What Does Vulnerability Mean?

C. Barry Hoffmaster

Hastings Center Report, Volume 36, Number 2, March-April 2006, pp.

38-45 (Article)

Published by The Hastings Center

DOI: https://doi.org/10.1353/hcr.2006.0024

For additional information about this article

https://muse.jhu.edu/article/195102

For content related to this article

https://muse.jhu.edu/related_content?type=article&id=195102
 What Does
Vulnerability
Mean?
by BARRY HOFFMASTER

Vulnerability does not mean much for our contemporary morality. It is antithetical to our emphasis

on individualism and rationality; it requires that we attend to the body and to our feelings. Yet only by

recognizing the depth and breadth of our vulnerability can we affirm our humanity.

V
ulnerability is one of those general notions
we bandy about confidently but carelessly,
assuming that we know what it means and
that it means the same thing for everybody. Were we
challenged to explain it, though, we might admit to
some unclarity and puzzlement. What does vulnera-
bility actually mean?
A dictionary provides multiple definitions. One
meaning of “vulnerable” is to be susceptible to some-
thing, a bad something naturally, such as disease or
infection. People living in a war-torn country where
the water and sewer systems have been destroyed are,
for example, vulnerable to contracting malaria. A
second meaning of “vulnerable” is to be capable of
being physically or emotionally wounded. A child
born with a physical or mental handicap, for in-
Barry Hoffmaster, “What Does Vulnerability Mean?” Hastings Cen-
ter Report 36, no. 2 (2006): 38-45.
stance, could be devastated by the unceasing jeers
and taunts of brutal schoolmates. A third meaning of
“vulnerable” is to be capable of being persuaded or
tempted. A young woman burdened by university
debt might be enticed, for example, to reply to an
advertisement that offers substantial remuneration
for egg donation. And a fourth meaning is to be li-
able to increased penalties, as any bridge player
whose team has won a game in a rubber knows. The
real meaning of vulnerability is richer than these
sketchy definitions, however. To understand it, we
must appreciate what it means to live with vulnera-
bility. People who are old, particularly those who re-
side in nursing homes or other long-term care facili-
ties, are vulnerable in many ways. What does vulner-
ability mean for them?
To try to answer that question, I have to describe
the vulnerability of two people I know. The first is
my eighty-five-year-old father. As this is written, my
father most likely is sleeping in a bed in a nursing

38 H A S T I N G S C E N T E R R E P O R T March-April 2006
home. Forty years ago my father
stopped playing basketball with me
and a friend of mine, went inside our
house, lay down on our living room
couch, and had a heart attack. Two
days later my mother threw open the
back door of our house, rushed in
crying, and told me that my father
had had a stroke in the hospital. I did
not know what that meant at the
time; it turned out that he did not
have just any stroke, but what is aptly
and ominously called a “catastrophic”
stroke. His entire right side was para-
lyzed. From then on, he could not
use his right arm and hand, and he
could walk only with a cane and a
brace. His speech was impaired, and
he always struggled—most often un-
successfully—to find the word he
wanted and to complete the sentence
he had started.
Now, forty years later, ravaged by
the misfortunes of stroke and old age,
How do we respond to our fear of sweeping, debilitating
vulnerabilities? As we do to other fears: we suppress and
ignore it. Rather than focusing on the person for whom a task
is being performed, we focus on the task itself.
my father epitomizes what it is to be
vulnerable. He contracts multiple in-
fections and diseases. He has recur-
ring urinary tract infections, each of
which renders him weaker and push-
es him to an ever-lower plateau. He
has some form of dementia on top of
the cognitive impairment caused by
the stroke. His left hand shakes, so he
might have Parkinson’s. In the nurs-
ing home, he fell prey to van-
comycin-resistant enterococcus,
which put him in a private room. Be-
cause he cannot swallow, he is fed
through a peg-tube. When the tube is
washed out, sometimes fluid builds
up in his lungs, and he is transferred
to the hospital to be treated for con-
gestive heart failure.
My father has been physically dev-
astated. He can still be further
wounded, however. Other than when
March-April 2006
he is transferred to a recliner and
wheeled into the hall, he spends all
his time in bed, so he gets bed sores.
One sore on his ankle refused to heal
and exposed bone, necessitating
surgery and a subsequent skin graft.
