In this article, I explore the role of affective feedback loops in creating and sustaining trust and distrust. Some emotions, such as fear and contempt, drive out trust; others, such as esteem and empathy, drive out distrust. The mechanism here is causal, but not merely causal: affective looping works through changing how the agent interprets the words, deeds, and motives of the other, thus making trust or distrust appear justified. Looping influences not only dyadic trust, but also climates, and networks (...) of trust and distrust. Not all trust-entrenching looping is virtuous, nor all distrust-entrenching looping vicious, but distrust looping is a powerful way to justify xenophobic public policy. I explore options for remedy. (shrink)

In this article I examine several criticisms of the concept of vulnerability. Rather than rejecting the concept, however, I argue that a sufficiently rich understanding of vulnerability is essential to bioethics. The challenges of international research in developing countries require an understanding of how new vulnerabilities arise from conditions of economic, social and political exclusion. A serious shortcoming of current conceptions of vulnerability in research ethics is the tendency to treat vulnerability as a label fixed on a particular subpopulation. My (...) paper examines the role of this “label” metaphor in current statements of research ethics. In contrast to this prevailing “label” metaphor, my own positive account of vulnerability develops a dynamic way of understanding the structure of the concept of vulnerability based on the idea of “layers of vulnerability.” I examine several cases involving women, as they are sometimes labeled as a vulnerable population and sometimes not. My analysis demonstrates the essential role of this revised concept of vulnerability in bioethics and research ethics. (shrink)

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)

Theories of social justice are necessarily abstract, reaching beyond the particular and the immediate to the general and the timeless. Yet such theories, addressing the world and its problems, must respond to the real and changing dilemmas of the day. A brilliant work of practical philosophy, Frontiers of Justice is dedicated to this proposition. Taking up three urgent problems of social justice neglected by current theories and thus harder to tackle in practical terms and everyday life, Martha Nussbaum seeks a (...) theory of social justice that can guide us to a richer, more responsive approach to social cooperation. The idea of the social contract--especially as developed in the work of John Rawls--is one of the most powerful approaches to social justice in the Western tradition. But as Nussbaum demonstrates, even Rawls's theory, suggesting a contract for mutual advantage among approximate equals, cannot address questions of social justice posed by unequal parties. How, for instance, can we extend the equal rights of citizenship--education, health care, political rights and liberties--to those with physical and mental disabilities? How can we extend justice and dignified life conditions to all citizens of the world? And how, finally, can we bring our treatment of nonhuman animals into our notions of social justice? Exploring the limitations of the social contract in these three areas, Nussbaum devises an alternative theory based on the idea of capabilities. She helps us to think more clearly about the purposes of political cooperation and the nature of political principles--and to look to a future of greater justice for all. (shrink)

This paper raises several concerns about vulnerability as an alternative language to conceptualize injustice and politicize its attendant injuries. First, the project of resignifying “vulnerability” by emphasizing its universality and amplifying its generative capacity, I suggest, might dilute perceptions of inequality and muddle important distinctions among specific vulnerabilities, as well as differences between those who are injurable and those who are already injured. Vulnerability scholars, moreover, have yet to elaborate the path from acknowledging constitutive vulnerability to addressing concrete injustices. Second, (...) vulnerability studies respond to, and have been shaped by, debates in the 1980s and 1990s over oppression, identity and agency. This genealogy needs to be acknowledged and evaluated. As I demonstrate, prominent theorists define vulnerability in contradistinction to victimization, adopting neo-liberal formulations of victims and victimhood. Finally, I turn to address the politics of vulnerability. At issue are not simply matters of utility or programmes for implementation, but the fraught relationship among ontology, ethics and politics, which I address through an engagement with Rancière's conception of the political and the case of the Black Lives Matter movement. (shrink)

Where society is viewed as an association of equal and autonomous persons, the work of caring for dependents, "love's labors", figure neither in political ...

