Centre for Biomedicine Self and Society, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
Centre for Biomedicine Self and Society, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK.
Med Humanit. 2024 Feb 22;50(1):125-134. doi: 10.1136/medhum-2023-012683.
In recent years, 'vulnerability' has been getting more traction in theoretical, professional and popular spaces as an alternative or complement to the concept of risk. As a group of science and technology studies scholars with different disciplinary orientations yet a shared concern with biomedicine, self and society, we investigate how vulnerability has become a salient and even dominant idiom for discussing disease and disease risk. We argue that this is at least partly due to an inherent indeterminacy in what 'vulnerability' means and does, both within and across different discourses. Through a review of feminist and disability theory, and a discussion of how vulnerability and disease both get recruited into a binary conceptualisation of normal versus abnormal, we argue that vulnerability's indeterminacy is, in fact, its strength, and that it should be used differently than risk. Using COVID-19 management in the UK as an illustration of the current ambivalence and ambiguity in how vulnerability versus risk is applied, we suggest that instead of being codified or quantified, as it has started to be in some biomedical and public health applications, vulnerability and its remedies should be determined in conjunction with affected communities and in ways that are polyvalent, flexible and nuanced. The concept of vulnerability encapsulates an important precept: we must recognise inequality as undesirable while not attempting to 'solve' it in deterministic ways. Rather than becoming fixed into labels, unidirectional causalities or top-down universalising metrics, vulnerability could be used to insist on relational, context-specific understandings of disease and disease risk-in line with contemporary social justice movements that require non-hierarchical and non-universal approaches to problems and solutions.
近年来，“脆弱性”作为风险概念的替代或补充，在理论、专业和大众领域越来越受到关注。我们是一群具有不同学科背景但共同关注生物医学、自我和社会的科学技术研究学者，研究脆弱性如何成为讨论疾病和疾病风险的突出甚至主导术语。我们认为，这至少部分归因于“脆弱性”在不同话语内部和之间的含义和作用存在内在的不确定性。通过对女性主义和残疾理论的回顾，以及对脆弱性和疾病如何都被纳入正常与异常的二元概念化的讨论，我们认为脆弱性的不确定性实际上是其优势，它应该与风险的应用方式不同。我们以英国 COVID-19 管理为例，说明了当前在应用脆弱性与风险方面的矛盾和模糊性，我们建议，脆弱性及其补救措施不应像在一些生物医学和公共卫生应用中那样被编码或量化，而应与受影响的社区一起，以多元、灵活和微妙的方式来确定。脆弱性概念包含了一个重要的原则：我们必须认识到不平等是不可取的，而不是试图以确定性的方式“解决”它。脆弱性不应成为固定的标签、单向因果关系或自上而下的普遍化指标，而可以用来坚持疾病和疾病风险的关系性、具体情境性理解——与当代社会正义运动保持一致，这些运动需要对问题和解决方案采取非等级和非普遍的方法。
