In the previous chapter, I presented the two most important interpretations of vulnerability in the literature: universal vulnerability and situational vulnerability. I argued that a convincing account of vulnerability must resolve the tension between these two conceptions, and I outlined the conditions it needs to fulfill. In the following, I introduce my own account of vulnerability. I describe the different parts of my definition in detail and I discuss which individuals should be considered particularly vulnerable. Furthermore, I distinguish morally relevant vulnerabilities from morally irrelevant ones, while differentiating vulnerability from other important notions, such as dependency and sentience. Lastly, I outline why vulnerability discourse matters and specify what role it fulfills.Footnote 1

3.1 Defining Universal Vulnerability

As outlined earlier, most accounts of vulnerability focus merely on one or more of its aspects, such as susceptibility to exploitation, neglect of an individual’s basic rights, or incapacity to give informed consent. But they thereby fail to encompass the full scope of vulnerability. All the aforementioned aspects have one common feature—their reference to interests that may potentially be frustrated or thwarted. Thus, it seems that universal vulnerability is determined by the possession of interests. However, not all types of interests seem to be relevant: we do not think that the frustration of trivial or futile interests is at stake when we talk about universal vulnerability. Rather, vulnerability ascriptions are linked to basic or fundamental interests that may potentially be frustrated.

Therefore, I define generally vulnerable beings as follows (Martin et al. 2014: 55):

Vulnerable beings are individuals with

  • either welfare interests or

  • agency interests

  • that may be frustrated by the individuals themselves, by external circumstances or by other living beings.

The first and second points represent the reasons why a being is vulnerable, while the last one outlines the potential circumstances of manifestation. In the following, I analyze these parts of my definition in detail.

The first condition for ascribing vulnerability to an individual is their having interests concerning their own welfare—in short, the possession of “welfare interests.” Such interests have the form “X is in the interest of A,” “X would be beneficial to A,” or “X would make a contribution to A’s well-being.” For example, if an individual is suffering from pneumonia, it is in her interest to receive antibiotics. The fulfillment of some welfare interests is a precondition for the possibility of living a good life within one’s capacities and wishes. These are not banal whims, but are rather interests that remain highly relevant to one’s long-term well-being.

Welfare interests can be distinguished from preference interests as well as mere desires and wants. Indeed, wants and desires do not necessarily create interests: my desire that my favorite football team win the World Cup does not necessarily constitute an interest of mine. Preference interests have the form “A is interested in X,” as in “Lisa is interested in expensive cars” or “Lisa loves ice cream.” To be sure, the satisfaction of some personal preferences, such as expensive cars or ice cream, may increase someone’s quality of life significantly. On the other hand, these preferences can sometimes be harmful, even detrimental to one’s long-term welfare. This means that the satisfaction of some preference interests may not be fundamental to my overall flourishing, while fulfilling my welfare interests is necessarily beneficial to me. Such is the case with highly addictive recreational drugs: they may improve one’s quality of life for a short while, but in the long term they negatively affect one’s overall welfare. Hence, I may want what is not in my interest, and I may not want what is in my interest—for example, due to weakness of will. For this reason, one should distinguish welfare from quality of life (although, at times, they amount to the same thing in practice). Taking harmful recreational drugs or pursuing extremely dangerous sports may greatly increase my quality of life over a period, but, all things considered, they are detrimental to my overall welfare.

Exactly which welfare interests matter for universal vulnerability? For my current purpose of defining vulnerability, I will not be concerned with giving a comprehensive and exhaustive list of all the welfare interests that vulnerable beings have. I will come back to this later, when I look more closely at human and animal vulnerability (including their similarities and differences). For the moment, it is only important to note that vulnerable beings have welfare interests such as those described above, and that these interests may potentially be frustrated, violated, transgressed, invaded, impaired, set back, and the like.

If welfare interests are thwarted, the individual normally incurs mental or physical harm, which is one type of manifestation of vulnerability. To be harmed is: (1) to be made worse off than one was before or could have been (which amounts to “harm by deprivation”); or (2) to be adversely affected physically or mentally (examples include permanent hunger, distress, coercion, a permanent state of anxiety, bearing the death or suffering of a loved one, exposure to humiliation and ridicule, or disregard of one’s autonomous decision-making). Manifesting vulnerability is therefore not reducible to mere physical suffering and pain. Individuals suffering from congenital analgesia cannot experience any pain; nonetheless, they can still encounter harm in various forms and see their welfare diminished.

However, not all negative effects incurred by someone constitute morally problematic harm. It does not count as harm if one’s trivial preference interests are frustrated: a game lost by a fan’s favorite football team or a boring plate of food served to a gourmet do not constitute harm. These experiences may very well distress or irritate us, yet they do not harm us. Furthermore, one is not harmed if one’s personal feelings are hurt. For instance, we would not—or better, should not—prohibit in vitro fertilization or same sex marriage on the basis that adoption of these practices may hurt someone’s feelings, because even if they did, the result would only be a minor harm that does not outweigh the benefits of these practices for others. There are various other unpleasant mental and physical states as well as offenses that do not rise to the level of harm. If my preferences are frustrated, I may be unhappy, disappointed, bored, and the like—but usually I am not thereby harmed.

Not all harmed states are morally problematic to the point of demanding action or compensation. Sometimes, it is not in our ability to satisfy the welfare interest in question, or an individual is made worse off by external natural circumstances that one cannot influence. Thus, even if some welfare interest of mine is frustrated and I am incurring harm, this is not necessarily problematic from a moral point of view. I will distinguish morally relevant from morally irrelevant harm later in this chapter.