Despite this intervention, the wound
persists.
My father can also be wounded
emotionally. After one hospital stay
he was transferred to a different nurs-
ing home, and when I went to see
him there, I found him in a lineup of
wheelchairs across from a nurses’ sta-
tion. Even from a distance, I could
see that his azure eyes were blazing.
When I approached and he recog-
nized me, he began waving his left
arm and talking, spewing sounds full
of fury but devoid of sense. I had
rarely seen him angry, and through-
out my entire life I had never seen
him that angry. He did not want to
be there, but he was helpless. At last,
probably out of desperation, he was
raging against a fate that he had en-
dured with patience, determination,
and equanimity for half his life.
As the days pass, though, he seems
less and less capable of being emo-
tionally wounded. And he no longer
is capable of being persuaded or
tempted, even by food—perhaps the
last pleasure he had. Nor, although he
and my mother were avid bridge
players, is he any longer capable of
playing a hand, let alone of winning a
game.
The second person is my eighty-
four-year-old mother. For forty years
she has cared for my father. In addi-
tion to all the usual spousal duties as-
sumed by a woman of her time and
background, she has attended to the
details of his care and his extra needs,
even when he was still at home in a
rented hospital bed, and she knew she
did not have the size and the strength
to get him into a wheelchair or to
turn him in bed. After he entered
what became a series of nursing
homes, she visited him at least once a
day, helped him eat, shaved him,
cleaned his dental plate, and took his
laundry home to wash. She was vigi-
lant in detecting lapses in his care and
aggressive in reporting those failings
to anybody who could do something
about them. She understood, intellec-
tually at least, that there were many
other patients in the nursing homes
who required care, and that there
were routines and schedules that had
to be followed. Yet her advocacy on
behalf of my father was unstinting
and unsparing. As a result, she had
tumultuous relationships with the
staff and the administrators, and she
was undoubtedly regarded as a “diffi-
cult” spouse.
My mother remains in amazingly
good physical health, lives in a house
by herself, drives a car, goes shopping,
cooks and cleans, pays the bills, and
gardens. Only recently has she started
to have problems with her short-term
memory. How, then, could she be re-
garded as vulnerable?
! ! !
L
et me approach that question
indirectly because I believe the
ways in which my mother is
vulnerable are, although not as palpa-
ble as the ways in which my father is
vulnerable, nevertheless regrettably
familiar. One of the articles I use
when I teach bioethics discusses the
plight of a hospitalized ninety-one-
year-old man who is profoundly de-
mented and, after a stay in the inten-
HASTINGS CENTER REPORT 39
 sive care unit, is at risk for a precipi-
tous decline.1 A new attending physi-
cian, who believes a return visit to the
intensive care unit would be “futile,”
asks the house staff about the patient’s
code status. They report that they
have tried, without success, to talk to
the patient’s eighty-seven-year-old
wife about her husband’s poor prog-
nosis, and that she has refused to con-
sent to a “do not resuscitate” order
and wants her husband to receive all
“aggressive measures.” They describe
the wife as “demanding and diffi-
cult.”
When the new attending physi-
cian talks to the wife, he discovers
that she has cared for her husband at
home for fifteen years, up until six
weeks ago, when she had to transfer
him to a nursing home. The wife is
tearful about the transfer; she says
that “he had been fine until he went
there.” In subsequent conversations
she explains that the house staff seem
too rushed and distracted to talk with
her. The residents speak to her in hall-
ways with clipboards in their hands,
and they are interrupted by pages.
When the attending physician talks
to her in the comparative quiet and
comfort of a solarium, she begins to
express her feelings and reveal her
own need to grieve and to be healed.
After providing devoted care for
many years, she now feels excluded
from decisions about her husband’s
care and wellbeing. Eventually, the at-
tending physician comes to see the
wife’s desire for “aggressive” manage-
ment as a product of her continuing
sense of responsibility and obligation
to her husband:
In a reparative way, she felt obliged
to rescue her husband. To . . .
[her], aggressive care was not an
intervention approaching medical
futility. Instead, the use of medical
technology was a means of
demonstrating the integrity of
their marriage covenant. As she
had cared for her husband at home
for years, she now would mobilize
all of the hospital’s resources in the
service of her husband. Simply
40 H A S T I N G S C E N T E R R E P O R T
put, she was making amends for a
misplaced sense of spousal aban-
donment. When the clinician sug-
gested to . . . [her] that she felt re-
sponsible for her husband’s situa-
tion, she broke down and cried.
