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

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.

Situational vulnerability within mental healthcare – a qualitative analysis of ethical challenges during the COVID-19 pandemic

“…As the German Ethics Council (2022) writes: “Vulnerability is not merely a characteristic of affected individuals, but precisely the result of comprehensive constellations in which risk factors and protective factors interact in a complex manner. To a good extent, these constellations can also be influenced and produced.” Victor and colleagues argue that it is our obligation to “eradicate, minimize, and not exacerbate vulnerability” [ 26 ]. In our analysis, we have identified different layers and triggers of vulnerability of service users and patients during the pandemic.…”

“…The data analysis included seven steps: (1) MF and AW both read and commented on all survey documents individually and wrote summaries for each survey document; (2) they developed main categories under the supervision of JG after coding 20% of the documents, by combining inductive coding based on the content of the survey documents, with deductive coding based on the experiences of the working group members and the categories were discussed with JG; (3) all material was coded by MF and AW using the categories developed in step 3; (4) all text parts coded within the same category were reviewed together by MF and AW and the categories were assigned to superordinate themes together with JG; (5) the categories and superordinate themes were discussed with all members of the working group; (6) all survey documents were coded again by MF and AW; finally, (7) topics deemed ethically salient were chosen for discussion by all authors. Based on the ethical challenges identified and the discourse on vulnerable groups during the pandemic, the authors decided to ethically evaluate the former using a framework of dynamic vulnerability [ 26 , 32 ]. The authors acknowledge that their social position, background, and experience with the mental healthcare system influences the interpretation of data.…”

“…The German Ethics Council’s use of the term is coherent with more recent theoretical works on vulnerability. Drawing on critiques of the traditional model [ 31 ], Luna [ 32 ] and further bioethicists [ 26 ] have developed a dynamic model of vulnerability for research ethics, public health, and the clinical context that uses the metaphor of “layers” [ 26 ]. Layers of vulnerability are dispositions that track an increased risk of suffering harm or disadvantage within a specific context.…”

“…The conditions that lead to the actualization of a vulnerability are called “triggers.” Different layers of vulnerability may coexist and be addressed independently of each other. “Layers of vulnerability with cascading effects” are those which may compound or generate further layers of vulnerability [ 26 ]. According to Luna, the concept of vulnerability is useful for bioethical evaluations, because normative obligations can be derived from sources and triggers of vulnerabilities [ 26 ].…”

“…“Layers of vulnerability with cascading effects” are those which may compound or generate further layers of vulnerability [ 26 ]. According to Luna, the concept of vulnerability is useful for bioethical evaluations, because normative obligations can be derived from sources and triggers of vulnerabilities [ 26 ].…”