Harm is often, but not always, experienced subjectively; in other words, harm is commonly perceived as harm by the individual concerned. However, one can sometimes be adversely mentally or physically affected without having a conscious impression of this fact. Imagine conservative women in sexist societies who are constantly oppressed, hindered, and intimidated. Some of these women may think, due to indoctrination, that they deserve no better treatment due to their gender. Consequently, they would not say that harm was being inflicted upon them. However, objectively, these women are harmed—they are deprived of the respectful treatment they are due—although they would disagree. The reason behind this is that if they were given all the available information and options, they would most likely not agree to their oppression. Thus, a relevant welfare interest need not be consciously acknowledged by its bearer. I can have welfare interest X even if I am not aware of it (which is often the case for infants, for example). It still counts.

Determining the harm related to welfare interests does not involve any reference to how others fare. For example, having one’s need for nourishment unmet represents the frustration of a welfare interest, regardless of whether others are worse or better off. Comparisons to other individuals are not necessary. Rather, frustrations of welfare interests are determined by referring either to the previous state of the individual when the welfare interest was satisfied (in the case of making someone worse off) or to a relevant counterfactual state (if the welfare interest has not yet been met, but could be in the future).

Not all frustrations of welfare interests necessarily result in harm. There are some cases in which a welfare interest is consciously disregarded by a moral agent (e.g., due to disrespectful attitudes) and the individual the moral agent is interacting with does not encounter any harm. In this case, the individual is wronged. Wrongs are acts or omissions that are imposed on someone by a moral agent and which are regarded as morally objectionable insofar as they cannot be justified. Examples include: bringing someone into existence with the mere aim of using her as a slave, if the alternative was that the individual would not have existed at all; epistemic injustices, that is, situations in which someone’s testimony is not trusted, for instance due to their gender or race, and the person is not made aware of this distrust; trying to shoot someone and discovering that one’s gun was not loaded; and some cases of over-determination in which an individual is killed by two persons at the same time.Footnote 2 In these cases, one cannot usually recognize any mental or physical harm in the form of suffering or pain, and the individual is not made worse off than before, as they are not adversely affected mentally or physically. Nonetheless, these cases represent serious moral wrongs.

To summarize, I have made a distinction between harm on the one side, and mere wrongs without any experienced harm on the other. Individuals are harmed if welfare interests that were previously satisfied are suddenly frustrated—they are adversely affected physically or mentally or they incur harm by deprivation. They are made worse off than before or than they could have been. Mere wrongs do not involve any harm—the victim may not even notice that she is a victim, as she is not negatively affected by what is happening to her, or she is unaware of it.

Welfare interests do not depend on species; rather, individual traits and capacities are what matter. Referring to species welfare may be problematic: there may be non-typical or non-paradigmatic species members whose welfare interests may differ from those of their fellow species members. This may be because they lack some capacity, or because they have higher capacities than their fellow species members. Consequently, they may have different interests and needs than other members of their species. That is, the interests of individuals matter, not the general interests of typical members of their group.

The second condition for vulnerability ascription is the possession of agency interests. These are individual values, focal aims, principles, and beliefs which the individuals in question pursue, and which may be subject to setbacks (Sen 1985: 203). Individuals consciously or unconsciously adhere to these values, aims, and beliefs, wishing to protect them as well as their freedom of choice and autonomy. Thus, my definition of vulnerability also accounts for the importance of personal values, individual goals and autonomous decision-making when shaping the course of one’s life. Importantly, agency interests do not concern any futile goals or values: they only concern goals which are well-considered and which matter to the individual concerned over the course of time. Some values may be religious, others political, and again others educational. For example, most individuals not only value their autonomy, but also adhere to religious beliefs, make life-plans, defend political views, and aim to protect their privacy.

The frustration of some agency interests may result in harm for the individual concerned. For example, having one’s autonomy ignored may cause severe mental distress. However, as in the case of welfare interests, frustrating someone’s agency interests need not necessarily result in harm as formerly defined (i.e., being physically or mentally adversely affected or made worse off). It may even be the case that acting against someone’s personal values strongly increases the individual’s welfare; nonetheless, such an action may be morally problematic. An example is enforced blood transfusion to Jehovah’s Witnesses. Imagine that during a planned operation, a member of this religion unexpectedly and urgently needs a blood transfusion. Beforehand, the patient had explicitly expressed refusal of blood transfusions and was aware of the concomitant risks. However, in order to save the patient’s life, the medical doctors in charge choose, against their patient’s will, to transfer blood, and conceal this fact after the operation. Such behavior by the physicians may be considered to have significantly increased the welfare of the patient. Although it does not result in any measurable or experienced harm, it nevertheless constitutes a wrong, since the doctors did not respect the patient’s autonomous decision-making and religious beliefs.

Other examples of harmless wrongs are the use of individuals’ organs after their death if they had explicitly declared opposition to organ transplantation beforehand; trespassing on land without the landowner’s noticing it; secretly reading a partner’s emails, letters, or diary; wrongly breaking promises that do not result in any harm to the promisee; being followed and filmed without informed consent; and in the domain of healthcare, cervical palpation in non-consenting anesthetized patients (Wainberg et al. 2010), or breaches of confidentiality without the patient’s noticing the disclosure of their personal information. None of these scenarios necessarily result in any harm, yet they may still deny the satisfaction of one or several agency interests of those concerned, and thus they represent wrongs from a moral point of view.

