based, and/or non-governmental organizations that serve immigrants and immigrant communities. (shrink)

Vulnerability as a critique of the one-sidedness of the principle of autonomy is at risk of overemphasizing the positive dimension of vulnerability. Moreover, in the discourse on vulnerability, the threat of dehumanization (or moral vulnerability) has not been scrutinized enough ethically. Therefore, the ethics of vulnerability is insufficient when faced with the force of war that requires the conceptualization of vulnerability for political-ethics. The Russian war in Ukraine demonstrates this weakness in a striking way: the called-for openness to the other (...) as well as an active form of nonviolence, as promoted by Judith Butler, may not be an option in times of war. Continuing Jessica Benjamin’s psychoanalytic approach to mutual recognition, the essay shows that the task of morality does not rest upon broadening one’s vulnerability, but rather in understanding vulnerable agency as the dialectic of vulnerability and agency. For the further development of this dialectic, the triadic figuration is emphasized, complementing the dyadic relation of self and other. While the Third can take multiple figurations in the psychoanalytical setting, I understand the Third within the political-ethical context as the possibility of a “moral world” of nonviolence and respect. During war, the role of the bystander is to become a witness who, through the process of witnessing, advocacy, diplomacy, and justice, allows for the moral Third to reemerge. Among others, the ethics of vulnerability must spells out the price for the failure of taking on this responsibility, namely the eclipse of morality. (shrink)

The vulnerability of patients receiving significantly innovative neurosurgical procedures, either as research or as non-standard therapy, presents particularly potent challenges for those attempting to substantially advance clinical Neurosurgical practice in the most ethically and efficacious manner. This beginning formulation has built into it several important notions about research participation, balancing values, and clinical advancement in the context of neurological illness. For the time being, allow vulnerability to act as a placeholder for circumstances or states of being wherein the established checks (...) and balances of power and interest are no longer sufficient in promoting the just treatment of persons. Further, the phrase to substantially advance Neurosurgical practice encompasses radical innovation as well as significant research into new procedures. Finally, few of these explorations involve true randomized placebo controlled trials, but rather they enroll patients rightfully hoping for some benefit by means of undergoing the procedure.When a neurosurgeon asks me, as an ethicist, to meet with a patient who has medically refractory disease and no good standard therapy options remaining, he is asking for help concerning whether to offer, as a last chance, an unproven therapy as either innovation or research. (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)

Several foundational documents of bioethics mention the special obligation researchers have to vulnerable research participants. However, the treatment of vulnerability offered by these documents often relies on enumeration of vulnerable groups rather than an analysis of the features that make such groups vulnerable. Recent attempts in the scholarly literature to lend philosophical weight to the concept of vulnerability are offered by Luna and Hurst. Luna suggests that vulnerability is irreducibly contextual and that Institutional Review Boards (Research Ethics (...) Committees) can only identify vulnerable participants by carefully examining the details of the proposed research. Hurst, in contrast, defines the vulnerable as those especially at risk of incurring the wrongs to which all research ethics participants are exposed. We offer a more substantive conception of vulnerability than Luna but one that gives rise to a different rubric of responsibilities from Hurst's. While we understand vulnerability to be an ontological condition of human existence, in the context of research ethics, we take the vulnerable to be research subjects who are especially prone to harm or exploitation. Our analysis rests on developing a typology of sources of vulnerability and showing how distinct sources generate distinct obligations on the part of the researcher. Our account emphasizes that the researcher's first obligation is not to make the research participant even more vulnerable than they already are. To illustrate our framework, we consider two cases: that of a vulnerable population involved in international research and that of a domestic population of people with diminished capacity. (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)

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)

ABSTRACTThe concept of ‘vulnerability’ is well established within the realm of research ethics and most ethical guidelines include a section on ‘vulnerable populations’. However, the term ‘vulnerability’, used within a human research context, has received a lot of negative publicity recently and has been described as being simultaneously ‘too broad’ and ‘too narrow’.1 The aim of the paper is to explore the concept of research vulnerability by using a detailed case study – that of mineworkers in post‐apartheid South Africa. (...) In particular, the usefulness of Kipnis’s taxonomy of research vulnerability will be examined.2In recent years the volume of clinical research on human subjects in South Africa has increased significantly. The HIV and TB pandemics have contributed to this increase. These epidemics have impacted negatively on the mining industry; and mining companies have become increasingly interested in research initiatives that address these problems. This case study explores the potential research vulnerability of mineworkers in the context of the South African mining industry and examines measures that can reduce this vulnerability. (shrink)

