Nursing as a Response to Human Vulnerability
this is the recognition that our vulnerability is a mat-
ter of degree and that when we say we are vulnera-
ble what we mean is that we are vulnerable to
something. We are ordinarily vulnerable just so long
as we retain the capacity to act in ways that offer us
some protection against everyday harms. We are
more-than-ordinarily vulnerable when, for whatever
reason, we do not have that capacity. So our vulner-
ability is not merely a function of the extent of our
exposure to harm but it is also a function of our
capacity for self-protection.
A person whose protective capacities are compro-
mised and who lives with the continual threat of type
2 risks of harm (those against which she or he must
rely on the actions of others for protection) will have
obstacles to overcome if they are to flourish. This is
particularly the case either where those others cannot
be trusted to provide some degree of protection or
where the individual perceives that the social and
political institutions cannot be relied upon to act
for the public good. People whose vulnerability is
exposed to type 3 risks of harm have even less oppor-
tunity to thrive regardless of their own capacities for
self-protection, and being more-than-ordinarily vul-
nerable compromises the possibility of human flour-
ishing in ways that being ordinarily vulnerable does
not.
People who are or who become recipients of health
care in general and nursing care in particular can
therefore be considered, at least in general terms,
more-than-ordinarily vulnerable because their expo-
sure to type 2 and/or type 3 risks of harm has
increased, and because their capacities for self-
protection are compromised. And this is the case
whether or not the patient has minor or major health-
related problems, and whether or not the patient has
real or imagined symptoms. For, despite the pro-
testations of those who rightly aim to empower
patients, to be a patient is to enter into a relationship
with health care professionals who will inevitably
retain a power advantage. The further the balance of
types of risks of harm moves towards types 2 and 3
risks for any given person, the greater the threat and
likelihood of harm precisely because they are more-
than-ordinarily vulnerable. Thus all patients are
more-than-ordinarily vulnerable but some are more
likely to suffer harm than others because more pro-
tection from harm is required.
Problems with current use of the
term ‘vulnerable’ patients
Current descriptions of certain patients or groups of
patients as vulnerable remain unsatisfactory for at
least two reasons. One reason is the ambiguity that
can arise when different understandings of the term-
in-use collide; a second reason takes the form of a
recognition of the different susceptibilities of individ-
ual patients.
Ambiguity in use
Current use of the adjective is indiscriminate for we
read of‘the vulnerable child’,‘the vulnerable family’,
‘the vulnerable adult’, and ‘the vulnerable older per-
son’, as well as ‘the vulnerable ITU patient’, ‘the vul-
nerable oncology patient’ and so on. While all these
groupings may share common features of vulnerabil-
ity, what the descriptions fail to do is to say anything
about what these patients or groups of patients are
vulnerable to. Hence the potential for ambiguity. By
way of illustration, health visitors consider the ‘vul-
nerable child’ as one who is, in older terminology, ‘at
risk’ (Appleton, 1994) and this is quite different from
considering children vulnerable research subjects
(RCN Research Society, 2003). While it is true that
the meaning of vulnerability in each of these exam-
ples can be determined by the context, it nevertheless
remains a distinct possibility that confusion and mis-
understandings could occur, especially in the context
of interprofessional working. This suggests that the
term ‘vulnerable’ is insufficiently precise; it may have
some value in generally parochial and rather vague
understandings but it does not identify the source of
the risk of harm. A person described as vulnerable in
this indiscriminate way is usually at risk of harm from
a specific and predictable source. Thus the ‘vulnera-
ble’ oncology patient may be at risk of harm from
inter alia opportunistic infections if neutropenic, and/
or of being rushed into making (what might turn out
to be) an inappropriate treatment choice if newly
diagnosed with a particularly aggressive cancer.
© Blackwell Publishing Ltd 2005 Nursing Philosophy, 6, pp. 2-10
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