She confessed that she felt respon-
sible for his current situation be-
cause she had not kept him at
home.2
This woman has been emotionally
wounded beyond what the house
staff have the time, and perhaps the
interest or the capacity, to compre-
hend. She tended lovingly and duti-
fully to a husband until that simply
became impossible. When she finally
had to give up, she lost control of
what happened to her husband. She
felt guilty about what she perceived as
her own failings. She felt ignorant be-
cause she could not obtain the infor-
mation she needed so badly. And be-
cause of her ignorance, she felt pow-
erless to affect her husband’s destiny
and to provide the care and comfort
she owed him. Yet she had to remain
faithful to her husband and find ways
of assuaging her guilt when she felt
she had failed. The only way she
could see to do that was to insist on
continued “aggressive” care. And that
made her “difficult and demanding.”
Change the details of the hus-
band’s history and present condition
and change the hospital to a nursing
home, and you have my mother. My
mother had supported and cared for a
husband with a catastrophic stroke
for half her life. When she finally had
to give up—a decision recommended
to her for a long time by many people
and beset by some reversals—it was
with enormous struggle and agony.
And now she has lost control of
what happens to her husband. The
person to whom she has scrupulously
attended and whom she has striven to
help and protect is abandoned to and
at the mercy of strangers. She feels
guilty. She attributes my father’s loss
of the strength to walk and the ability
to swallow food and drink water to
being in a nursing home. She excori-
ates staff—usually, but not always, to
my brother and me—for not provid-
ing care as good as the care she had
provided at home. More than once
she has had a point. On several occa-
sions, with her keen and practiced
senses, she has detected worrisome
deteriorations in my father’s condi-
tion that went unnoticed by staff.
One time her insistent concern led to
a rapid transfer of my father to a hos-
pital. She never seems able to obtain
the information she desperately
wants, and consequently she, too,
feels powerless. She complains that
she cannot talk to my father’s doctors,
either in the nursing home or when
he is transferred to the hospital. She
complains that the staff in the nurs-
ing home either do not have the time
to talk to her or are not willing to talk
to her.
In some sense and to some extent,
she understands why information is
so hard to come by. She realizes that
the nurses, aides, and social workers
in a nursing home are responsible for
many people and are busy coping
with inordinate, unceasing demands
on their time. She realizes that it is
the doctor who ultimately is responsi-
ble for my father’s care, who knows
my father’s condition best, and who
makes decisions about his medical
treatment. She realizes that nurses
and aides might not fully know what
is being done to my father, nor why it
is being done, nor what the expected
outcome is. And she realizes that
rather than provide incomplete, inac-
curate, or misleading information, it
is better that they provide no infor-
mation. Nevertheless, her ignorance
and her powerlessness foster feelings
of guilt, inadequacy, and infidelity.
She, too, has suffered deep and ir-
reparable emotional wounds.
! ! !
M
y father’s and my mother’s
vulnerabilities are linked,
of course. When my father
was still at home, my mother could
have injured her back trying to turn
him in bed or help him sit up. When
my father entered a nursing home,
March-April 2006
my mother was plagued by fears and
anxieties about how he was doing
there and how he was being treated.
As my father becomes progressively
more withdrawn and silent, my
mother loses even the partial interac-
tion and the incomplete, uncertain
communication she has had with
him. She becomes more isolated, and
her worries magnify because her
guesses about what he wants and how
he is feeling are even more specula-
tive. For a long time my mother has
completed sentences for my father
and done things for him when he was
struggling. She has fewer opportuni-
ties for that now, but she has always
believed, quite sincerely, that she is
Vulnerability doesn’t mean much to morality because, in part, it is
missing from moral philosophy, yet it is our very vulnerability that
creates the need for morality.
helping him. And after years of help-
ing him in countless unremitting
ways, it is easy to understand why she
would want to make it a little easier
and quicker for herself. But the words
she spoke for him, the decisions she
made for him, and the things she did
for him made him even more vulner-
able because they highlighted what he
could not do for himself. They also
made it impossible for him to do
more for himself, and, on occasion,
undoubtedly made it impossible for
him to get what he really wanted. He
was aware of that, and he could be
frustrated and angered by that. It was
obvious when he simply gave up.