So far, I have argued that we may manifest our vulnerability if our welfare or agency interests are disregarded and we consequently encounter harm or mere wrongs. One may object that interests are the wrong currency for vulnerability ascriptions, and argue in favor of understanding vulnerability based on the possession of needs. However, I do not think that a needs-based theory can entirely encompass all the factors that are crucial for a convincing account of vulnerability. Statements that refer to needs are insufficient if they do not refer to some final end or interest. Consider the following examples: “humans need water on a daily basis,” or “employees periodically need a break from their work.” There is something missing in these statements—namely, the final aim. Why do we need food, and why do we need breaks? Because we value surviving, work-life balance, health, and the like. These are our final interests. Thus, statements such as “Sally needs X” suggest that X (or something related to X) is a valuable end that can usually be reformulated as an interest. What seems to be important for the individual in need is to achieve this valuable end, and not the need per se. Therefore, an account of vulnerability that focuses directly on these ends is superior to needs-based accounts which only indirectly address the ends in question.

Agency and welfare interests are the reasons for a being’s vulnerability. They are basic interests we care about, and which determine whether our life is going well or not. These interests may be frustrated by individuals themselves, by external circumstances, or by other living beings—which are the conditions of manifestation. This may result in harm (wrongful or non-wrongful) or mere wrongs without any harm involved—that is, the different types of manifestation of vulnerability. The important question now is: which frustrations of agency and welfare interests are morally problematic, and why?

3.2 Morally Relevant Vulnerabilities

Some forms of harm cannot be prevented. Accidental injury during habitual occupations, a natural catastrophe, or an attack by someone who is not responsible for their actions may diminish our welfare or agency and may result in harm. But these events are unavoidable. Furthermore, sometimes we bring avoidable harm upon ourselves. For example, some people practice risky sports which may be detrimental to their welfare. However, if nobody had the power, duty, and ability to prevent these practices (either because it is not possible or because it would unduly infringe upon the liberty of the person undertaking these risky activities), they cannot be considered cases of wrongful harm.

But there are cases where the manifestation of vulnerability could—and should—have been prevented. Wronging someone (whether harmfully or not) presupposes moral agents (i.e., persons who are responsible and liable for their actions) who have power over the frustration or satisfaction of the interests of others. These moral agents should take the welfare and agency interests of others into consideration, in a fair and impartial manner. If the means and the situation permit it, they should act upon the result of these deliberations. If someone’s welfare or agency interests are not fairly considered—for example, due to biases, neglect, or prejudices—the individual can incur wrongful harms or harmless wrongs. This means that two conditions need to be fulfilled for an action to qualify as a wrong (with or without harm): (1) it must be an act or omission that is directly or indirectly caused by a moral agent; (2) it is regarded as morally objectionable insofar as it could not be justified—that is, no acceptable reasons can be presented for discounting the interests at stake.

If a person X has power over the fulfillment of the agency and welfare interests of others, X also has the duty to impartially take these interests into consideration: X should consider them fairly. In this case of corresponding duties, we are no longer talking only about individuals’ interests; rather, we are talking about their claims. An individual, Sally, has a claim regarding a moral agent, Petra, if Petra has power over the impartial consideration of the welfare or agency interests of Sally, and at the same time has a duty to fairly consider these interests.

More must be said about what claims are. Claims are similar to rights, insofar as they entail corresponding duties.Footnote 3 A duty is an action that is “due” to someone, to the point of being a considered a requirement—an action that we must accomplish. Claims are thereby based on morally important interests that should be protected—a wider class than rights. Agency and welfare interests are interests important enough to hold someone to a duty. According to the view I defend here, we have the duty to justly consider the welfare and agency interests of others if we have power over their satisfaction or dissatisfaction.

Why speak of the person having power over the situation, and not of the responsible person? Having the power is implied in being responsible: being morally responsible for some negative state Y implies that one had the power to prevent Y. Power is a clearer concept than “being responsible”: the person who is responsible may be (i) the one in charge (although they do not have the ability to prevent Y); (ii) or the one who could and should have prevented Y. However, regarding (i), one cannot be blameworthy for not having prevented (or having caused) Y if one could not have done otherwise. On the other hand, the agent who should have and could have prevented Y (so ii) is the one who had the power to prevent X and thus had the responsibility to do so.

It is not necessary for the moral agent to be a clearly identifiable person who is aware of their duty: Sally has a claim on the moral agent even if the moral agent does not consciously acknowledge their own power and thus their responsibility. Likewise, the individuals who have a claim do not necessarily need to utter it. One can have a claim without being aware of it or without having asked for anything—as is often the case with young children and, as will become clear later in this book, animals. Furthermore, note that a group of people, and not only individuals, can have the power over the just consideration of claims, and thus bear a duty to do so.

One may object that mentioning having both power and a duty is redundant: having the duty to φ presupposes having the power to φ. This is indeed the case. However, I regard mentioning both to be necessary, as we can have a duty to justly consider some interests which, at first sight, do not seem to belong to our realm of action. A common assumption is that we only have duties to those who are close to us, such as family members, society members, and people with whom we directly interact. However, we actually often have the means and power to influence the welfare and agency of people who are distant from us, with whom we do not directly interact and whom we do not know in person. Given that we have the power to influence the satisfaction of their agency and welfare interests, we also have the duty to at least consider their case.