This paper aims to understand the relationship between ignorance and vulnerability by drawing on recent work on the epistemology of ignorance. After elaborating how we might understand the importance of human vulnerability, I develop the claim that ignorance of vulnerability is produced through the pursuit of an ideal of invulnerability that involves both ethical and epistemological closure. The ignorance of vulnerability that is a prerequisite for such invulnerability is, I contend, a pervasive form of ignorance that underlies and grounds other (...) oppressive forms of ignorance. Thus, undoing such forms of ignorance requires working toward a particular form of vulnerability: epistemic vulnerability. (shrink)

What does it mean to be disadvantaged? Is it possible to compare different disadvantages? What should governments do to move their societies in the direction of equality, where equality is to be understood both in distributional and social terms? Linking rigorous analytical philosophical theory with broad empirical studies, including interviews conducted for the purpose of this book, Wolff and de-Shalit show how taking theory and practice together is essential if the theory is to be rich enough to be applied to (...) the real world, and policy systematic enough to have purpose and justification. The book is in three parts. Part 1 presents a pluralist analysis of disadvantage, modifying the capability theory of Sen and Nussbaum to produce the 'genuine opportunity for secure functioning' view. This emphasises risk and insecurity as a central component of disadvantage. Part 2 shows how to identify the least advantaged in society even on a pluralist view. The authors suggest that disadvantage 'clusters' in the sense that some people are disadvantaged in several different respects. Thus identifying the least advantaged is not as problematic as it appears to be. Conversely, a society which has 'declustered disadvantaged' - in the sense that no group lacks secure functioning on a range of functionings - has made considerable progress in the direction of equality. Part 3 explores how to decluster disadvantage, by paying special attention to 'corrosive disadvantages' - those disadvantages which cause further disadvantages - and 'fertile functionings' - those which are likely to secure other functionings. In sum this books presents a refreshing new analysis of disadvantage, and puts forward proposals to help governments improve the lives of the least advantaged in their societies, thereby moving in the direction of equality. (shrink)

It is not unusual for the adjective ‘vulnerable’ to be applied to those in receipt of nursing practice without making clear what it is that persons thus described are actually vulnerable to. In this paper I argue that the way nursing has adopted the idea of vulnerability tends to imply that some people are in some way invulnerable. This is conceptually unsustainable and renders the idea of the vulnerable patient meaningless. The paper explores the meaning of vulnerability both in general (...) terms and in the context of nursing practice. It is argued that to be in receipt of nursing is to become, to a greater or lesser extent, more‐than‐ordinary vulnerable. Thus all patients are more‐than‐ordinarily vulnerable and this restricts their potential to flourish. Nurses are well placed to contribute to the flourishing of more‐than‐ordinarily vulnerable persons and my substantive claim is that this ‘protective’ function is indeed a legitimate and fundamental part of the role of nurses. (shrink)

I argue to a conclusion I find at once surprising and intuitive: although many considerations show trust useful, valuable, important, or required, these are not the reasons for which one trusts a particular person to do a particular thing. The reasons for which one trusts a particular person on a particular occasion concern, not the value, importance, or necessity of trust itself, but rather the trustworthiness of the person in question in the matter at hand. In fact, I will suggest (...) that the degree to which you trust a particular person to do a particular thing will vary inversely with the degree to which you must rely, for the motivation or justification of your trusting response, on reasons that concern the importance, or value, or necessity of having such a response. (shrink)

Despite broad agreement that the vulnerable have a claim to special protection, defining vulnerable persons or populations has proved more difficult than we would like. This is a theoretical as well as a practical problem, as it hinders both convincing justifications for this claim and the practical application of required protections. In this paper, I review consent-based, harm-based, and comprehensive definitions of vulnerability in healthcare and research with human subjects. Although current definitions are subject to critique, their underlying assumptions may (...) be complementary. I propose that we should define vulnerability in research and healthcare as an identifiably increased likelihood of incurring additional or greater wrong. In order to identify the vulnerable, as well as the type of protection that they need, this definition requires that we start from the sorts of wrongs likely to occur and from identifiable increments in the likelihood, or to the likely degree, that these wrongs will occur. It is limited but appropriately so, as it only applies to special protection, not to any protection to which we have a valid claim. Using this definition would clarify that the normative force of claims for special protection does not rest with vulnerability itself, but with pre-existing claims when these are more likely to be denied. Such a clarification could help those who carry responsibility for the protection of vulnerable populations, such as Institutional Review Boards, to define the sort of protection required in a more targeted and effective manner. (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.

In this urbane and witty book, Ronald de Sousa disputes the widespread notion that reason and emotion are natural antagonists.

