Vulnerability as a Key Concept in Relational Patient- Centered Professionalism

by Janet Delgado

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“The goal of this paper is to propose a relational turn in healthcare professionalism, to improve the responsiveness of both healthcare professionals and organizations towards care of patients, but also professionals. To this end, it is important to stress the way in which difficult situations and vulnerability faced by professionals can have an impact on their performance of work. This article pursues two objectives. First, I focus on understanding and making visible shared vulnerability that arises in clinical settings from a triple perspective: patient and family, health professionals, and institutions. Second, to address this challenge for professionalism, in this paper I articulate the term “relational centered-patient professionalism”, which has two main axes. The relational approach means taking into account how the relationships among professionals, patients and institutions determine the constitution and evolution of those professional values. The focus on patient centered care is indispensable, because it is the ultimate goal pursued by the development of these professional values, and must always be at the center.”

Read more here.

Delgado, J. Vulnerability as a key concept in relational patient- centered professionalism. Med Health Care and Philos (2021).

Writing Vulnerability into the Social Contract

by Martha Albertson Fineman

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In western political traditions, the idea of political (and legal) subjectivity places the individual in relationship to the state and its institutions, with the understanding of the terms of the social contract defining the quality and nature of that relationship. Specific conceptualizations of the political subject will affect the status of everyone in society, although not everyone may be considered a fully realized and legally capable subject. For example, at the formation of American democracy (and within its foundational documents), fully realized political subjectivity was limited to white, male, property-owning or tax-paying individuals of a certain age and religion, who were also “free.” Over the course of the nineteenth and twentieth centuries, certain of these qualifiers were removed and full political subjectivity was recognized for members of previously excluded groups. However, the expansion of the membership of the population granted full political subjectivity did not automatically transform the perceived nature or assumed capabilities of the political subject. Indeed, the inclusion of those previously excluded was based on the assertion that there were no relevant differences between them and the original political subject. The mode of inclusion was assimilation, underscored by the application of a principle of formal equality.

The implications of this exclusion and eventual assimilation of women and significant numbers of previously excluded men are significant. While the contemporary race- and gender-neutral political subject may look different than the original, many aspects of the constitutional relationship between the political subject and the state remain similar to those developed hundreds of years ago. Importantly, the historic political subject was not only white, male, and propertied, but phenomenologically deemed to possess idealized qualities and characteristics derived from the aspirations, experiences, and perceived capabilities of the members of that limited and unrepresentative group. The experiences and perceptions of those previously excluded were, in many ways, significantly different from that narrowly defined subject, and potentially incompatible with the norms and values underlying the original organization of state and individual responsibilities. The contemporary political subject incorporates only some of the host of possible variations in human characteristics, experiences, and capabilities: he is a fully functioning adult who is independent and self-sufficient, fully capable of taking care of his own needs and the needs of those dependent upon him. This political construct is theoretically inadequate, incapable of fully (or fairly) informing the development of political and legal norms to address many of the situations and circumstances that occur over the life course of most actual individuals. It is certainly inadequate to support a robust sense of social justice.

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Manufacturing Resilience on the Margins: Street Gangs, Property, & Vulnerability Theory

by Lua K. Yuille

“The pages that follow advance a simple central proposition: Local governments should pay gang members to refrain from gang activity. But the deeper story this article tells is more complex, with implications far beyond the relatively confined world of the contemporary American street gang inhabited by an estimated 850,000 members. That more complex story is of the universal human condition of vulnerability, the instinct and imperative to build mechanisms to confront that vulnerability, and of property’s important role in that task.

The surface story of this article offers a provocative and unexpected approach to what is framed as a growing national, regional, and local gang threat. More predictable, is the response of local governments and law enforcement agencies, which have developed creative initiatives to disrupt and dismantle the reported 33,000 gangs across the country. Most of this experimentation has focused on variations on traditional policing, like the creation of specialized “gang units” within police departments and targeted heightened surveillance operations against gang leaders. However, in the 1980s and 1990s, political actors also turned to civil legal mechanisms to combat what continues to be framed as the growing, intractable menace of the corporatized, terroristic, criminal street gang.

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Vulnerability and Power in the Age of the Anthropocene

An excerpt from “Vulnerability and Power in the Age of the Anthropocene” by Angela P. Harris

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“In a paper published in 2011, a group of scientists led by Will Steffen presented evidence of what they called “The Great Acceleration:” a sudden intensification of the impact of human activity on the global environment. Taking the measure of diverse human phenomena, from human population and fertilizer consumption to the number of McDonald’s restaurants worldwide, the authors generated a series of charts. Each chart featured a curve sloping steeply upward, beginning around 1945. Extreme environmental change on planet Earth is nothing new. As J.R. McNeill points out in his environmental history of the twentieth-century world, “[a]steroids and volcanoes, among other astronomical and geological forces, have probably produced more radical environmental changes than we have yet witnessed in our time.” Nor is human impact on the biosphere unprecedented. As beings embedded in biological systems, humans have always affected the fortunes of plant and animal species around us (and within us, as we will see), and these impacts increased as humans began farming, building cities, and domesticating other animals. However, since the dawn of the Industrial Age the scale of human intervention in human and trans-human planetary systems has grown dramatically. McNeill explains that the transition from reliance on human and animal power to reliance on fossil fuels made possible an extraordinary growth in energy use:

We have probably deployed more energy since
1900, than in all of human history before 1900.
My very rough calculation suggests that the
world in the twentieth century used 10 times as
much energy as in the thousand years before
1900 A.D. In the 100 centuries between the dawn
of agriculture and 1900, people used only about
two-thirds as much energy as in the twentieth

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