ON VULNERABILITY—ANALYSIS AND APPLICATIONS OF A MANY-FACETED CONCEPT Introduction

The concept of vulnerability has received some attention in philosophical thinking for a while (see, amongst others, Lévinas 1968; Habermas 1981 and 1991; Jonas 1984; Ricoeur 2001), but it was only more recently that philosophers and bioethicists started to systematically investigate (and sometimes criticize) its meaning and ethical applicability (see, for example, Goodin 1986; Rendtorff & Kemp 2000; Levine et al. 2004; Hurst 2008; Schroeder & Gefenas 2009; Luna 2009; Mackenzie, Rogers, and Dodds 2013; Straehle 2016). Despite the many academic contributions on vulnerability over the last two decades, the concept remains underdeveloped and many ethical issues related to it are still unresolved. One of the biggest challenges is probably to determine the scope of vulnerability. On the one hand, vulnerability is often regarded as a shared property of all human beings: we have fragile bodies and we are mortal, fallible, and susceptible to harm and suffering (see, amongst others, Callahan 2000; Thomasma 2000; Rendtorff 2002; Kottow 2003; Fineman 2008; Butler 2009 and 2012). This understanding of vulnerability as a human condition is mostly (with a few exceptions) regarded as descriptive, and its link to other concepts such as dependency, care, sentience, and frailty so far remains open. On the other hand, one can find more normative accounts of vulnerability in the literature: many medical codes of research and health-care ethics require special protection for and attention to those vulnerable in these settings—a view that presupposes that some individuals and groups are more vulnerable than others (see, for example, Belmont Report 1979; ICH Good Clinical Practice 1996; Declaration of Helsinki 2013; CIOMS 2016). The groups designated as particularly vulnerable in this sense depend on the ethical code and guideline in question and may include pregnant women, prisoners, the elderly, the disabled, children, refugees, etc. This approach, which ascribes vulnerability to some only, was criticized for stigmatizing and labelling the individuals who fall into these categories (Luna 2009; Brown 2011). For this reason, some accounts of vulnerability do not focus exclusively on group membership, but rather single out the property that the individuals in these groups allegedly share. According to these views, we should regard as vulnerable those who are more likely to be exploited, who are unable to protect or safeguard their own interests, who lack basic rights, who are susceptible to additional harm, or who are at risk of having unequal opportunity to achieve the maximum possible health and quality of life (Zion et al. 2000; Danis & Patrick 2002; Kottow 2003; Macklin 2003; Nickel 2006). The group identified as vulnerable in a given situation can thus substantially vary according to the definition used, and some vulnerable groups may be overlooked when the focus is on only a single aspect of vulnerability. This shows that it is still far from clear who actually is vulnerable in certain contexts and who, as a consequence, should receive special protection and additional attention. Only a few accounts have attempted to resolve this apparent conflict in the lite-rature between the different understandings of vulnerability. Rogers, Mackenzie, and Dodds (2012), for example, present a taxonomy of vulnerabilities by distinguishing inherent, situational, and pathogenic vulnerability: while all humans share the same inherent vulnerability, there can be certain situations where some individuals are more vulnerable than others. Furthermore, some responses to existing vulnerabilities may exacerbate them or generate new ones. Luna (2009, 2018) argued that we should not use vulnerability as a label for certain groups; rather, we should accept a layered account of vulnerability. According to her view, vulnerability is determined by the relationship of the person in question to a certain context: individuals can …