The concept of ‘vulnerability’ is well established within the realm of research ethics and most ethical guidelines include a section on ‘vulnerable populations’. However, the term ‘vulnerability’, used within a human research context, has received a lot of negative publicity recently and has been described as being simultaneously ‘too broad’ and ‘too narrow’.1 The aim of the paper is to explore the concept of research vulnerability by using a detailed case study – that of mineworkers in post‐apartheid South Africa. (...) In particular, the usefulness of Kipnis’s taxonomy of research vulnerability will be examined.2In recent years the volume of clinical research on human subjects in South Africa has increased significantly. The HIV and TB pandemics have contributed to this increase. These epidemics have impacted negatively on the mining industry; and mining companies have become increasingly interested in research initiatives that address these problems. This case study explores the potential research vulnerability of mineworkers in the context of the South African mining industry and examines measures that can reduce this vulnerability. (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)

Background:In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged.Objective:This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China.Research design:This article adopts an empirical ethical approach that integrates empirical investigation with ethical inquiry.Participants and research (...) context:The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital.Ethical considerations:Approval was obtained from the university ethics committee.Findings:The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care.Conclusion:Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations. (shrink)

I propose a reconsideration of the role that ‘interpellations’ play in the dynamic process of identity construction. ‘Interpellation’ is a quasi-technical term introduced by Louis Althusser (1969) that I reinterpret using the lens of contemporary social ontology. I therefore look at it as an identity proposal that the individual can either accept, reject, negotiate, or outright ignore. In the original text, Althusser mentions the fact that the individual’s acceptance is the essential moment of an interpellation, but he does not elaborate (...) on the other options available to the individual. I believe it is important to analyze the individual’s options and the factors that may influence whether the individual’s freedom of choice is fully exercised in such contexts. I further discuss the human vulnerabilities that cause ‘interpellations’ to be adopted without much reflection, even in the absence of a repressive system that would try to enforce a mainstream ideology. (shrink)

Many contexts shape and limit moral thinking in philosophy and life. Human conditions of vulnerability and interdependency, of limited awareness and control, of imperfect insight into ourselves and others are inevitable contexts that neither moral thought nor theory should forget. To be truly reflective, moral thinking and moral philosophy must become aware of the contexts that bind our thinking about how to live. This collection of essays by Margaret Urban Walker seek to show how to do this, (...) and why it makes a difference. Contingent and changeable contexts that shape moral thinking include our individual histories, our social positions, and institutional roles, relationships, cultural settings, and social arrangements, and the specific moral idioms we pick up along the way. The paradigms and specialized language of ethical theory are contexts, too; they shape how moral theory looks and what or whom it looks at. Ethical theory and practice are meaningless without these Moral Contexts. (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 vulnerability of a patient gives rise to special obligations to provide aid, but the extent of our obligations to those vulnerable is not always clear. How far we are obligated to provide aid raises profound questions over the balance of liberty, equality, utility, and other core values for which we ought to strive in modern society. This essay helps illustrate how such a balance must be worked out in relation to rich contexts and be responsive to continually (...) evolving epistemic and social configurations. (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)

This paper uses an environmental justice framework to examine government response to weather-related disasters dating back some eight decades. It places the 2005 Hurricane Katrina disaster in socio-historical context of past emergencies with an emphasis on race and class dynamics and social vulnerability. Key questions explored include: What went wrong? Can it happen again? Is government equipped to plan for, mitigate against, respond to, and recover from natural and manmade disasters? Can the public trust government response to be fair? Why (...) are so many African Americans Alocked out@ of New Orleans= post-Katrina rebuilding, reconstruction, and recovery? (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)

The article analyses the three terms autonomy, dignity and vulnerability. The relevance and practical application of the terms is tested in two spheres. First, as guiding principles in the area of ethics of medicines and science. Second, as human rights principles, serving to guide the conduct of public policies for an effective realization of human rights. The article argues that all human beings have the same dignity, but that the autonomy—and therefore vulnerability—differs considerably. Simply said, with reduced autonomy comes increased (...) vulnerability, implying extra attention to the protective dimensions. The article finds that the three terms approach the protection of human beings in different ways and that all are relevant and applicable in both spheres, but that an isolated notion of autonomy and a ‘group-based’ notion of vulnerability are not adequate. (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)

In conceptualizing vulnerability, it is common for researchers to assume that some participants are more vulnerable on the basis of their membership of a particular group or because they exhibit particular characteristics. Older people are often viewed as inherently more vulnerable by ethics committees and the ethical guidelines committees construct. Because age alone does not confer or cause vulnerability, risk of harm to older research participants is not purely associated with their intrinsic connection to a vulnerable group, (...) and classifying older research participants as vulnerable may not necessarily protect them from harm. Drawing on the preliminary findings of a qualitative study of older people who had survived a suicide attempt, we reflect on how the specific context of our study had the potential of framing older people as vulnerable, and describe ways in which these were managed and resolved. Specifically, we discuss potential for harm through the ethical principles of coercion and distress. (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)

