Hastings Center Report

Vulnerability is one of those general notions we bandy about confidently but carelessly, assuming that we know what it means and that it means the same thing for everybody. Were we challenged to explain it, though, we might admit to some unclarity and puzzlement. What does vulnerability actually mean?

A dictionary provides multiple definitions. One meaning of "vulnerable" is to be susceptible to something, a bad something naturally, such as disease or infection. People living in a war-torn country where the water and sewer systems have been destroyed are, for example, vulnerable to contracting malaria. A second meaning of "vulnerable" is to be capable of being physically or emotionally wounded. A child born with a physical or mental handicap, for instance, could be devastated by the unceasing jeers and taunts of brutal schoolmates. A third meaning of "vulnerable" is to be capable of being persuaded or tempted. A young woman burdened by university debt might be enticed, for example, to reply to an advertisement that offers substantial remuneration for egg donation. And a fourth meaning is to be liable to increased penalties, as any bridge player whose team has won a game in a rubber knows. The real meaning of vulnerability is richer than these sketchy definitions, however. To understand it, we must appreciate what it means to live with vulnerability. People who are old, particularly those who reside in nursing homes or other long-term care facilities, are vulnerable in many ways. What does vulnerability mean for them?

To try to answer that question, I have to describe the vulnerability of two people I know. The first is my eighty-five-year-old father. As this is written, my father most likely is sleeping in a bed in a nursing [End Page 38] home. Forty years ago my father stopped playing basketball with me and a friend of mine, went inside our house, lay down on our living room couch, and had a heart attack. Two days later my mother threw open the back door of our house, rushed in crying, and told me that my father had had a stroke in the hospital. I did not know what that meant at the time; it turned out that he did not have just any stroke, but what is aptly and ominously called a "catastrophic" stroke. His entire right side was paralyzed. From then on, he could not use his right arm and hand, and he could walk only with a cane and a brace. His speech was impaired, and he always struggled—most often unsuccessfully—to find the word he wanted and to complete the sentence he had started.

Now, forty years later, ravaged by the misfortunes of stroke and old age, my father epitomizes what it is to be vulnerable. He contracts multiple infections and diseases. He has recurring urinary tract infections, each of which renders him weaker and pushes him to an ever-lower plateau. He has some form of dementia on top of the cognitive impairment caused by the stroke. His left hand shakes, so he might have Parkinson's. In the nursing home, he fell prey to van-comycin-resistant enterococcus, which put him in a private room. Because he cannot swallow, he is fed through a peg-tube. When the tube is washed out, sometimes fluid builds up in his lungs, and he is transferred to the hospital to be treated for congestive heart failure.

My father has been physically devastated. He can still be further wounded, however. Other than when he is transferred to a recliner and wheeled into the hall, he spends all his time in bed, so he gets bed sores. One sore on his ankle refused to heal and exposed bone, necessitating surgery and a subsequent skin graft. Despite this intervention, the wound persists.

My father can also be wounded emotionally. After one hospital...