Epistemic Injustice and Illness

Abstract

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.Without the narrative acts of telling and being heard, the patient cannot convey to anyone else -or to self -what he or she is going through. More radically and perhaps equally true, without these narrative acts, the patient cannot himself or herself grasp what the events of illness mean.

Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome

“…A growing body of work has suggested that individuals suffering from ill health are more vulnerable to testimonial injustice, and this vulnerability exists across the different stages and epistemic practices of medical work 10 11 30–32. There is a risk of testimonial injustice when, for example, the inadvertent negative stereotyping of an illness or disability (on the part of a healthcare professional) constrains the patient's epistemic contribution to consultations, and wider conversations, about their condition.…”

“…Fricker classifies these wrongs and harms as ‘epistemic injustice’. Developing its application, Havi Carel and Ian Kidd have recently argued that Fricker's framework provides a fruitful perspective for analysing the distinctive epistemic injustice that may arise within the healthcare arena, and in particular in healthcare consultations, medical education and policymaking 10 11. This paper applies this theoretical framework to the case of CFS/ME and examines the ethical repercussions of the deep differences between lay and healthcare professional perspectives on this illness.…”

“…Thus, a concern about epistemic injustice is not merely a narrow medical or bioethical concern, but a broad and pervasive problem that has particular ethical consequences, in terms of suffering, health inequality and medical treatment, when it plays itself out in the healthcare arena (for a full discussion of epistemic injustice in healthcare, see Carel and Kidd and Kidd and Carel) 10 11…”

Epistemic Vices in Organizations: Knowledge, Truth, and Unethical Conduct

“…Anywhere in organizations and societies where there are gendered, ethnic, disabled, or other minorities, there is a likelihood of many epistemic injustices of both forms occurring ). An employee with a healthcare or disability issue may either not be believed by epistemically unjust managers or doctors (testimonial), or find it difficult to explain, formulate, and secure reasonable adjustments (hermeneutic) (Kidd and Carel 2017). Women may report having their workplace testimonials or contributions ignored or 'mansplained' back to them in an epistemically unjust culture, where men are unfairly discrediting, then re-appropriating, their role as a credible knower (Luzzi 2016).…”

“…Surprising given the general links between epistemological concerns, such as how we acquire knowledge, and ethical concerns, such as how we deliver fair hearings or deliberate on policy-making (e.g., Griffin 2011;Kidd et al 2017). Significant because a failure to consider these epistemic-ethical relationships risks leaving the spread of ignorance and confusion inadequately theorized (Oreskes and Conway 2012), and fails to hold accountable those who disregard 'epistemic goods' such as 'truth,' 'justification,' 'wisdom,' and 'understanding' as responsible for the consequences of their attitudes and actions (Matheson and Vitz 2014).…”