There are also, of course, differ-
ences between my father’s and my
mother’s vulnerabilities. My father’s
vulnerability is largely the result of
natural causes and is much more
comprehensive because of the exten-
sive physical damage he has suffered.
Many functions of the tissues, organs,
and systems of his body have been
disrupted or destroyed, and harm to
those biological functions has cascad-
ed into his physical and mental func-
March-April 2006
tions. Paralysis and progressive weak-
ness have rendered him immobile
and unable to eat or drink. Destruc-
tion of tissues in his brain has im-
paired his alertness, his perceptive-
ness, and his comprehension. And
the loss of physical and mental func-
tions has virtually eliminated his so-
cial functioning. His exchanges with
other people are limited, brief, and
transitory. When vulnerability is the
result of natural causes, there is little,
if any, difference between being “vul-
nerable” and being “at risk.” One
could instead describe my father as at
risk of having another urinary tract
infection, of getting aspiration pneu-
monia, of developing bed sores.
My mother’s vulnerability is, in
contrast, more limited and more se-
lective. It derives primarily from
blocked or impeded social function-
ing. For that reason it is largely the re-
sult of human causes and human cre-
ations. Some of those causes are indi-
vidual: the incapacity or unwilling-
ness of individuals to provide the in-
formation she needs or to provide it
in a manner she can comprehend and
retain. Some of those causes are cul-
tural. My mother, like many people,
has a deep and abiding belief in the
myths of medicine. She expects med-
icine to discover the cause of every
new illness, infection, ailment, and
complication, and she expects medi-
cine to have a cure for every new
problem. Those expectations, as unre-
alistic as they are, are not entirely her
own creation. They have been fos-
tered and encouraged by the scientifi-
cally and technologically oriented,
progress-preoccupied society she in-
habits, by the cure and research mis-
sions of the medical community and
the fund-raising organizations that
support them, by the rampant adver-
tising of drug companies, and by the
deeply rooted cultural injunction that
associates responsibility with action
rather than with acceptance, to cite
just a few factors. And some of those
causes are organizational or institu-
tional: the structures, staffing, and
schedules of hospitals and nursing
homes, and the public and private
arrangements for providing and fund-
ing health care services.
Despite those differences, though,
there is a crucial similarity between
the vulnerability of my father and the
vulnerability of my mother. What
does not come out explicitly in the
dictionary definitions of “vulnerable,”
but what is most important about
vulnerability, is what my father and
my mother experience the most: the
loss of power that vulnerability im-
poses and signifies, and the attendant
loss of control that ensues. We fear
vulnerability most immediately be-
cause of the particular harms we seek
to avoid. But we fear vulnerability
most profoundly because of the
power we seek to retain.
Rollo May, a psychologist and psy-
choanalyst who used to be read a lot
but is not read much anymore, once
said, “no human being can stand the
perpetually numbing experience of
his own powerlessness.”3 My father’s
powerlessness extends almost as far as
it can. When I speak to my mother,
she regularly tells me: “Your father’s
not good. He hardly speaks, and all
he does is sleep.” In my view sleep is
one of his last blessings. My mother’s
powerlessness, although less exten-
sive, is more agonizing because she is
acutely aware of it. She appreciates
what my father has lost and how little
she now can do for him. She appreci-
ates what she has lost and what they
together have lost. She sees the lives
HASTINGS CENTER REPORT 41
 that other people have, and she
knows that their kinds of past, pre-
sent, and future opportunities were
foreclosed to my father and her, never
to be recovered and never to be recti-
fied. More than once, my mother has
said to me, “This is not much of a
life,” but it is the only life she has.
And she has to think about the fu-
ture. What kind of life will she have
after my father dies? Perhaps she will
be liberated to do things for herself,
to have fun and enjoy life in ways that
heretofore have not been possible.
Less optimistically, perhaps she will
struggle to find a new orientation and
focus for her life, and the depreda-
tions of aging will add deep physical
wounds to her already deep emotion-
al wounds. Like the wife of the nine-
ty-one-year-old, severely demented
man, my mother has much for which
to grieve and much about which to
worry.
How do we respond to such
sweeping, debilitating vulnerabilities?
