Universal Vulnerability Research Articles

Why bioethics needs a concept of vulnerability

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.

“What should make thee inaccessible to my fury?”: Gothic Self‐Possession, Revenge, and the Doctrine of Necessity in William Godwin’s Caleb Williams

This essay argues that Caleb Williams (1794) continues the critique of liberalism’s insistence on individual rights and autonomous subjectivity that William Godwin launched in An Enquiry Concerning Political Justice one year earlier. Throughout the novel, various conflicts are staged around competing individuals’ claims to inalienable rights; however, Godwin shows that these competing claims reproduce the paranoid and vengeful narrative logic of the Gothic. He offers an alternative to this narrative dead end through the Doctrine of Necessity, which views human action as deriving from prior and external causes rather than as the expression of free will. This doctrine allows Godwin to imagine individuals as interdependent links in a virtually endless chain of causes and reactions. Thus, the “unsatisfactory” ending of the novel – which finds Caleb and Falkland no longer concerned with their competing individual claims to life and liberty but instead “penetrated” by remorse and concern for one another – represents a rejection of the narrative appeal of the Gothic and an endorsement of universal vulnerability, rather than universal rights, as an ethical basis for the relationship of self and other.

State Killing, the Stage of Innocence, and The Exonerated

Ryan's essay analyzes the coordination of the innocence argument and sentimentality in Jessica Blank and Erik Jensen's TheExonerated (2003), a documentary play based on interviews with people sentenced to die for crimes they did not commit. The play's composition, performance, and reception reveal the challenges of creating art that is aimed at social reform and confirm the difficulty in assessing the political function or, in Fredric Jameson's sense, the political unconscious of American literature. As a celebrated example of political theater, The Exonerated also provides a forum for thinking through the contemporary terms and framework of conversations about state killing. Ryan argues that the play stimulates reform and elicits sympathy by substituting a false rhetoric of universal vulnerability for a more accurate assessment of imprisonment and judicial murder. The attempt to make the play accessible, emotional, and persuasive also sets real limits on how audience members are asked think about personal and social responsibility. Some of these efforts include a focus on the wrongly convicted instead of the guilty, a balance of white and black interviewees in the face of a racially unbalanced justice system, a rendering of pain as uplifting for audiences, and an encouragement of personal and financial solutions rather than structural and political ones.

Misfits: A Feminist Materialist Disability Concept

This article offers the critical conceptmisfitin an effort to further think through the lived identity and experience of disability as it is situated in place and time. The idea of a misfit and the situation of misfitting that I offer here elaborate a materialist feminist understanding of disability by extending a consideration of how the particularities of embodiment interact with the environment in its broadest sense, to include both its spatial and temporal aspects. The interrelated dynamics of fitting and misfitting constitute a particular aspect of world-making involved in material-discursive becoming. The essay makes three arguments: the concept of misfit emphasizes the particularity of varying lived embodiments and avoids a theoretical generic disabled body; the concept of misfit clarifies the current feminist critical conversation about universal vulnerability and dependence; the concept of misfitting as a shifting spatial and perpetually temporal relationship confers agency and value on disabled subjects.

DUTY TO CARE: ACKNOWLEDGING COMPLEXITY AND UNCERTAINTY

DUTY TO CARE: ACKNOWLEDGING COMPLEXITY AND UNCERTAINTY

Walking a mile in their patients' shoes: empathy and othering in medical students' education

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy.

Analysts Who Commit Sexual Boundary Violations: A Lost Cause?

The causes of sexual misconduct by analysts are discussed, as is the viability of rehabilitation for different types of transgressors. Common misunderstandings about the transgressor (such as the assumption of psychopathy and the likelihood of multiple offenses) are countered with a summary of data derived from the evaluation and/or treatment of over two hundred cases, most of them one-time transgressors. The typical characteristics of the analyst or therapist who engages in sexual misconduct are presented and discussed as qualities that are to some extent present in analysts generally. The temptation to deny this universal vulnerability is viewed as effectively replicating the kind of vertical splitting or compartmentalization that makes one vulnerable to sexual misconduct in the first place. (Reprinted with permission from J Am Psychoanal Assoc 2003; 51(2):617–636)

Holding Hope and Humanity in the Face of Trauma’s Legacy: The Daunting Challenge for Group Therapists

Reading the introduction and the five articles that follow in this special Issue of the International Journal of Group Psychotherapy takes one on a journey that is both enlightening and frustrating. We must navigate between the Scylla and Charybdis of affect and intellect, self–disclosure and interpretation, participation and authority. The important commonality is that the journey navigates the waters of trauma. The articles in this volume tell a story of struggle, fear, and humility. First, by examining countertransference, the authors take the risk of self-awareness and self–disclosure. They expose their own painful vulnerabilities and emotions, the dark places of their souls, their overwhelming doubts, and fervent wishes to be healers. They include themselves as observing participants in the endlessly challenging work of group psychotherapy. Second, by focusing on trauma, the authors do two things. One, they acknowledge a universal vulnerability that levels the playing field and includes the therapist in the category of risk

Analysts who commit sexual boundary violations: a lost cause?

