IN TRO DUCT IO N

Approches medicales de la vulnerabilite humaine,or Medical Approaches to Human Vulnerability

Christian Herve

� Springer Science+Business Media New York 2013

What does the term ‘vulnerability’ mean when applied to living things, and in

particular human beings? How should it be understood? A defining characteristic,

indeed the very identity of a human being, is mortality. But health, good or ill, is not

expressed discontinuously in the ‘all-or-nothing’ way of a physical law. On the

contrary, health must first be viewed as subject to a gradual ageing, a certain

‘wearing out’ of the body. Yet, the body also undergoes a constant cellular renewal,

different for each organ. Thus, we are left to consider a biological individual as

being under continual overhaul (notwithstanding its permanent features) due to the

qualities inscribed in its genes and the potential it develops through life’s

conditions—particularly cultural and social conditions. Living conditions and social

organisation, especially in democracies, are in fact the predominant factors acting

on health, while the contribution of classical therapeutic medicine, contrary to our

immediate assumptions, amounts to barely 10 % of the total impact.

As a result, vulnerability must be thought of as a dynamic concept, if only with

reference to the subtle balance between a person’s biological entity and the outside

world, between ‘self’ and ‘non-self’. Any imbalance between a person’s needs and

the possibilities of meeting those needs in a specific environment will thus present

as a physical, mental or social disability, in a word, a vulnerability. This

vulnerability must then be addressed through the influence of the person’s identity,

the construction of their sense of being and by the metaphysical choices in their

worldview—whether inherited from their own culture or taken from another culture

of their choice.

In these dynamic dimensions, definitions of vulnerability take on their full

meaning. As stated by Matthieu Piccoli (www.ethique.sorbonne-paris-cite.fr) in his

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e-mail: christian.herve@parisdescartes.fr

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Cult Med Psychiatry

DOI 10.1007/s11013-013-9357-4

ethics master’s dissertation, the definition of vulnerability cannot be derived solely

through the aetiology of the illnesses that bring about vulnerability as a physical

state. Analysing the recent report of the French High Committee for Public Health

focusing on persons affected by insecurity, he highlights the relevance of a patient’s

sensations, described as a state of fragility, precariousness or ill-being over the last

6 months—a vulnerability that the person can no longer compensate for or cope

with. In his ethics master’s degree and PhD on ageing and its attendant health

impairment due to biological wear and tear, Benoıt Tudrej points to the stabilising

effect of sharing medico-social data within care networks. Medico-social data

sharing enables a range of responses to patients’ needs or difficulties. In addition,

sharing assuages the feeling of vulnerability, and recourse to a professional carer or

other informed helper can facilitate a more precise response to patient requirements

(www.ethique.sorbonne-paris-cite.fr). The ability for a carer to make themselves

available for another person, right down to their factual existence, i.e. through a

perception of the person’s ontic nature (as is usual in the family and close com-

munities), is essential. Since isolation and abandonment by others can cause deadly

moral suffering, the resource of presence must be conceptualised and implemented

as a way to help relieve all vulnerability that may become unbearable.

Faced with vulnerability, mankind has built myths and exercised creativity,

becoming co-creator of the world through certain rituals. By constructing

institutions, we enshrine values that promote the status of the human being: a

desire for liberty and equality, which when combined allows fraternity and fosters

justice. I, therefore, end this discussion of vulnerability by citing the author Paul

Ricoeur, who has worked so much on capacity and vulnerability. In ‘Oneself as

another’ (Ed. Seuil, 1990), the good life (here, ‘coping with one’s vulnerability’ or

transcending it) is described as living ‘with and for others’ in ‘fair institutions’; thus,

he sums up the essential part of his life in this otherness: ‘I draw life from frontiers,

exchanges and borrowings’, highlighting the reciprocal movement expected of

others to limit the violence of non-self in general and of other people in particular.

Philosophy, metaphysics and culture are all to be considered in maintaining our

health. Vulnerability appears only when there is a lack, a lack that characterises us

as ‘imperfect human beings’, ever-searching, even unwittingly, for a stability that

has perpetually and biologically refused us by identity itself. The texts that follow

seek to take a closer look at what actions address the range of human deficits so that

we may, at the very least, move forward.

Christian Herve, Head of the Medical Ethics and Forensic Medicine Laboratory,

Paris Descartes University, Sorbonne Paris Cite.

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