Nursing as a Response to Human Vulnerability
also be subjective and internal: physical, psychologi-
cal, emotional and so on. A psychological risk might
come from, e.g. holding the false belief that there is
a risk of imminent collapse of a building. Assuming
there to be no physical evidence for this, and assum-
ing that the structure is not built above the site of
some natural ‘disaster waiting to happen’, then it
would be difficult to say, in this case, that the percep-
tion of risk is either an objective or an external
phenomenon.
Claim 2: vulnerability as purely subjective
They say that ‘The subjective quality of vulnerability
relies on perception, the knowing and understanding
brought about by awareness gained through the
senses’ (Clarke & Driever, 1983, p. 213). Thus they
make no allowance for the possibility that someone
who is unable to know or understand their vulnera-
bility can be vulnerable. In so doing their account fails
to recognize that many recipients of nursing practice
do not have the full range of capacities necessary to
articulate the subjective experience of vulnerability:
e.g. those with severe mental and/or physical disabil-
ity, those in a coma, infants and those with Alzheimer’s
disease. It would be unusual to claim that people in
such states should not be considered vulnerable. Vul-
nerability is not just a subjective experience.
Thus while it may be important for ordinarily vul-
nerable people to have a low perception of their vul-
nerability if they are to flourish in the world this is
neither without constraints nor is it significant in the
same way for more-than-ordinarily vulnerable per-
sons. For ordinarily vulnerable persons to have a per-
ception of vulnerability that is so low as to be virtually
absent is to tempt them to begin to feel ‘invulnerable’;
and, as suggested earlier, to feel ‘invulnerable’ is to
run the risk of actually increasing one’s vulnerability.
Similarly for more-than-ordinarily vulnerable per-
sons a sense of ‘invulnerability’ is generally speaking
incompatible with human flourishing.
Claim 3: the patient will feel less vulnerable
If I have understood them correctly, Clarke and
Driever claim that nurses should adopt psychological
interventions to make their patients feel less vulner-
able on the grounds that feeling less vulnerable is a
good thing. However, while it is true that people do
wish, in general, to reduce their feelings of vulnera-
bility and while it may be that in some instances this
may have some therapeutic value, there may be times
when reducing feelings of vulnerability is unhelpful
or even counterproductive. The competent adult sur-
gical patient may well feel less vulnerable once she or
he understands the safeguards that exist to protect
patients while under general anaesthesia. But apart
from the suspicion that this may be merely an exercise
in anxiety reduction the patient will still actually be
vulnerable during an operation. The patient in a coma
being nursed in an intensive care unit will actually be
less vulnerable when certain protective procedures
and protocols are observed but is unlikely to feel less
vulnerable while she or he remains unconscious. The
patient who believes she or he can fly would be better
served by being encouraged to feel more rather than
less vulnerable when about to launch her or himself
from the third floor of a building.
Thus to merely accept that helping people to feel
less vulnerable is a good thing is not a position that
can be sustained. Encouraging people to feel less vul-
nerable may lead to foolish risk taking and conse-
quently compromise human flourishing. The claim of
a therapeutic reduction of the perception of vulnera-
bility may apply when perceptions of vulnerability get
in the way of human flourishing (as in the earlier
example where the perception that a building was
about to collapse was based on a false belief), but it
cannot be assumed that it will be a good thing in all
situations. From this it should be clear Ihatjudgement
is required to ensure that in any therapeutic attempt
to reduce feelings of vulnerability an individual’s
sense of vulnerability remains consistent with human
flourishing. To do otherwise is to effect rather than
avoid harm.
Nurses and protection of patients
as more-than-ordinarily
vulnerable people
To state that all patients are vulnerable is to do no
more than recognize our common human frailty. It
© Blackwell Publishing Ltd 2005 Nursing Philosophy, 6, pp. 2-Ю
217