In other words, we may owe duties to distant strangers. As Peter Singer famously stated, “if it is in your power to prevent something very bad from happening, without thereby sacrificing anything morally significant, we ought, morally, to do it” (Singer 1972: 231).Footnote 4 He uses the example of a drowning child in a shallow pond to illustrate his point: we all are probably inclined to save a child drowning in front of us in a pond, even if we thereby destroy our new expensive shoes or clothes. We deem this materialistic loss insignificant in comparison with a child’s life. Singer’s expression “something very bad” includes our actions or omissions regarding individuals living far away, with whom we do not have any direct contact or relationships. This means that we may be morally responsible or blameworthy for actions and omissions which we were not directly assigned, or which we do not immediately recognize as within our sphere moral responsibility.

According to this view, we are prima facie blameworthy if we do not prevent avoidable suffering which is happening far away from us, but which we could have prevented by investing a reasonable amount of money or time. Indeed, distance is not morally significant: it does not matter, from a moral point of view, if an individual is physically close to us and in our field of vision. From a psychological point of view, to be sure, we may be more inclined to help an individual who is physically close to us than an individual who is distant from us. But this psychological fact does not tell us how we ought to act from a moral point of view. If one takes the principles of impartiality and equality seriously, we should not discriminate against others just because they are farther away from us than most of the people we naturally care about.

The view that distance does not matter from a moral point of view may appear counterintuitive. Nonetheless, we commonly respect this view on a political level. For example, we expect governments, and international organizations such as the United Nations, to provide aid after natural catastrophes, or to take a stance on conflicts such as civil wars and genocides, even if they are happening far away from our own country. This is because most people are convinced that human rights—which are grounded in basic interests—ought to be protected, and that suffering is intrinsically bad, independently of where it occurs.

Many individuals make donations to help the victims of natural disasters or civil wars in distant lands. The question is whether this individual help is in some cases obligatory, or merely “supererogatory”—that is, beyond the call of duty. The fact is, individuals can sometimes help faster with financial means than international organization. Consequently, private persons may have an immediate duty to provide assistance, while the international community has the final responsibility to address the situation. Instead of donating money, individuals may also sometimes have a duty to mobilize and to motivate politicians to act. That is, in some situations, individuals may not have financial duties but a duty to publicly express their discontent with political decisions (such as when the government of a country is failing to take actions against climate change, or when a foreign country is committing genocide). Accordingly, an individual is not only blameworthy for their actions; they are also morally blameworthy for omissions, if they have the same consequence or outcome as actions.

Implied in having a claim is an entitlement to a fair consideration of one’s case. As a matter of justice, one’s case ought to be fairly considered by the relevant moral agents. The fair consideration of the interests at stake is morally binding: failure to take them duly into account is morally problematic. One may object that it is sufficient to take claims into consideration, and deny that impartiality is necessary. However, merely taking claims into consideration is not enough. The consideration process may be rendered unfair by unjustifiably discounting some claims due to biases, one’s personal preferences or discriminatory attitudes. Impartial—and thus unbiased—consideration is therefore required.

Overriding a claim does not necessarily constitute a wrong. There may be good reasons not to fulfill someone’s claim. Fair and impartial consideration does not imply that all agency or welfare interests must be granted. For example, there may be restricted means available, or an urgent need to prioritize the claims of someone else. Claims are thus not absolute, but rather sit along a spectrum: they can be overridden by more important competing claims that deserve priority. Furthermore, claims may be stronger or weaker. For example, if one has to choose, one would usually prefer avoiding injury to avoiding insult.

In summary, we can distinguish the following manifestations of vulnerability: on the one side, there is non-preventable or justified harm, which cannot be considered morally problematic since it does not constitute a wrong; on the other side, there are manifestations of vulnerability which stem from an unjust consideration of an individual’s claims. The latter result in either morally problematic harmful states or wrongful states with no direct impact on the welfare of those concerned. Both these states are not justified and represent wrongs that should have been prevented.

3.3 Particularly Vulnerable Individuals

In some situations, some individuals have a comparatively higher risk of having their claims disregarded (intentionally or unintentionally) or unfairly considered by others. As a consequence, they are more likely to incur wrongful harm or mere wrongs. Such individuals can be called “particularly vulnerable” in a certain domain or context:Footnote 5

Particularly vulnerable individuals =df individuals with a comparatively higher risk of having their claims disregarded or unfairly considered by moral agents.

For example, in the domains of health care, medical research and humanitarian aid, individuals can be considered particularly vulnerable when they have an increased likelihood of not having their basic claims taken into just consideration by those holding power over the satisfaction or dissatisfaction of these claims. These individuals consequently run a higher risk of being wronged (Hurst 2008).Footnote 6 To reduce this risk to an acceptable, normal level, particularly vulnerable individuals and groups should be afforded special protection and additional attention. That is, special scrutiny should be applied when assessing their case to avoid overlooking some of their claims due to neglect or biases, among other reasons.

To identify such particularly vulnerable individuals in a certain context, those in charge (such as members of aid organizations, government officials, healthcare professionals, members of Institutional Review Boards IRBs, and the like) can proceed along the following lines. As a first step, all legitimate claims of the individuals involved should be determined. Those in charge should exclude the claims that fall outside of their sphere. This may not be evident in all cases: for example, it is a subject of debate in healthcare whether medical doctors should invest time in helping their patients satisfy basic claims that are not directly related to healthcare, as in the case of patients who are victims of conjugal violence or homelessness. Another ethically challenging question concerns how much ancillary care (i.e., additional medical care that falls outside of the scope of a medical study) should be provided by researchers to their research subjects in a clinical trial.

