Vulnerability: what kind of principle is it?
The so-called European principles of bioethics are a welcome enrichment of principlist bioethics. Nevertheless, vulnerability, dignity and integrity can perhaps be more accurately understood as anthropological descriptions of the human condition. They may inspire a normative language, but they do not contain it primarily lest a naturalistic fallacy be committed. These anthropological features strongly suggest the need to develop deontic arguments in support of the protection such essential attributes of humanity require. Protection is to be universalized, since all human beings share vulnerability, integrity and dignity, thus fundamenting a mandate requiring justice and respect for fundamental human rights. Being a feature of all humanity, vulnerability is improperly extended to designate destitute individuals and populations. Rather, they are in a state of fallen vulnerability, for they already are harmed in some way, and have become deprived of their range of capabilities. These individuals are destitute and are no longer in command of their fundamental human rights. They have lost the status of unharmed vulnerability; identifying them as susceptible--vulnerated and no longer only vulnerable--stresses the point that bioethics demands specific social action to palliate or remove their distress. When harm does occur--in the form of disease, for example-, individuals are no longer vulnerable--for they have ceased to be intact -, they become susceptible to additional deprivations and sickness; integrity is demeaned and dignity is offended, leading to states of dysfunction that require specific remedial social practices, aimed at treating and removing injuries. The main point this paper addresses is that vulnerability--as well as dignity and integrity--are descriptive characteristics of human beings qua humans, which are not normative in themselves, but fundamental enough to inspire bioethical requirements of protection and respect for human rights in the wake of social justice. A clear distinction must be made in regard to human beings who are injured by poverty, sickness, discriminating deprivations or suffer other destitutions, having ceased to be only vulnerable for they are no longer intact. These individuals and populations require more than protection, their needs must be met by specific care and remedial measures to be identified and instigated by bioethics qua applied ethics.
Kottow
Michael H
MH
Faculty of Medicine, Public Health School, University of Chile, Casilla 16168, Correo 9, Santiago, Chile. mkottow@med.uchile.cl
D000884:Anthropology, Cultural; D004992:Ethics, Medical; D006801:Humans; D010344:Patient Advocacy; D012935:Social Justice; D035862:Vulnerable Populations