The causes of sexual misconduct by analysts are discussed, as is the viability of rehabilitation for different types of transgressors. Common misunderstandings about the transgressor (such as the assumption of psychopathy and the likelihood of multiple offenses) are countered with a summary of data derived from the evaluation and/or treatment of over two hundred cases, most of them one-time transgressors. The typical characteristics of the analyst or therapist who engages in sexual misconduct are presented and discussed as qualities that are to some extent present in analysts generally. The temptation to deny this universal vulnerability is viewed as effectively replicating the kind of vertical splitting or compartmentalization that makes one vulnerable to sexual misconduct in the first place.

“Betcha it won't happen to me”: Self‐assessments of the projected occurrence of under‐age sexual experiences1

This project assessed the impact of the nature and frequency of sexual acts, experienced while legally under‐age and a victim, upon the projected rates of occurrence, for the same sexual acts, for people of the same age and gender. University students (376) were asked to indicate their own experiences with a variety of sexual activities before the age of sixteen and were also asked to project the extent to which these activities were experienced by others. Consistently, those who experienced an underage sexual activity projected higher rates of occurrence than those who did not have the experience, demonstrating a sense of universal vulnerability. Implications for victimology and victimization are discussed.

Perceptions of Vulnerability to Victimization

Individuals who have not been victimized by negative life events, such as serious illness, accidents, or crime, tend to perceive themselves as “uniquely invulnerable,” as less vulnerable to victimization than others. The actual experience of victimization, however, appears to shatter this illusion of invulnerability, creating in victims a new and unfamiliar sense of vulnerability often accompanied by psychological distress. This article reviews literature documenting nonvictims' perceptions of unique invulnerability and victims' heightened perceptions of vulnerability, and addresses the potentially adaptive versus maladaptive consequences of these perceptions. It is argued that victims who have the most difficulty coping with their misfortune may be precisely those individuals who initially felt least vulnerable prior to being victimized. Therefore, how victims cope may depend in part on their prior beliefs about risk. In addition, a distinction is made between victims who feel “uniquely vulnerable” (more vulnerable than others) and those who feel “universally vulnerable” (equally vulnerable as others) to future misfortune. It is proposed that perceptions of universal vulnerability may be a more adaptive reaction to victimization than are perceptions of unique vulnerability.

Immunologic problems in islet transplantation.

Rapid rejection of islet allografts is due to both cellular and antibody mechanisms. Isolated islets transplanted intraportally across a major histocompatibility complex (MHC) barrier in rats are rejected in 3–5 days. However, with MHC identity, the median survival time can be as long as 30.5 days. In mice, isolated islets transplanted between H-2-compatible strains survive no more than 1 wk, only a few days more than with an H-2-incompatible cross. In addition, in certain strains of rats and mice, islet isografts from male donors are rejected by female recipients. Fetal pancreases transplanted beneath the kidney capsule (Lewis to Fisher) are rapidly rejected by 4 days, although long-established grafts of fetal pancreas are not vulnerable to rejection in contrast to adult islets. Minimizing histoincompatibility has been unsuccessful in overcoming rejection because of the universal vulnerability of transplanted islets, and attempts to minimize immunogenicity by use of fetal tissue have not prevented rejection; however, culture of donor tissue may prove helpful in reducing immunogenicity. Transplantation of islet tissue into immunologically privileged sites has not resulted in reliable reversal of diabetes. immunosuppression by pharmacologie agents such as cyclophosphamide, azathioprine, and corticosteroids was of minor effectiveness, but antilymphocytic serum was quite effective in rodents, even on xeno-grafts when the injections were continued. Immunologic tolerance produced at birth by donor lymphopoietic cells permits later engraftment of isolated donor islets or whole pancreas. However, enhancement by anti-donor antibody has not been greatly effective in protecting islets against rejection. The possibility that autoimmunity to islet tissue might interfere with the function of transplanted islets was tested in three types of possible autoimmunity: (1) repeated small doses of streptozotocin, (2) encephalomyocarditis virus, and (3) “BB” rats. In all three cases, transplanted islets were effective in reversing experimental diabetes.