During this process, special attention should be paid to group-specific claims. For example, disabled individuals, children, and members of minority groups may have additional interests, compared to other groups. Such individuals may, for instance, need special measures to enable them to access buildings; they may need to be provided with opportunities for education, play, and relaxation areas; they may need translators; they may need support from people trained in post-traumatic stress therapy; they may have specific health needs that should be met; and so on. That is, individuals’ specific context has to be taken into account. Furthermore, nobody should be overlooked or neglected due to morally irrelevant properties and factors. Despite this context-sensitivity, it should be possible to list the main claims of those concerned in a particular setting.

As a second step, the people in charge should identify those individuals who run a higher risk of not having their claims taken into fair consideration—that is, those individuals who are less likely to be treated as they ought to be. Disregard of some individuals and groups and their interests may be due to mere ignorance of their specific needs, implicit or explicit biases and prejudices, language barriers, poverty, age, discriminatory attitudes, conflicts of interest, dependencies and asymmetric power relationships, potential system-inherent problems, cognitive and physical impairments, and so on. This step entails a probabilistic element, insofar as it requires predicting who is more likely to encounter wrongful harm or wrongs. Empirical studies might provide some guidance on this issue: by studying which individuals or groups commonly do not receive what they are due (e.g., because they are victims of discrimination or because they have very specific needs that are often not met), one may infer who is more likely to have their legitimate claims disregarded.

As a third step, measures must be taken to reduce the risk of particularly vulnerable groups’ incurring wrongful harm and mere wrongs to an acceptable level in the specific situation—that is, a level similar to that of other groups. To this end, those in charge should recognize whether their judgements about how to handle the situation at stake are affected by biases, ignorance, and the like. For example, they should reflect whether their choice to include certain populations in a clinical study was guided by scientific and ethical criteria, or whether they chose to involve some groups because they are easily available, because they can be easily convinced to participate (e.g., because they do not understand what the study means for them, or because they hope to get access to medical care or money without understanding the concomitant risk, as it was the case in the Tuskegee study presented in the previous chapter). In the context of humanitarian aid, aid work professionals should check whether they are about to allocate means justly, by ascertaining whether they are instead guided by biases, such as selecting the most convenient (but perhaps not the fairest) methods for assessing and treating people and distributing help.

In some cases, this may involve allocating more means or time to certain groups. For example, some populations may need to be provided with translators. In the healthcare domain, some patients may fail to understand what they are told by healthcare professionals due to a lack of education or language barriers. In these cases, those in charge of the patients’ care are obligated to invest more time in explaining patients’ condition and treatment in terms they can understand. Others, such as children, may need access to leisure and educational activities and resting areas in refugee camps. For still others, such as blind or deaf people, information (e.g., in healthcare systems, clinical trials, and refugee camps) has to be provided in a way that is accessible to them.

It is crucial to distinguish particularly vulnerable individuals from those who should be given priority in a certain setting. The particularly vulnerable are comparatively more likely to have their claims disregarded and thus to experience unjustified harm or mere wrongs. This does not yet tell us anything about who has priority concerning resource allocation, however. It could be the case that a not particularly vulnerable group has more urgent claims that need satisfaction than a particularly vulnerable group, for example, because the healthcare situation of the group that is not situationally particularly vulnerable is life-threatening and they consequently need urgent medical assistance. Although the situationally particularly vulnerable are those who are more likely to have their claims disregarded, this does not mean that they should be given priority in all situations.

Situational vulnerability is context-dependent. Some individuals are particularly vulnerable in some contexts, but not in others. A change of setting may, correspondingly, change the degree of vulnerability. For example, some individuals may have a risky profession: they are frequently exposed to harmful substances at their workplace or they are more likely to fall victim to workplace accidents due to unsafe equipment. They are thus more likely to encounter unjustified harm. However, this does not mean that such persons are particularly vulnerable in other domains, such as healthcare or medical research. In this case, it is not necessarily the duty of, say, healthcare professionals to diminish the risks of harm; rather, it is the duty of the employer. Thus, to be more likely to manifest vulnerability in some context, such as at one’s working place or during one’s leisure time, does not necessarily imply that one is a particularly vulnerable individual in another domain, such as healthcare or medical research.

In conclusion, there is only one type of vulnerability encompassing everyone who has interests. Depending on the context and the individuals involved, vulnerability has different likelihoods of manifestation: a change in setting may render individuals particularly vulnerable who were not particularly vulnerable before. The controversy as to whether vulnerability is a property of all living beings or of only some, turns out to be a philosophical pseudo-problem. Any account of particularly vulnerable individuals in need of special protection must be embedded in a larger understanding of vulnerability—an understanding that includes all beings with interests who can be harmed and wronged.

The account of vulnerability I propose here fulfills the criteria I outlined previously: it is able to account for both a universal and a situational account of vulnerability; it is applicable to different situations and contexts; and it can distinguish morally relevant vulnerabilities from morally irrelevant ones by explaining why some vulnerabilities matter from a moral point of view whereas others do not.

The advantages of this account are manifold. It accounts for a non-ideal world in which there are conflicts of interest and where moral agents sometimes make flawed or biased judgements. Moreover, it does justice to the intuition that vulnerability is an irreducible part of human life. Furthermore, it avoids a potential stigmatization of the vulnerable: according to my account, vulnerability cannot be said to be the individual’s fault, given that anyone may, depending on the context, encounter an increased likelihood of having their claims unjustly treated by those in charge. Many individuals and groups may be rendered particularly vulnerable by their environment, without this being due to any fault of their own. In the case of healthcare, for example, there may be patients who evoke implicit biases in the treating physicians, which may result in unfavorable treatment. Such neglect due to the emotions or prejudices of the treating physicians may render these patients particularly vulnerable, insofar as they are less likely to receive the treatment they are due.