Introduction: Vulnerability is a poorly understood concept in research ethics, often aligned to autonomy and consent. A recent addition to the literature represents a taxonomy of vulnerability developed by Kipnis, but this refers to the conduct of clinical trials rather than qualitative research, which may raise different issues. Aim: To examine issues of vulnerability in cancer and palliative care research obtained through qualitative interviews. Method: Secondary analysis of qualitative data from 26 black Caribbean and 19 white British patients with advanced (...) cancer. Results: Four domains of vulnerability derived from Kipnis’s taxonomy were identified and included: (i) communicative vulnerability, represented by participants impaired in their ability to communicate because of distressing symptoms; (ii) institutional vulnerability, which referred to participants who existed under the authority of others—for example, in hospital; (iii) deferential vulnerability, which included participants who were subject to the informal authority or the independent interests of others; (iv) medical vulnerability, which referred to participants with distressing medical conditions; and (v) social vulnerability, which included participants considered to belong to an undervalued social group. Participants from both ethnic groups populated all these domains, but those who were black Caribbean were more present among the socially vulnerable. Conclusions: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualise vulnerability using the domains identified in this study and consider the research context and interviewers’ skills. (shrink)

Introduction -- Entering the world of medicine: contexts -- Why bioethics needs a philosophy (and theology) of medicien -- Perspectives on philosophy of medicine -- Perspectives on theology of medicine -- Finding the target: Messer's theology of health -- A philosophical-theological framework for medicine -- Human vulnerability and the goods of medicine -- Re-engaging the world of medicine: applying philosophy and theology of medicine.

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)

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)

The central thesis of Susan Okin's Justice, Gender, and the Family—that the ideology of the traditional family is the linchpin of contemporary gender inequality in the US—remains significant more than a quarter-century after the book's publication. On a political register, Okin's insistence on structural analysis of gender inequality is an important corrective to recent mainstream feminist emphasis on individual women's choices. On an academic register, her work reveals the incoherence of scholarly classifications of feminist theories as “liberal feminist” or “radical (...) feminist” by confounding such distinctions. I argue that her thesis is best understood in relation to the early radical feminism of Juliet Mitchell's Woman's Estate, a book Okin praised. Placing Okin's work in the context of its radical roots clarifies her “linchpin thesis,” but also reveals the limitations of her argument: in her emphasis on what Iris Young has termed the “distributive paradigm of justice,” Okin unnecessarily adopts a much narrower definition of the family than did Mitchell, and overestimates the influence of economic vulnerability after divorce on women's capacity to exit marriage. I suggest modifications to her theory, and conclude by showing the continuing relevance of her argument for analyzing recent legal, policy, and demographic shifts. (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)

Vulnerability and politics are among the relevant and key topics of discussion in the Ethiopian healthcare context. Attempts by the formal bioethics structure in Ethiopia to deliberate on ethical issues relating to vulnerability and politics in healthcare have been limited, even though the informal analysis of bioethical issues has been present in traditional Ethiopian communities. This is reflected in religion, social values, and local moral underpinnings. Thus, the aim of this paper is to discuss the bioethical implications of vulnerability and (...) politics for healthcare in Ethiopia and to suggest possible ways forward. First, we will briefly introduce what has been done to develop bioethics as a field in Ethiopia and what gaps remain concerning its implementation in healthcare practice. This will give a context for our second and main task – analyzing the healthcare challenges in relation to vulnerability and politics and discussing their bioethical implications. In doing so, and since these two concepts are intrinsically broad, we demarcate their scope by focusing on specific issues such as poverty, gender, health governance, and armed conflicts. Lastly, we provide suggestions for the ways forward. (shrink)

The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a (...) satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories. (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)

Sophie Scott-Brown’s intellectual biography of Colin Ward does a superb job of putting Ward’s anarchism in its historical and political context. In so doing Scott-Brown arguably draws attention to how Ward’s pragmatic anarchism was dependent on post-war social democracy in the UK. This comment explores whether this makes Ward’s anarchism vulnerable in the following sense: that, as an anarchism, it cannot take sides in the struggle between social democracy and neo-liberalism even though its own prospects for success depend on (...) the strength of social democracy. Ward’s anarchism may be contrasted in this respect with libertarian/radical democratic socialisms (such as of Sheila Rowbotham and Stuart Hall) which envisage a simultaneous struggle both ‘for’ and ‘against’ the (social democratic) state. (shrink)