Not the usual suspects: addressing layers of vulnerability

Bioethics. 2013 Jul;27(6):325-32. doi: 10.1111/bioe.12035. Epub 2013 May 30.


This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of 'usual suspects', focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different approaches to 'vulnerability' are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Argentina
  • Blood Banks* / economics
  • Blood Banks* / ethics
  • Blood Specimen Collection* / economics
  • Blood Specimen Collection* / ethics
  • Blood Specimen Collection* / trends
  • Conflict of Interest
  • Educational Status
  • Emigrants and Immigrants
  • Female
  • Fetal Blood* / transplantation
  • Health Literacy
  • Health Policy*
  • Humans
  • Policy Making*
  • Poverty
  • Pregnancy
  • Pregnant Women*
  • Reproductive Rights
  • Social Class*
  • Transplantation, Autologous
  • Transplantation, Homologous
  • Uncertainty
  • Vulnerable Populations*