Vulnerability gives us much to fear,
and we respond to it as we do to
other fears: we try to suppress and ig-
nore it. A familiar strategy for fleeing
from fear and discomfort is to be-
come task-oriented. Rather than fo-
cusing on the person for whom a task
is being performed, focus on the task
itself. That strategy is alluring because
it offers the reward of efficiency when
many tasks are accomplished and the
reward of satisfaction when those
tasks are accomplished well. But its
greatest reward is distance from fear
and discomfort. With that reward
comes a danger, however. The person
lying in the bed can be depersonal-
ized and objectified. Cheerfulness,
encouragement, and familiarity are,
of course, gifts to those for whom one
is providing care, and they should not
be foregone. Yet they are brief and
episodic, and their scheduled repeti-
tion might only expose their ultimate
hollowness. They can be incorporated
into a routinized way of making it
through a shift or a day, but they can-
not dispel the intractable realities of
debilitation and dependence. When
those realities are pervasive, the only
42 H A S T I N G S C E N T E R R E P O R T
way to cope might be to immerse
oneself in the demands of the job, to
disengage from what overwhelming
vulnerability does to a person.
There is another strategy for re-
sponding to the fear of vulnerability:
denial. That is what enabled me to
cope. Despite my father’s cane,
braces, walker, and wheelchair; de-
spite the chair-lift that was installed
on the stairs; and despite the handi-
capped license plates on the car, I did
not think of my father as disabled.
There were, of course, times when
the impact of his condition was too
vivid and too concrete to be ignored,
but I quickly dismissed and sup-
pressed those unwelcome intrusions.
Being disabled or handicapped was
something—had to be something—
that happened to other people. My
father’s struggles were, for me, an or-
dinary part of life. Notwithstanding
the overwhelming evidence to the
contrary, I did not regard him as dif-
ferent, and I did not regard my fami-
ly as different.
! ! ! enduring suffering. Frank points out
S
o what does vulnerability mean
for those who are vulnerable?
The philosopher Alfred North
Whitehead once said that human be-
ings have “a three-fold urge: (i) to
live, (ii) to live well, and (iii) to live
better.”4 Vulnerability means loss to
all three: loss of opportunities to live
better, loss of abilities to live well,
and, at its extreme, loss of living. My
father’s stroke deprived my father and
my mother of opportunities to live
better and severely constrained their
abilities to live well. Vulnerability can
impair living well and can destroy the
good life. Ethics, from the time of
Plato and Aristotle, has been about
living well, about the good life.
Shouldn’t ethics therefore be con-
cerned about vulnerability, and if so,
what does vulnerability mean for
morality?
The sad answer to that question,
as of now, is “not much.” There are
three reasons for this, I think. The
first is that vulnerability is antithetical
to the ethos of individualism that
pervades and dominates the morali-
ties of Western societies. The individ-
ualistic ideal is to make one’s own
way in the world, to make one’s mark
on the world through one’s accom-
plishments, and to be rewarded for
those accomplishments by happiness.
In pursuit of that ideal, individualism
seeks and requires self-sufficiency and
insulation from the risks that vulner-
ability poses. Respect for autonomy
is, in large measure, a moral proxy for
that individualistic ideal. Vulnerabili-
ty threatens individualism, however,
because it is enveloped in contin-
gency and chance, the elements of life
that caught the attention of Greek
writers. The tragedy and suffering
that vulnerability can bring mean de-
pendence, and dependence means the
failure of self-sufficiency.
The sociologist Arthur Frank rec-
ognizes this incompatibility when he
explains how Inanna’s journey to the
underworld exemplifies Joseph
Campbell’s view that heroism is not a
matter of overcoming adversity but of
that, in Campbell’s interpretation of
the myth, Inanna’s heroism is “hero-
ism as perseverance,” and he makes
the connection to today: “The notion
of fate that pervades Inanna’s heroism
seems increasingly intolerable to
more individualistic notions of the
person.”5 Frank explains why:
Campbell’s heroic model is more
feminine than masculine, finding
its earliest paradigm in the journey
of Inanna to the underworld.
Inanna undertakes the journey,
suffers helplessly, is rescued by
helpers from the world she has left,
and returns to sort out matters
with those who did not contribute
to her rescue. She wields no
weapons; her strength is her perse-
verance. This trope of heroism as
perseverance is most useful to peo-
ple who are ill and dying.6
Inanna is vulnerable because she suf-
fers “helplessly” and because she de-
pends on the help of others for her
rescue. She cannot do it on her own.