_The Ethics of Need: Agency, Dignity, and Obligation_ argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely to meet others’ needs but (...) to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

Vulnerability has been extensively discussed in medical research, but less so in health care. Thus, who the vulnerable in this domain are still remains an open question. One difficulty in their identification is due to the general criticism that vulnerability is not a property of only some, but rather of everyone. By presenting a philosophical analysis of the conditions of vulnerability ascription, we show that these seemingly irreconcilable understandings of vulnerability are not contradictory. Rather, they are interdependent: they refer to (...) the same concept with different likelihoods of manifestation. We argue that the general vulnerability of living beings relies on their having certain types of interests. In health care, those individuals are particularly vulnerable who are more likely to have these interests unjustly considered. They should be afforded special protection in order to receive what is due to everyone, but which they are likely to fail to receive. (shrink)

In this paper I argue for a special kind of injustice I call “trust injustice.” Taking Miranda Fricker's work on epistemic injustice as my starting point, I argue that there are some ethical constraints on trust relationships. If I am right about this, then we sometimes have duties to maintain trust relationships that are independent of the social roles we play.

A summary of the philosophical literature on trust.

The Ethics of Need: Agency, Dignity, and Obligation argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely to meet others’ needs but (...) to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

What makes individuals, groups, or even entire countries vulnerable? And why is vulnerability a concern in bioethics? A simple answer to both questions is that vulnerable individuals and groups are subject to exploitation, and exploitation is morally wrong. This analysis is limited to two areas. First is the context of multinational research, in which vulnerable people can be exploited even if they are not harmed, and harmed even if they are not exploited. Second is the situation of women, who are (...) made vulnerable in cultural settings or in entire countries in which they are oppressed and powerless. (edited). (shrink)

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

This paper advances a new criterion of a vulnerable population in research. According to this criterion, there are consent-based and fairness-based reasons for calling a group vulnerable. The criterion is then applied to the case of people with serious illnesses. It is argued that people with serious illnesses meet this criterion for reasons related to consent. Seriously ill people have a susceptibility to “enticing offers” that hold out the prospect of removing or alleviating illness, and this susceptibility reduces their ability (...) to safeguard their own interests. This explains the inclusion of people with serious illnesses in the Belmont Report’s list of populations needing special protections, and supports the claim that vulnerability is the rule, rather than the exception, in biomedical research. (shrink)

ABSTRACTThis essay elaborates how an imbalanced reciprocity between inhabitants of places of relative safety and places of greater precarity results from pursuing security on the basis of a reactive fear of vulnerability. It analyzes a range of features that shape the complex forms that vulnerability takes with a particular focus on how the constitution of places as rhetorically and corporeally secure or not renders different groups of people secure and/or subject to heightened exposure to harm. This analysis suggests that vulnerability (...) is better conceived as a process than a quality, mediating between conceptions of vulnerability as a universal condition and as a highly specific empirical condition. Finally, by departing from the negative, reactive view of vulnerability that animates the supposition of the boundedness of selves and places, an alternative conception of security that neither equates it with invulnerability nor opposes it to vulnerability can be developed. (shrink)

The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a (...) satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories. (shrink)

Traditionally, philosophers have focused on whether and how emotions threaten autonomy, insofar as they lie outside the sphere of rational agency. That is, they have conceptualized emotional vulnerability as passivity. Second, they have considered how emotions are insensitive to rational judgment, focusing on cases in which emotions are dissonant or recalcitrant. Third, in recognizing the motivational force of emotions, philosophers have tracked their negative impact on rational deliberation. Indeed, emotions are often contrastive elements in rational deliberation. They appear to defeat (...) deliberative judgments about what to do, survive rational deliberation or preempt the very possibility of rational deliberation. But there are more interesting cases in which it is apparent that emotions bear a rather complicated relation to autonomy. Love and shame provide powerful examples of the ambivalences and complexities of such a relation. In analyzing such complexities, my aim is to present a case for appreciating various dimensions of vulnerability and, correspondingly, for exposing the importance of emotional vulnerability for agential autonomy. This view is rooted in a general account of agential autonomy marked by mutual respect and recognition of others, as a normative response to constitutive vulnerability, understood as the capacity to affect and be affected by others as well as by external agentive and non-agentive causes. (shrink)