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”