Vulnerability: An integrative bioethics review and a proposed taxonomy

Nurs Ethics. 2021 Aug;28(5):750-765. doi: 10.1177/0969733020976180. Epub 2021 Jan 12.

Abstract

Background: Vulnerability is a concept frequently encountered in the bioethical literature, particularly in the context of research ethics. It can be said that the usage of the concept expanded in the 2000s and started to be used in many new contexts in the literature. However, there appears to be no systematic review that examines the definition of the concept of vulnerability.

Objectives: The rationale for this study constitutes the questions regarding how vulnerability is defined and which components are used to define the concept of vulnerability in the bioethics literature.

Research design: The integrative review method was conducted to reach various definitions of the concept of vulnerability in bioethics. Whittemore and Knafl's revised framework for integrative reviews guided the analysis. 'Vulnerability' and 'vulnerable' keywords, intercrossing with the words 'bioethics' and 'medical ethics', were searched in three different databases (PubMed, Web of Science and Scopus). Collected data were analysed thematically and a taxonomy was developed.

Findings: A total of 1287 studies obtained through search were reduced to 123 that kept the definition of vulnerability. As a result of the review, a comprehensive taxonomy of vulnerability has been proposed. The proposed taxonomy of vulnerability has two categories, ontological and circumstantial, with three subcategories each, which might provide a multidimensional perspective.

Discussion: Publication dates, origins and contexts of included publications were discussed. Specifications of the term vulnerability and components of its definition and factors that constitute these components provided from the view were evaluated and also discussed.

Conclusion: The proposed taxonomy provides a useful classification for assessing vulnerability in bioethics. It is hoped that the taxonomy we put forward as a result of the review will increase awareness on the issue and also take into account the factors that create vulnerability in the context of research, healthcare and nursing care policies.

Ethical considerations: The review was conducted in accord with ethical and scientific standards.

Keywords: Bioethics; integrative review; medical ethics; nursing ethics; vulnerability.