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. 2022 Jun;36(5):587-596.
doi: 10.1111/bioe.13023. Epub 2022 Apr 28.

Vulnerability in practice: Peeling back the layers, avoiding triggers, and preventing cascading effects

Elizabeth Victor  1 , Florencia Luna  2 , Laura Guidry-Grimes  3 , Alison Reiheld  4
Affiliations

Vulnerability in practice: Peeling back the layers, avoiding triggers, and preventing cascading effects

Elizabeth Victor et al. Bioethics. 2022 Jun.

Abstract

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.

Keywords: prisoner research; psychiatric ethics; public health ethics; research ethics; transgender healthcare; vulnerability.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

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References

    1. Council for International Organizations of Medical Sciences in collaboration with the World Health Organization. (2002). International ethical guidelines for biomedical research involving human subjects. World Health Organization. - PubMed
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    2. In this article, the President and Secretary of CIOMS address some of the modifications introduced and point out the need for changing the notion of vulnerability, endorsing Luna’s analyses and quoting her work.

    1. Critics have noted that “the concept is so nebulous that it becomes at most meaningless. The label of ‘vulnerability’ is so broad that in one way or another, ‘everybody’ is vulnerable.”

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    1. For an extended analysis of the concept of vulnerability, including historical criticisms of the term, see

    2. Guidry-Grimes L, & Victor E (2012). Vulnerabilities compounded by social institutions. International Journal of Feminist Approaches to Bioethics, 5(2), 126–146.
    1. Luna F (2009). Elucidating the concept of vulnerability: Layers not labels. International Journal of Feminist Approaches to Bioethics, 2(1), 121–139.

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