March-April 2006
Campbell’s interpretation of the myth
makes sense of her suffering and gives
it a moral point. That sense and that
point are foreign to the ethos of indi-
vidualism, though, and Frank right-
fully worries about how Inanna’s
struggle with her vulnerability is mis-
represented by that ethos:
I am troubled by what happens
when Campbell’s notion of the
heroic is transformed into self-help
prescriptions for a happy life; re-
constructing the myth within a
contemporary spiritual narrative
loses the heroic. Though Inanna
increases her power and her divini-
ty through her journey, she does
not enter the underworld to have a
personal growth experience. She
goes because it is her fate to go.
She is called to the underworld as
preparation to become the goddess
whom she can become only by
making that journey and incurring
Vulnerability engages our feelings as much as, if not more than,
our reason. Our common vulnerability bonds us and binds us to
other people.
such suffering. The cosmic order
requires her becoming and thus
her journey. Neither the journey
nor its aftermath makes her happy
by most human standards. Inanna
does increase in wisdom and
stature, but this “growth” is neither
personal nor linked to pleasure.7
Vulnerability means that one is con-
trolled by, rather than in control of,
the world. Vulnerability marks the
limits of individualism, but the ethos
of individualism doggedly refuses to
acknowledge those limits and instead
construes vulnerability to fit its as-
sumptions and goals.
The second reason that vulnerabil-
ity doesn’t mean much to morality is
that vulnerability is missing from
moral philosophy, our intellectual en-
deavor to understand and enhance
morality, because moral philosophy
ignores the body. Moral theories, at
March-April 2006
least in the tradition of Western ana-
lytic philosophy, are grounded in rea-
son, and the purer that reason can
be—the more it can emulate the rea-
son of logic and mathematics—the
better it is. A paradigm of this strong-
ly rationalistic approach is Immanuel
Kant’s classic work, Groundwork of the
Metaphysic of Morals,8 which has
shaped the course of moral philoso-
phy ever since it appeared in 1785.
Kant’s challenge in the Groundwork is
to explain how imperatives—direc-
tives that tell us what we ought to
do—are possible and, in turn, how
the supreme principle of morality,
which Kant calls the “Categorical Im-
perative,” is possible. Kant’s answer is
that a categorical imperative can exist
only if there is something that is an
“end in itself”—that is, is not valu-
able as a means to something else but
has intrinsic, unconditional value.
The only thing that has such intrin-
sic, unconditional value, in Kant’s
view, is rationality. Kant famously dis-
tinguishes nonrational beings, which
have “only a relative value as means
and are consequently called things,”
from rational beings, which “are
called persons because their nature al-
ready marks them out as ends in
themselves—that is, as something
which ought not to be used merely as
a means—and consequently imposes
to that extent a limit on all arbitrary
treatment of them (and is an object of
reverence).”9 In this tradition of
moral philosophy, rationality gives
human beings their unique moral sta-
tus and their incomparable moral
worth.
Human beings are rational, but
human beings also have bodies, and
because they have bodies, they are
vulnerable. In fact, vulnerability is an
even more basic feature of our human
constitution than rationality because,
while all human beings are vulnera-
ble, not all human beings are rational
or even possess the potential to be-
come rational. All human beings are
born into vulnerability and remain
deeply vulnerable for some time, but
human beings who are born without
certain portions of their brains or
with extreme mental impairments
never will become rational. Moreover,
our universal vulnerability resonates
with moral significance. For one
thing, it is our very vulnerability that
creates the need for morality. The
legal philosopher H.L.A. Hart links
the fundamental moral and legal pro-
hibitions on killing and inflicting
harm to our common vulnerability.
That people are “prone to, and nor-
mally vulnerable to, bodily attack” is,
Hart says, a truism:
[T]hings might have been, and
might one day be, otherwise.
There are species of animals whose
physical structure (including ex-
oskeletons or a carapace) renders
them virtually immune from at-
tack by other members of their
species and animals who have no
organs enabling them to attack. If
men were to lose their vulnerabili-
ty to each other there would vanish
one obvious reason for the most
characteristic provision of law and
morals: Thou shalt not kill.10
None of us is invincible; all of us are
vulnerable, in similar ways at the be-
ginning of our lives and later in dif-
ferent ways at different times in dif-
ferent circumstances. All of us, there-
fore, need the protection—and legal
enforcement—of morality.
