Epistemic Injustice in Healthcare: A Philosophical Analysis

Epistemic Injustice in Healthcare: A Philosophical Analysis | Ian James Kidd – Academia.edu

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Miranda Fricker (2007).

Ill persons can suffer testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies.

Ill persons can also suffer hermeneutical injustice…  

Hermeneutics is the theory and methodology of interpretation…which includes written, verbal, and non-verbal  communication as well as semiotics, presuppositions, and pre-understandings.

because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources.

We then argue that epistemic injustice arises in part owing to the epistemic  privilege enjoyed by the practitioners and institutions of contemporary healthcare services – the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons.

We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice

We further argue that health professionals are considered to be epistemically privileged, in  both warranted and unwarranted ways, by virtue of their training, expertise and third-person  psychology.

Moreover, they decide which patient testimonies and interpretations to act upon.

We contrast cases in which patients are assigned undeservedly low credibility with cases in which patients’ credibility is undeservedly high.

We show that these are two ways in which health professionals’ clinical judgement can be skewed as a result of assigning too little or too much credibility to patients.

In certain extreme cases of paternalistic medicine patients might simply not be regarded as epistemic contributors to their case in anything except the thinnest manner (e.g. confirming their name or ‘where it hurts’).

Denying someone credibility they deserve is one form of epistemic injustice; denying them the role of a contributing epistemic agent at all is a distinct form of epistemic exclusion (Hookway 2010)

even if the patient’s testimony were relevant, emotionally balanced and so on, what they say is not expressed in the accepted language of medical discourse and will therefore be assigned a deflated epistemic status.

As one physician said: “patients say a lot of irrelevant things like ‘when I eat lettuce my elbow hurts’. I have to listen carefully for the important stuff and ignore the rest”

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4 thoughts on “Epistemic Injustice in Healthcare: A Philosophical Analysis

  1. Kathy C

    This is Systemic, The calculation has more to do with the Bottom Line, and the HMO’s organization that proving Medical Care. Certain people, the ones whose Insurance does nto re-reimburse enough,, woman and minorities. The Industry found that any condition that was deniable, could be attribute to a “Mental Condition.” There was no oversight or Research to counter any of this. The Industry found a way to deny healthcare and protect their bottom line. The APA was more than willing to increase the scope op of their “practice” to include this Philosophy. It increased their profitability. This is so ingrained, they had to justify the failures, so this became an Ideology. They are still told they are “helping” whether it is saving medical resources for those that “Deserve it” or denying care to “Help.” In the Post Science World they can justify anything, with the help of Cherry Picked Statistics, uncollected data, or Pop Psychology that goes Viral on the internet.

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  2. Kathy C

    This is Systemic, The calculation has more to do with the Bottom Line, and the HMO’s organization that proving Medical Care. Certain people, the ones whose Insurance does nto re-reimburse enough,, woman and minorities. The Industry found that any condition that was deniable, could be attribute to a “Mental Condition.” There was no oversight or Research to counter any of this. The Industry found a way to deny healthcare and protect their bottom line. The APA was more than willing to increase the scope of of their “Practice” to include this Philosophy. It increased their profitability, and put them on the level of Physicians.. This is so ingrained, they had to justify the failures, so this became an Ideology. They are still told they are “helping” whether it is saving medical resources for those that “Deserve it” or denying care to “Help.” In the Post Science World they can justify anything, with the help of Cherry Picked Statistics, uncollected data, or Pop Psychology that goes Viral on the internet.

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  3. Emily Raven

    I still think in many cases this kind of behaviour comes from doctors knowing their pedestals are now basically nonexistent when dealing with a patient that is capable of research. They’re no longer the “keepers of the knowledge” and their 8 years of expensive school being pretty irrelevant in some cases is a pretty hard pill to swallow. Because of this anyone with a chronic illness or that has more than two symptoms suffers. Whatever is going on im getting sick of it.

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    1. Zyp Czyk Post author

      I, too, am sick of all the misery being doled out in the name of “pain management” these days. It tries to put all pain patients into the same bucket even though the cause of having pain varies so widely, as does the response to treatments.

      That’s not a scientific or evidence-based approach – and lacks all compassion.

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