In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations of (...) Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

A currently popular view traces autistic cognitive abnormalities to a defective capacity for theorizing about other minds. Two prominent researchers, Uta Frith and Francesca Happé, extend this account by tracing further autistic abnormalities to impaired self-consciousness. This paper argues that Frith and Happé's account requires a treatment of autistic self-report that is problematic on both methodological and philosophical grounds. However, the philosophical problems point to an alternative account of self-awareness and self-report in normal individuals; and this account gives us a (...) methodologically more attractive approach to explaining autistic abnormalities. (shrink)

For them, citizenship is by definition a matter of treating people as individuals with equal rights under the law. This is what distinguishes democratic citizenship from feudal and other pre-modern views that determined people's political status by ...

In lieu of an abstract, here is a brief excerpt of the content:The Interpersonal and Emotional Beginnings of Understanding: A Review of Peter Hobson’sThe Cradle of Thought: Exploring the Origins of ThinkingShaun Gallagher (bio)Hobson's book (2002) is extremely accessible, interestingly interdisciplinary, and knowledgeable in all the right ways. He pulls together work in psychiatry, experimental psychology, and psychoanalysis in a framework that is relevant to issues in the philosophy of mind. We are told much of this in the preface, and (...) it is true. I think it is an excellent book for students and for theorists who have an interest in, but who are not working in the specific areas of, cognitive development. I recommend it highly for those audiences. For those who are already working in these areas, and for those who are already familiar with Hobson's work, there are no surprises. As someone who has learned a good deal from Hobson and who is in substantial agreement with many of his conclusions, I read the first six chapters of the book looking for something new and exciting, but did not find it. The reader will nonetheless find clear and careful discussions of contributions from evolutionary theory, developmental psychology, and psychopathology to our understanding of the mind.Hobson does tackle the difficult question of why we should include psychoanalysis as part of the investigation. He views psychoanalysis as a kind of experimental procedure. Like the experimentalist, the psychoanalyst "sets up an unusual situation that allows him to observe things that would otherwise remain hidden" (p. 19). What the psychoanalyst looks for in these arrangements are patterns of relationship that shape all of the patient's behavior and thought, relations with others and with herself. The analyst has to engage in something like a second-person phenomenology, examining not only the subjective [End Page 253] patterns of the patient, but also the effects (specifically the emotional effects) those patterns have on the analyst himself. The outcome of analysis, for purposes of the research project that Hobson is engaged in, is twofold. First, the psychoanalytic procedure reaches certain dimensions of thought and social relationships that seem unavailable to experimental approaches. "We find that the mind works in ways that are more complex than common sense or even experimental psychology would suggest. In particular, there are ways of thinking and relating to people that appear to be more primitive and less rational than we might suppose" (pp. 21-2). Second, psychoanalysis shows that what happens within an individual's mind is essentially related to what happens in her social relationships. The latter point, as Hobson notes, is a central theme of his book.This is all well and good, the experimental psychologist might say, but it seems overly subjective. After all, if the data include the emotional effects that a patient might have on the investigator, how precisely can we make that scientifically objective? I think that the right answer to that question is embodied in Hobson's approach, and perhaps in who Hobson is. Hobson is himself an experimental psychologist, as well as a practicing psychoanalyst and psychiatrist. He balances the claims that he bases on psychoanalysis with results from studies (including many of his own studies) in experimental psychology and psychiatry. To put it precisely, the task is not to turn the subjective or intersubjective data from psychoanalysis into objective data, but to explore subjectivity (which is certainly part of what we want to explain) by means of a method that gets at things from a different perspective, but that is also consistent with and balanced by the more objective results of experimental science. My own doubts about psychoanalysis are somewhat mitigated by the balance that Hobson maintains throughout this book.Chapters 2 through 6 summarize a large number of studies that ultimately make the case for the importance of intersubjectivity in the development of mental abilities. Chapter 2 explores the necessary prerequisites for the emergence of thought in infancy. Evidence found in experiments on and observations of the interaction between infants and caregivers, early imitation, and emotional relatedness supports the picture of a mix of innate and acquired aspects that move the child toward thought. Significant emphasis is devoted to the role of perception and... (shrink)

Imagine you are walking down a city street. It is windy and raining. Amidst the bustle you see a young woman. She sits under a railway bridge, hardly protected from the rain and holds a woolen hat containing a small number of coins. You can see that she trembles from the cold. Or imagine seeing an old woman walking in the street at dusk, clutching her bag with one hand and a walking stick with the other. A group of male (...) youths walk behind her without overtaking, drunk and in the mood for mischief. It doesn't need an academic to say what vulnerability is. We can all see it, much more often than we care to. (shrink)

Book reviewed in this article: Protecting The Vulnerable: A Reanalysis of Our Social Responsibilities. By Robert E. Goodin. Chicago: University of Chicago Press.