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  • Introduction
  • Wendy Rogers (bio), Catriona Mackenzie (bio), and Susan Dodds (bio)

Our motivation for proposing a special issue of IJFAB on vulnerability is twofold. First, there is growing interest in the concept of vulnerability within both bioethics and feminist theory. Reflecting this interest, this special issue provides a forum for exploring the relevance for bioethics of feminist perspectives on vulnerability. Second, despite growing recognition within bioethics of the moral significance of vulnerability, the concept remains under-theorized in bioethical (and wider philosophical) discourse. Questions that are central to current debates but that require further theoretical analysis include the following: What is vulnerability and what are the sources of vulnerability? What duties are owed to the vulnerable, and by whom? How can we respond to vulnerability while also respecting autonomy and promoting resilience? And should vulnerability be a foundational concept in bioethics, alongside autonomy, justice, beneficence, and nonmaleficence? The articles in this special issue address these and other questions from a range of theoretical perspectives.

Within bioethics, vulnerability has received the most attention in relation to research ethics. Protection of vulnerable research participants has been a major concern since the publication of the Nuremberg Code. Although the Code did not specifically mention vulnerability, by mandating informed consent it sought to mitigate the general vulnerability of patients asked to participate in research. The Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research 1979) explicitly introduced the concept [End Page 1] of "vulnerable groups," paving the way for special considerations directed toward those whose capacities to consent freely might be compromised, or who are dependent or easily exploited. These two early codes set in train a tension about the scope of the concept that continues to resonate in current debates. On the one hand, all research participants are potentially vulnerable and need the protections offered by measures such as the requirement to give uncoerced, informed consent. On the other hand, vulnerability is used as a marker to identify individuals or groups who require extra protections or exclusion from research altogether. The concept of vulnerability thus seems to be both universal and particular in scope. When applied universally, however, vulnerability seems to lose its moral purchase, while its use in identifying only some individuals or groups as especially vulnerable risks stereotyping and paternalism (Luna 2009).

In other areas of bioethics such as clinical and public health ethics, discussions of vulnerability are less detailed. The European Commission has identified vulnerability as one of its Basic Ethical Principles in Bioethics and Biolaw (along with autonomy, dignity, and integrity), and vulnerability is identified in Article 8 of UNESCO's Universal Declaration on Bioethics and Human Rights. These documents refer both to the universal vulnerability of the human condition, and single out individuals or groups who are especially vulnerable. Within public health ethics, vulnerability has come to be used as a marker for increased risk of ill health, where vulnerable populations are those who, by virtue of socioeconomic or other disadvantage, have higher burdens of morbidity and mortality than those who are better off. While there are accounts of what is owed the vulnerable within public health ethics (see, for example, Brock 2002), there is no agreement about how to identify the vulnerable or develop responses to vulnerability that avoid the discrimination and paternalism identified as problematic in research ethics. Thus within bioethics, scholars are increasingly using the concept of vulnerability, while at the same time, there is confusion about its scope and little consensus about how to reconcile the universal notion of vulnerability with that of the especially vulnerable.

These tensions reflect a more general ambiguity between two different ways of understanding the concept of vulnerability, which is evident in both the philosophical literature and in feminist theory. On the one hand, some theorists understand vulnerability as "a universal, inevitable, enduring aspect of the human condition" (Fineman 2008, 8). To be vulnerable is to be fragile and susceptible to wounding and to suffering; this susceptibility is an ontological condition of our corporeal humanity. It is because we are embodied that human beings have "an [End Page 2] organic propensity to disease and sickness, that death and dying are inescapable, and that...

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