Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

Vulnerability does not mean much for our contemporary morality. It is antithetical to our emphasis on individualism and rationality; it requires that we attend to the body and to our feelings. Yet only by recognizing the depth and breadth of our vulnerability can we affirm our humanity.

There is a wind of change about to affect the training of all house officers in the United States. The Accreditation Council of Graduate Medical Education has promulgated a set of general competencies for all U.S.-trained residents, with a major thrust focused on bioethics and professionalism that will likely catch residency directors unaware. The ACGME's General Competencies document globally addresses many relationship-based ethical roles and responsibilities of house officers in healthcare. Of note, this document contains a specific section on professionalism. (...) However, the entire document is woven with a sustained thread of medical ethics throughout its other sections. The intent is to imbue each physician with those skills, rules, and aspects of character that will be a foundation for humane, ethical, professional conduct. Professionalism does indeed go beyond ethical principles, accounting for competency and commitment to excellence and, most of all, implying a virtue ethics account of medical practice. The need to address the central place of virtue ethics in house-staff education is apparent, and we now have the right tool for the job—the ACGME General Competencies. (shrink)