My account of vulnerability further shows that vulnerability is not necessarily something negative: we do not disapprove of vulnerability per se. Rather, what we disapprove of is its potential manifestations, such as unjustified harm and wrongs, which we seek to avoid. This implies that vulnerability is not something that can be entirely canceled or eliminated—we can only reduce its risk of unjustified manifestations.

In addition, my account explains how vulnerability is linked to morality. As outlined earlier, there is a dispute as to whether vulnerability matters from a moral point of view—and if so, to what extent. Insofar as my account of universal vulnerability is linked to the possession of interests, it might seem at first sight that it is therefore a purely descriptive notion. Since some frustration of welfare and agency interests simply cannot be prevented, it seems false to assume that vulnerability always entails a normative component. However, increased vulnerability gives rise to special duties: if someone is more likely to have their legitimate claims unjustly considered, they have a claim to special protection. In these cases, vulnerability has normative implications. But how is this duty of special protection grounded? The reason for our duty toward particularly vulnerable individuals lies in the fact that we all have a claim to the just consideration of our interests, which is independent from vulnerability. Rather, it is a requirement of justice and impartiality. If others fail to justly consider our interests, for example, due to biases or sheer ignorance, we have a claim to some sort of compensation or restoration. Obligations toward particularly vulnerable individuals are therefore not grounded in vulnerability itself.

This approach resolves the problem of other definitions of vulnerability that ground moral duties directly in vulnerability and are therefore circular. According to my account, the normative pull of vulnerability lies in the disregard or denial of independently legitimate claims. Thus, my account can non-circularly explain why moral agents have additional duties of protection in the case of increased vulnerability of some individuals. Particularly vulnerable individuals are those who are more likely to have their welfare and agency interests unfairly disregarded. They require additional attention and special protection in order to be afforded what they are legitimately due but are unlikely to receive. The special protection or additional attention should cancel out, or at least reduce, their increased risk of being wronged.

3.4 Differentiating and Defending Vulnerability

The aim of this section is to defend my account of vulnerability against potential objections, to delimit it from other ethically important concepts such as sentience, fragility, mortality, and dependency, and to outline why vulnerability discourse matters. This will render the implications of my account more evident, while explaining how vulnerability can be distinguished from other phenomena.

The first topic I wish to address is the link between consciousness and vulnerability. One may be puzzled by the fact that I propose an interest-based account of vulnerability. Should we not regard those without any actual, occurrent interests—for example, embryos and individuals in a permanent vegetative state—as particularly vulnerable, since they are at our mercy and dependent on us? And would my account of vulnerability not entirely exclude them? Some clarifications are in order.

Who has interests? There are some uncontroversial cases. Conscious sentient humans and animals have a welfare. They care about how they fare, even if they may not be able to consciously utter this concern. They seek to avoid pain and suffering, and they strive for flourishing and pleasant experiences. By contrast, plants, rivers, and stones do not have interests: they do not have any experiential well-being of their own, and they have no interests that can be thwarted. So it seems that the account presented here presupposes a link between consciousness and vulnerability. Indeed, conscious experience seems to be a prerequisite for the possession of interests. But what is consciousness, exactly?

Being conscious implies being able to perceive something as something (e.g., seeing a wall as red), that is, the capacity to have phenomenal states, also called “qualia.” These are qualitative states of mind that include the perception of color, sound, hunger, thirst, fear, sadness, joy, and the like. Conscious states thus encompass a wide variety of phenomena, such as simple sensations, bodily perceptions, feelings, and complex emotions. Given that my account of vulnerability is based on the possession of interests, it presupposes a mental sphere. Individuals without any conscious mental life, then, cannot be regarded as vulnerable, according to my account. Two different thought experiments may clarify this point:

ZOMBIE THOUGHT EXPERIMENT: Imagine being A. A is an almost exact copy of a human being with a body as we all have; the only difference is that she does not experience qualia. She is unable to feel emotions or pain. Some may be tempted to call her a philosophical “zombie.” She does not experience the same states of mind as humans. In fact, she does not experience any mental states at all. She does not have any emotional attitudes toward anything. We can therefore say that she does not have any interests concerning her person. Now imagine that A is attacked with a knife or severely insulted. Would we say that A is vulnerable to physical attacks or insults? This is improbable. She is vulnerable to attacks in the same way as countries or computers are, but not in the way ordinary humans are. A does not care whether any pain is inflicted on her or whether she is destroyed. She cannot be harmed and wronged.

This thought experiment shows the role of mental states in vulnerability. This becomes even clearer with a second thought experiment:

CONGENITAL INSENSITIVITY TO PAIN THOUGHT EXPERIMENT: Imagine an individual B who has been unable to feel any pain since birth. Even when his C-fibers are firing on the physiological level, he does not experience any pain. But, in contrast to A, B is able to experience other mental states, such as pleasure or sadness. He only lacks mental states connected to pain. Now, would we say that person B is vulnerable? Yes. Contrary to A, B has mental states and thus interests. He may feel anxious, angry or sad when betrayed. He may feel fear when menaced, and disappointed when deceived. He therefore has an interest in avoiding negative states of mind. He may be harmed and wronged.

