Fineman contends that although we might think of others as vulnerable, woundable, weak, or dependent, the labelling or setting up of classes of “vulnerable others,” as it were, as if we ourselves are immune to vulnerability, woundability, weakness, and dependency, has vast implications for individual, communal, institutional, and state responsibility for the care of others. Clearly, this also invites a reassessment of the (power) dynamics of the relationship between the patient and health-care professional as well as serious attention to the increasing disparity in access to health-care resources. For Fineman, vulnerability is not only inherent and universal, it also provides “the impetus for the creation of relationships and institutions and necessitating the formation of families, communities, associations, and even political entities and nation-states” (Fineman 2014, 310). As such, she calls for an appreciation of vulnerability as generative:
Properly understood, vulnerability . . . presents opportunities for innovation and growth, as well as creativity and fulfillment. Human beings are vulnerable because as embodied and vulnerable beings, we experience feelings such as love, respect, curiosity, amusement, and desire that make us reach out to others, form relationships, and build institutions. Both the negative and the positive possibilities inherent in vulnerability recognize the inescapable interrelationship and interdependence that mark human existence. (Fineman 2012, 71)
This is important because the claim that vulnerability is universal, constant, inevitable, and inherent could easily suggest that, in the face of vulnerability, the only response could ever only be apathy or surrender. After all, if vulnerability is an ontological condition of humanhood, how could we possibly get away from it?
Clearly, Fineman does not think that we can, but this need not amount to passivity or the shirking of responsibility on the part of the collective. Here, she speaks of resilience as being “the essential, but incomplete antidote to our vulnerability” (Fineman 2014, 320). Resilience is that which “provides an individual with the means and ability to recover from harm or setbacks” and, like vulnerability, is also generative, because “when individuals have resilience it allows them to take advantage of opportunities knowing that if they take a risk and something fails, they have the means to recover” (Fineman 2014, 320). Furthermore, a serious recognition of the inevitability of our dependence on societal structures and relationships should configure the social and political culture “to reflect that independence and self-sufficiency are impossible to achieve and it should demand that institutions be shaped to be generally and equitably responsive to our vulnerability” (Fineman 2014, 320) as well as to those conditions, practices, and behaviours that encumber resilience.
It would be negligent of me not to include in this discussion about vulnerability, dependency, and resilience yet another element of the equation that is so very often left untreated (certainly in mainstream bioethics): love. The following passage from C.S. Lewis’s Four Loves helps to underscore how love relates to what we have seen thus far:
There is no safe investment. To love at all is to be vulnerable. Love anything, and your heart will certainly be wrung and possibly be broken. If you want to make sure of keeping it intact, you must give your heart to no one, not even to an animal. Wrap it carefully round with hobbies and little luxuries; avoid all entanglements; lock it up safe in the casket or coffin of your selfishness. But in that casket—safe, dark, motionless, airless—it will change. It will not be broken; it will become unbreakable, impenetrable, irredeemable. The alternative to tragedy, or at least to the risk of tragedy, is damnation. (Lewis 1960, 138–39)
Love and vulnerability, as both Lewis and Fineman make plain, are sources of relationship, challenging the socially constructed dichotomies that seek to divide the world between poor and rich, weak and strong, old and young, ill and healthy. Solidarity, in itself a moral virtue, is not a “feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good. That is to say to the good of all and of each individual, because we are all really responsible for all” (Pontifical Council 2004, §193). Here, this notion of solidarity takes interdependence and mutual responsibility of one to another as characteristics of, if not prerequisites for, the human community. Indeed, this is very much behind the imperative to love one’s neighbour, an axiom that is not exclusive to the Christian world.
If by common good we mean “the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily” (Catechism of the Catholic Church 1992, §1906), then a solidarity that is truly committed to the common good inevitably seeks to contribute to the building up of individuals and communities of resilience in order to best respond to the constancy of vulnerability and to emergent particular vulnerabilities over the course of life that impair human fulfillment. If our society is serious about its commitment to the poor and vulnerable, there is, then, a moral obligation to protect people in their vulnerability as well as to foster and provide social services, practices, and support that would help promote their flourishing.
I lament that discussions of the patient–health-care professional relationship—as well as of many other pressing areas of study in biomedical ethics for that matter—so very rarely consider love and vulnerability as concepts worthy of serious academic engagement. I suspect that this is the case out of fear that the one who raises such things in public discourse risks calling into question their intellectual rigour. To be sure, talk of vulnerability is ubiquitous in bioethics, especially in reference to vulnerable patient populations in research and health care, but lacking in the literature is the promotion and inclusion of frequently overlooked approaches and theories that have love and vulnerability at their core (I am thinking here of the ethics of vulnerability and vulnerability theory in particular) as new frameworks for bioethical analysis and deliberation.5