Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium.
BMC Med Ethics. 2022 Aug 16;23(1):84. doi: 10.1186/s12910-022-00819-3.
Vulnerability is a key concept in traditional and contemporary bioethics. In the philosophical literature, vulnerability is understood not only to be an ontological condition of humanity, but also to be a consequence of contingent factors. Within bioethics debates, vulnerable populations are defined in relation to compromised capacity to consent, increased susceptibility to harm, and/or exploitation. Although vulnerability has historically been associated with older adults, to date, no comprehensive or systematic work exists on the meaning of their vulnerability. To fill this gap, we analysed the literature on aged care for the meaning, foundations, and uses of vulnerability as an ethical concept.
Using PRISMA guidelines, we conducted a systematic review of argument-based ethics literature in four major databases: PubMed, Embase®, Web of Science™, and Philosopher's Index. These covered biomedical, philosophy, bioethical, and anthropological literature. Titles, abstracts, and full texts of identified papers were screened for relevance. The snowball technique and citation tracking were used to identify relevant publications. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the QUAGOL methodology.
Thirty-eight publications met our criteria and were included. Publication dates ranged from 1984 to 2020, with 17 publications appearing between 2015 and 2020. Publications originated from all five major continents, as indicated by the affiliation of the first author. Our analyses revealed that the concept of vulnerability could be distinguished in terms of basic human and situational vulnerability. Six dimensions of older adults' vulnerability were identified: physical; psychological; relational/interpersonal; moral; sociocultural, political, and economic; and existential/spiritual. This analysis suggested three ways to relate to older adults' vulnerability: understanding older adults' vulnerability, taking care of vulnerable older adults, and intervening through socio-political-economic measures.
The way in which vulnerability was conceptualised in the included publications overlaps with distinctions used within contemporary bioethics literature. Dimensions of aged care vulnerability map onto defining features of humans, giving weight to the claim that vulnerability represents an inherent characteristic of humans. Vulnerability is mostly a value-laden concept, endowed with positive and negative connotations. Most publications focused on and promoted aged care, strengthening the idea that care is a defining practice of being human.
脆弱性是传统和当代生命伦理学的一个关键概念。在哲学文献中，脆弱性不仅被理解为人类的一种本体论状态，而且还被理解为偶然因素的结果。在生命伦理学的辩论中，弱势群体被定义为同意能力受损、更容易受到伤害和/或剥削的人群。尽管脆弱性在历史上与老年人有关，但迄今为止，还没有关于他们脆弱性的含义的全面或系统的研究。为了填补这一空白，我们分析了老年人护理文献，以了解脆弱性作为一个伦理概念的意义、基础和用途。
我们使用 PRISMA 指南，在四个主要数据库中对基于论证的伦理文献进行了系统回顾：PubMed、Embase®、Web of Science™和 Philosopher's Index。这些数据库涵盖了生物医学、哲学、生命伦理学和人类学文献。筛选确定论文的标题、摘要和全文的相关性。使用滚雪球技术和引文追踪来确定相关出版物。数据分析和综合遵循 QUAGOL 方法详细说明的编码过程的预备步骤。
有 38 篇出版物符合我们的标准并被纳入。出版物的日期范围从 1984 年到 2020 年，其中 17 篇出版物发表于 2015 年至 2020 年。出版物的来源地覆盖了所有五个大陆，这一点可以从第一作者的所属机构看出。我们的分析表明，脆弱性的概念可以根据基本的人类和情境脆弱性来区分。确定了老年人脆弱性的六个维度：身体；心理；关系/人际关系；道德；社会文化、政治和经济；以及存在/精神。这一分析表明了与老年人脆弱性相关的三种方式：理解老年人的脆弱性、照顾脆弱的老年人、以及通过社会政治经济措施进行干预。
纳入文献中对脆弱性的概念化与当代生命伦理学文献中使用的区分方法相重叠。老年人护理脆弱性的维度映射到人类的定义特征上，这有力地证明了脆弱性代表了人类的固有特征。脆弱性主要是一个带有价值判断的概念，具有积极和消极的内涵。大多数出版物都关注和促进老年人护理，这加强了护理是人类定义性实践的观点。
