Why Marginalization, Not Vulnerability, Can Best Identify People in Need of Special Medical and Nutrition Care

In a 2015 paper published in the Journal of Bioethical Inquiry, bioethicist Henk ten Have identifies vulnerability as a "controversial topic in bioethics" and argues that bioethical attention to vulnerability comes at the expense of sufficient attention to the social structures that shape human life.In this paper, we situate ten Have's argument within the broader bioethical literature, emphasizing how critiques of vulnerability can enrich approaches in clinical settings, including in nutrition, where the concept of vulnerability is not foreign (eg, children are often labeled members of a vulnerable group).We use an example of food (in)security to show how reframing vulnerability to capture "layers of marginalization" can help clinicians and organizations more clearly identify who is most in need, develop solutions for what should be done, and determine how and by whom those solutions should be implemented. Vulnerability and MarginalizationIn a 2015 paper published in the Journal of Bioethical Inquiry, bioethicist Henk ten Have identifies vulnerability as a "popular though controversial topic in bioethics" and argues that bioethical attention to vulnerability focuses on individuals at the expense of sufficient attention to the social connections that shape human life. 1 The concept of vulnerability has been applied in a variety of contexts, including nutrition; children, adolescent girls, pregnant and lactating women, displaced persons, indigenous persons, and the elderly are often labeled members of nutritionally vulnerable groups.In this paper, we situate ten Have's argument within the broader bioethical literature and emphasize how critiques of vulnerability in research contexts can enrich approaches in clinical care broadly and nutrition care specifically.We close the paper using food (in)security as an example to demonstrate how a more nuanced view of marginalization can improve health care interventions.In so doing, we build on the work of Florencia Luna, 2 arguing that by reframing vulnerability in terms of "layers" we can capture how patients can be marginalized in many overlapping ways, as opposed to being marginalized by single group membership.We suggest that attention to marginalization