Individual A is invulnerable, while B is vulnerable. To be invulnerable means that one could at first sight meaningfully ascribe vulnerability to the individuals concerned. This is the case because the beings in question are similar to vulnerable beings in many respects. They share basic properties with conscious and sentient humans that make it possible for them to be considered vulnerable. At the same time, however, the individuals in question cannot incur any form of harm or be wronged. Finally, there is also a category of non-vulnerable entities. Non-vulnerable entities cannot meaningfully fulfill any of the conditions of vulnerability ascriptions. For instance, one cannot meaningfully say that a stone is vulnerable or invulnerable. The predicate just does not apply to it.

The capacity for conscious experience is a requirement for the types of vulnerability ascriptions I am concerned with in this book. However, vulnerability ascriptions go further than mere states of consciousness. They presuppose certain classes of interests—that is, welfare and agency interests. Vulnerable beings care about their lives and can be harmed and wronged—they can be exploited, injured, humiliated, and the like—or, conversely, they can flourish. Furthermore, being vulnerable involves the possibility of valuing something, namely one’s life or external goods.

One may now ask whether the interests determining vulnerability must be actual and occurrent, or whether potential and future welfare and agency interests also count. A first scenario concerns cases of individuals who already exist, but who do not yet have or no longer have actual welfare and agency interests. The second scenario concerns beings who do not yet exist, such as future humans and animals. I will discuss these two options in turn.

Examples of the first case are embryos at a very early stage of development (before the development of the cortex that allows conscious experiences) or coma patients in a permanent vegetative state. According to my definition, they are not actually, but only potentially, vulnerable: they do not have welfare or agency interests that can be frustrated. However, they probably will have such interests at some point in their life, or they had them in their past. What are the moral implications? Do these individuals deserve as much protection as actually vulnerable beings? I cannot discuss this question in as much detail here as would be necessary to fully account for the problem, but I will sketch some lines of thought.

In our everyday language, we may say that embryos at an early stage of their development are vulnerable to harm. However, they do not fulfill the criteria of my explicative account of vulnerability. This is because embryos at an early stage do not yet have any actualized welfare and agency interests. Embryos may be destroyed, but since they will not have any actual interests until a later stage of their development, they cannot count as actually vulnerable, but only as potentially so. The view that embryos are only potentially, and not actually, vulnerable may at first sight appear counterintuitive. For example, one may claim that non-conscious and non-sentient embryos are always particularly vulnerable because they depend heavily on their surrounding environment, notably the decisions and actions of their mother. As a result, they have an increased risk of being wronged. Yet this is not always the case.

Dependency does not necessarily render a being particularly vulnerable to the point of needing special protection and attention: dependent individuals, such as small children or those with severe mental disabilities, do not necessarily have an increased likelihood of having their interests unjustly considered. It may be the case in some situations, for example, if caregivers have malicious intentions or biases toward them, but it is not inevitable. Such dependent entities may be particularly vulnerable in some situations, but not in others. Likewise, there may be many cases in which the future interests of embryos are duly considered.

Admittedly, though, there may be specific circumstances in which embryos and fetuses may count as particularly vulnerable and in need of special attention. Imagine a carelessly designed clinical study that involves pregnant women whose unborn children will be negatively affected by the medication being tested (e.g., the children will be born with severe disabilities). The foreseeable negative consequences for the embryos or fetuses were not considered by the researchers. In this case, we intuitively believe that the future disabled children with actual interests were wronged by the careless researchers who failed to appropriately regard the interests of the future children. The question is then whether the embryos should have been regarded as particularly vulnerable research subjects in need of special protection and attention. In this scenario, this seems to be the case. Researchers should have payed attention not only to the interests of currently existing research participants, but also to the potential future interests of the embryos and fetuses. They should have taken steps to ensure the welfare of the future children, by paying special attention to the study design and potentially harmful consequences for the embryos. Thus, in this scenario, the future children with severe handicaps were indeed wronged by the careless researchers, who should have paid more attention to the embryos and their future interests and well-being.

Even if embryos or individuals in a persisting vegetative state are not currently but only potentially vulnerable, this does not logically imply that one can do with them whatever one wishes, for vulnerability is not the only reason why a being may be worthy of moral consideration. Although embryos and patients in irreversible and profound vegetative comas cannot be considered actually vulnerable, they may nevertheless be regarded as being morally relevant and thus as having moral status. This may be due to their intrinsic value, to their dignity, or to an extrinsic value (i.e., their value in virtue of their relationship to others, such as caregivers and their family). By restricting vulnerability to a certain class of beings, it is not implied that those who do not necessarily fulfill the conditions of vulnerability ascriptions fall outside the scope of morality altogether, as if they were entities that did not count from a moral point of view. Claims for their protection simply need to be grounded differently. Vulnerability is therefore not a necessary condition of moral status. The question of “Who is morally relevant?” needs to be distinguished from the question of “Who is vulnerable?” The class of entities that should receive moral consideration is larger than the class of those who are vulnerable.

The second scenario to discuss concerns vulnerable future individuals—ones who do not exist yet, but who will or might exist one day. One could raise the question of whether it is possible to wrong future vulnerable beings, for example, by destroying the environment they will live in (which will negatively affect their welfare) or simply by bringing them into existence in a hostile environment. Let me thus sketch some ideas here regarding the creation of new vulnerable beings. One might be tempted to argue that existence, as miserable as it may be, is always better than non-existence. However, such an argument immediately runs into metaphysical difficulties: existence and non-existence cannot be easily compared. Regardless, this comparison is not necessary for making the argument that it may sometimes be wrong to bring someone into existence. It is sufficient to believe that non-existence would have been preferable. Imagine for this the case of Anna and her son Beat. Beat lives an extremely miserable and painful life (due to a congenital disease), and Anna could have easily prevented his existence, for example, by postponing conception. Here, one could say that even if one cannot compare non-existence to existence, Beat could be so badly off that it would be rational and understandable if he preferred non-existence to his current situation. Compared with living with his disease, Beat could prefer not living at all or ceasing to exist, as his suffering outweighs all pleasures (or there is no pleasure at all, only pain and suffering). One can thus wrong individuals by bringing them into existence if—from their point of view—they will lead a thoroughly miserable life, and this condition cannot be changed.