For another thing, we cannot un-
derstand the persons we are, and thus
how to live well, without recognizing
vulnerability as an ineluctable feature
HASTINGS CENTER REPORT 43
 of our embodied humanity. In his
Paul Carus Lectures, the philoso-
pher Alasdair MacIntyre criticizes
himself for making the error of
“supposing an ethics independent
of biology to be possible,”11 and he
criticizes Western moral philoso-
phy, from Plato through Kant to
G. E. Moore in the twentieth cen-
tury, for ignoring the vulnerabili-
ties inherent in that biology:
Consider how both physical
and mental disability are afflic-
tions of the body and how
therefore habits of mind that
express an attitude of denial to-
wards the facts of disability and
dependence presuppose either a
failure or a refusal to acknowl-
edge adequately the bodily di-
mensions of our existence.12
Our vulnerabilities and concomi-
tant dependencies are, as MacIn-
tyre puts it, “so evidently of singu-
lar importance that it might seem
that no account of the human con-
dition whose authors hoped to
achieve credibility could avoid giv-
ing them a central place.”13 Yet
human vulnerabilities and depen-
dencies have no place, let alone a
central place, in philosophical ap-
proaches that equate morality with
rationality and moral agency with
rational agency.
! ! ! emerged.
T
he third reason vulnerabili-
ty doesn’t figure in our un-
derstanding of morality is
that, like vulnerability, feelings
have no place in rationalistic con-
ceptions of moral philosophy and
morality. Nevertheless, vulnerabili-
ty engages our feelings as much as,
if not more than, our reason. My
father taught me that. During my
family’s last visit to see my father
and mother, I spent a lot of time in
my father’s room watching him
sleep. Sometimes he was sleeping
when I arrived and sleeping when I
left; I would come back later, and
he still would be sleeping. But
44 H A S T I N G S C E N T E R R E P O R T
there were exceptions. On one oc-
casion, shortly after I arrived, my
father looked at me and said,
“That’s a nice shirt.” Before our
visit, my mother had wanted to
put some goldfish in my father’s
room to give him something to
look at, but his nursing home does
not allow pets. My wife then had
the inspiration of using some col-
ored glass fish we had bought in
Nova Scotia instead. The fish are
tied to glass balls that float on top
of the water, so it looks as if they
are swimming. While I was spend-
ing time with my father, my wife
scattered brightly colored stones on
the bottom of a goldfish bowl,
added water, and then carefully
arranged three fish inside the bowl.
She set the bowl on a window
ledge where my father could see it.
He gazed at it for a while, then
said, “That’s very neat.” What
amazed me was that my father had
uttered two complete, articulate
sentences. Often the sounds he
makes as he struggles to speak are
garbled and incoherent, or he will
get out a few words that begin a
sentence but be unable to com-
plete it. I cannot remember the last
time I heard a coherent sentence
from my father. When he spoke
those two sentences, and for a long
time afterwards, I had no idea why
they suddenly and unexpectedly
Now I have a suspicion. My
suspicion is that it was because
they expressed feelings. Rollo May
says that although care goes be-
yond feeling, it begins with feeling:
“It is a feeling denoting a relation-
ship of concern, when the other’s
existence matters to you; a rela-
tionship of dedication, taking the
ultimate form of being willing to
get delight in or, in ultimate terms,
to suffer for, the other.”14 I think
that in complimenting my shirt
my father was telling me that I
mattered to him, and that in com-
plimenting the fish bowl he was
telling me that he was happy that
he mattered to us.15 And I think he
was able to utter those sentences
because feeling is more basic than
reason. Listen to Rollo May again:
When William James says,
“Feeling is everything,” he
means not that there is nothing
more than feeling, but that
everything starts there. Feeling
commits one, ties one to the
object, and ensures action. But
in the decades after James made
this “existentialist” statement,
feeling became demoted and
was disparaged as merely sub-
jective. Reason or, more accu-
rately, technical reason was the
guide to the way issues were to
be settled. We said “I feel” as a
synonym for “I vaguely be-
lieve,” when we didn’t know—
little realizing that we cannot
know except as we feel.16
The denial that MacIntyre casti-
gates and the denial that shrouded
me is so powerful, and the habit of
mind that promulgates denial is so
entrenched, that, as May insists,
we cannot know vulnerability ex-
cept as we feel vulnerability.
