Relational approachesvulnerability and autonomy in bioethics. Enfoques relacionales: vulnerabilidad y autonomía en bioética

Abstract

ABSTRACT The concept of vulnerability is central to current Bioethics. In the past several years there has been a great deal of interest generated around the concept of vulnerability in the Bioethics field. Due to this, it is necessary to define and analyse a conceptual framework in which the notion of vulnerability is developed within the scope of bioethics. The purpose of this thesis is to develop an ethics of vulnerability, based on the vulnerability theory. To address this issue, I analyse the reflection that we find in the work of Martha Fineman, emphasizing the main relevant aspects for bioethics. I highlight what are the main implications of an ethics based on a theory on vulnerability on bioethics. First, it is necessary to re-think the concept of autonomy. Theorizing about the concept of vulnerability there is a tension between how to respond to human vulnerability, while also promoting autonomy. A relational perspective on autonomy offers a different way to understand the link between vulnerability and autonomy. This approach maintains the value of autonomy, but avoids the individualism associated with liberal conceptions of it. I consider how rethinking autonomy in its relational sense affects understandings of vulnerability. I explain the meaning of relational autonomy and consider the main implications of this concept in regard to a vulnerability approach. If we are to effectively recognize and respond to ontological vulnerability, we also must the meaning of autonomy. The second implication of a reflection on vulnerability theory in bioethics is the fact that it can foster better relationships between healthcare professionals and patients, through the recognition of our shared vulnerability. Mainstream literature about vulnerability in healthcare field has been developed attending to patient’s vulnerability as a consequence of illness. In addition to patients and their families, it is necessary to take into account vulnerability from the perspective of health professionals: these professionals also face day-by-day suffering. Vulnerability theory can guide professionalism to incorporate an ethics of vulnerability in healthcare field, focusing on fostering resilience in patients and families, but also, and less considered in Professionalism literature, in healthcare professionals and healthcare institutions. Vulnerability Theory can offer an important contribution to the studies in professionalism in healthcare. The third implication is a reflection about the concept of “asymmetrical responsibility” in the context of healthcare. The encounter between a healthcare professional and a patient is a professional relationship based on care. This means that the responsibility to provide all the necessary tools and strategies to foster relational autonomy in patients correspond to professionals. Fostering relational autonomy and increasing resilience are the main objectives pursued by a relationship based on care. These achievements can be acquired through the understanding of our shared vulnerability as the human condition. At the same time, we cannot think about relations between professionals and patients without considering the institutional framework that can provide support or not. It is important to define and think about what is the role of the institutions of healthcare in this effort to promote an ethics of asymmetrical responsibility towards patients and healthcare professionals. In the attempt to improve the face to face relationships in healthcare it is essential the institutional commitment to address the care of those who care for others.