In summary, future vulnerable beings may be wronged by being brought into existence under two conditions: (1) if we can meaningfully say that the individuals would have preferred not to live because their condition is unbearable; and (2) if it was in someone’s power not to bring these individuals into existence and they did so regardless and knowingly. Accordingly, the future interests of future vulnerable beings—including future generations—also count and should be taken into consideration in ethical decision-making.

So far, I have outlined the connection between vulnerability and conscious experience. One may now raise the question of what the difference between sentience and universal vulnerability amounts to. After all, according to my account, vulnerability is determined by the possession of interests. And is this not the very essence of sentience? Hence, one might argue that vulnerability is equivalent to mere sentience. However, there are two noteworthy differences between these concepts.

First, vulnerability is not equivalent to sentience, if one understands the latter—as it is usually defined—as consciousness qua feeling, especially the capacity to feel pain and pleasure, and if one thus understands sentience as being solely linked to one’s welfare. Indeed, some frustrations of welfare and agency interests do not necessarily lead to any mental or physical harm and may occur without being perceived. Examples of wrongs that do not involve any harm include secretly reading a partner’s emails, stalking an unwitting target, allowing breaches of confidentiality in healthcare, or wrongly breaking promises that do not result in harm for the person concerned. These are cases in which the privacy or other legitimate claims and values of individuals are disregarded.

Second, while sentience ascriptions point us toward those individuals who are worth considering morally (sentience is often seen as a sufficient reason for conferring moral status), vulnerability ascriptions help us to identify those individuals in need of special protection and attention because they are at greater risk of not being given what they are due. In addition, by including agency interests in my definition of vulnerability, I go beyond mere sentience to include values that we care about even when they do not necessarily have an impact on our well-being.

These considerations reveal the importance of vulnerability discourse. Vulnerability ascriptions, as they are currently used in bioethics, do not merely refer to embodiment and the capacity to feel and experience something. The universal vulnerability of sentient beings reveals the fact that these beings can not only be harmed, but also wronged. To be a particularly vulnerable individual means that one is a member of a group that is more likely to be mistreated or ignored (e.g., because of prejudices). Therefore, stating that some groups of humans are particularly vulnerable has not only rhetorical, but also normative force: it shows that increased attention is needed when dealing with these groups, that caution is advised insofar as the individuals of these groups may be more likely to be denied what they are due, and that protective measures may be required. This shows that vulnerability ascriptions serve an important purpose.

After all these considerations, the difference between vulnerability and fragility should now be clearer. Some individuals may be physically or mentally fragile. This is, for instance, the case for individuals suffering from brittle bone disease or those who easily get emotionally upset and hurt. However, as outlined before, not all frustrations of interests are morally relevant. The above-mentioned individuals are vulnerable insofar as they have interests that may be thwarted; however, they are not necessarily particularly vulnerable and in need of special protection and additional attention in specific situations.

The last two points concern the connections between vulnerability, autonomy, and mortality. One may argue that a definition of vulnerability must be linked to a diminished capacity for autonomous decision-making. Autonomy encompasses self-rule, free from interference by others and from limitations such as inadequate understanding. It may thus be argued that a lack of autonomy leads to increased vulnerability. However, lack of autonomy is not a necessary condition for manifesting vulnerability, but only a sufficient one. We can perfectly well imagine a person who is autonomous yet particularly vulnerable, for example, if they are more likely to participate in high-risk medical studies because it is the only way to receive medical care and earn a living. Further examples include autonomous persons who are more likely to have their confidentiality disregarded or those who are more likely to be discriminated against in healthcare settings. We would regard these people as particularly vulnerable and in need of special protection, despite their being autonomous.

One may further criticize my account of vulnerability for overlooking the purportedly strong link between vulnerability and mortality. One may be tempted to argue that a convincing account of vulnerability should refer to the finitude of human corporality and, thus, to mortality. Are vulnerable beings not, after all, necessarily and essentially mortal beings? This is not the case, however. Accounts of vulnerability that focus on the fact of human mortality consider only some contingent, and therefore not necessary, features. Mortality does not determine vulnerability, as a simple thought experiment shows. Imagine an individual who has the same properties of an ordinary human being. She can physically or mentally suffer; she can be wronged or hurt. But imagine furthermore that this individual is immortal. We would still say that she is vulnerable, despite her immortality. Mortality is therefore not a necessary condition for the ascription of vulnerability to a being. The fact that we will certainly die one day should not necessarily be included in the definition of vulnerability for bioethics.

Nevertheless, mortality plays a role in vulnerability: we can not only be harmed by other people, but also be killed and die prematurely. Given that we have a fundamental interest in our life and in our continued existence, mortality increases our vulnerability. To continue living is one of our most fundamental interests. Therefore, we can say that mortality reinforces our vulnerability or adds an additional layer to it. Vulnerable beings not only have interests which can be frustrated; they can also be deprived of the prerequisite for having interests at all, namely their life.