We need to feel our vulnerabili-
ty to affirm our humanity. While
we are not invincible, neither are
we superhuman. When we recog-
nize the depth and the breadth of
our vulnerability, we realize how
much we need the help of others to
protect us from our weaknesses
and our infirmities. How well my
father has coped for four decades
has depended, in large measure, on
my mother. His plight reflects, as
MacIntyre observes, a general truth
about the human condition: “It is
most often to others that we owe
our survival, let alone our flourish-
ing, as we encounter bodily illness
and injury, inadequate nutrition,
mental defect and disturbance, and
human aggression and neglect.”17
Vulnerability is a source of our
concern for others, but it also is a
source of our interest in and re-
liance on others. Our common
vulnerability bonds us and binds
us to other people. The demented,
March-April 2006
helpless individual lying in a bed
might still be capable of feeling, but,
perhaps more important, that person
is capable of making us feel. We can
feel compassion for that person’s loss-
es and that person’s suffering. We also
can feel our common humanity—our
own fragility and our own dependen-
cy. If we do, we truly can care for that
person and for ourselves. That is what
vulnerability means for us.
Acknowledgments
The first draft of this paper was writ-
ten for a conference on “Vulnerability
in Later Life: Challenges and Possibili-
ties for Supporting Persons ‘At Risk,’”
the 20th Annual McMaster Summer
Institute on Gerontology, organized by
the McMaster Centre for Gerontologi-
cal Studies, Hamilton, Ontario, and
held on June 2, 2003. I thank the orga-
nizers for the invitation to speak and
the participants for their helpful ques-
tions and supportive comments. I
thank Sylvie Lamer and Kathryn Desai
for reading drafts of this paper and for
their valuable suggestions. I thank
March-April 2006
Arthur Frank for his detailed, acute as-
sessments of several versions of this
paper, his wealth of knowledge, and his
encouragement. And I thank the Hast-
ings Center Report’s anonymous referees
for their perceptive comments and crit-
icisms.
References
1. J.J. Fins, M.D. Bacchetta, and F.F.
Miller, “Clinical Pragmatism: A Method of
Moral Problem Solving,” in Pragmatic
Bioethics, ed. Glenn McGee (Nashville,
Tenn.: Vanderbilt University Press, 1999),
30-44. The précis of the case is taken from
32-39.
2. Ibid., 37-38.
3. R. May, Love and Will (New York: Dell
Publishing Co., 1969), 14.
4. A.N. Whitehead, The Function of Rea-
son (Boston, Mass.: Beacon Press, 1929), 8.
5. A.W. Frank, “Narratives of Spirituality
and Religion in End-of-Life Care,” in Nar-
rative Research in Health and Illness, ed. B.
Hurwitz, T. Greenhaigh, and V. Skultans
(London, UK: Blackwell Publishing and
BMJ Books, 2004), 141.
6. Ibid., 140-41.
7. Ibid., 141.
8. I. Kant, Groundwork of the Metaphysic
of Morals, tr. H.J. Paton (New York: Harper
& Row, 1964).
9. Ibid., 96 (pages 428 and 65 in the edi-
tion issued by the Royal Prussian Academy
in Berlin and in the second edition, respec-
tively).
10. H.L.A. Hart, The Concept of Law
(New York: Oxford University Press, 1961),
190 (emphasis in original).
11. A. MacIntyre, Dependent Rational
Animals (Chicago, Ill.: Open Court, 1999),
x.
12. Ibid., 4.
13. Ibid., 1.
14. May, Love and Will, at 303.
15. Richard Zaner makes this point
about people who are dying: “Some . . . are
haunted by whether or not their lives made
any difference, whether they mattered. Oth-
ers want especially to let us know they care
for us, that we who remain alive matter to
them, that our lives have been worthy.”
R.M. Zaner, Troubled Voices (Cleveland,
Oh.: The Pilgrim Press, 1993), 144.
16. May, Love and Will, at 303 (emphasis
in original).
17. MacIntyre, Dependent Rational Ani-
mals, at 1. See also Zaner, Troubled Voices, at
145.
HASTINGS CENTER REPORT 45