Recent studies have explored the effectiveness of open-label placebos for a variety of conditions, including chronic pain, cancer-related fatigue and irritable bowel syndrome. OLPs are thought to sidestep traditional ethical worries about placebos because they do not involve deception: with an OLP, patients or subjects are told outright that they are not given an active substance. As deception is framed as the primary hurdle to ethical placebo use, the door is ostensibly opened to ethical studies of OLPs. In this article, (...) I suggest that even though OLPs seemingly do not involve deception, there are other ethical considerations in their clinical investigation and subsequent use. Research ethics often focusses on informed consent—of which, deception and honesty are a piece—as a means to justify research practices with human subjects. Yet, it is but one of the ethical considerations that should be taken into account. With research into placebo effects in particular, I argue that the history of clinical placebo use grounds special considerations for OLP research that go beyond respect for the autonomy of individual patients through informed consent and encompass structural concerns about the type of patient for whom a placebo has historically been thought appropriate. (shrink)

Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for describing and assessing morally problematic situations in healthcare. However, surprisingly scarce attention has been devoted to how epistemic injustice relates to physicians’ professional duties on a conceptual level. I argue that epistemic injustice, specifically testimonial, collides with physicians’ duty of nonmaleficence and should thus be actively fought against in healthcare encounters on the (...) ground of professional conduct. I do so by fleshing out how Fricker’s conception of testimonial injustice conflicts with the duty of nonmaleficence as defined in Beauchamp and Childress on theoretical grounds. From there, I argue that testimonial injustice produces two distinct types of harm, epistemic and non-epistemic. Epistemic harms are harms inflicted by the physician to the patient qua knower, whereas non-epistemic harms are inflicted to the patient qua patient. This latter case holds serious clinical implications and represent a failure of the process of due care on the part of the physician. I illustrate this through examples taken from the literature on fibromyalgia syndrome and show how testimonial injustice causes wrongful harm to patients, making it maleficent practice. Finally, I conclude on why nonmaleficence as a principle will not be normatively enough to fully address the problem of epistemic injustice in healthcare but nevertheless may serve as a good starting point in attempting to do so. (shrink)

People can be treated unjustly with respect to the level of credibility others accord to their testimony. This is the core idea of the philosophical idea of epistemic justice. It should be of utmost interest to criminal law which extensively deals with normative issues of evidence and testimony. It may reconstruct some of the long-standing criticisms of criminal law regarding credibility assessments and the treatment of witnesses, especially in sexual assault cases. However, philosophical discussions often overlook the intricate complexities of (...) real procedural law and its underlying considerations. In its present form, the philosophical notion of epistemic injustice provides limited insights into legal discourse; it necessitates translation and adaptation. This study contributes to this endeavor by examining the contentious issue of testimony from witnesses who have undergone trauma-focused psychotherapy. Since the 1980s, courts worldwide were troubled with cases of false accusations based on false memories generated by suggestive therapeutic interventions. As a result, such post-therapy testimonies are discounted in one way or another in many jurisdictions. However, courts are still confronted with such testimonies, and the modi vivendi legal systems have established to deal with them continue to give rise to concerns about unjust treatment of witnesses. The question is thus whether legal rules or established practices of evaluating testimony based on memories which resurfaced after psychotherapy are epistemically and legally just. The paper presents seven ways in which courts may assess such testimonies and examines them in light of epistemic and procedural justice. Some of them prima facie constitute a form of epistemic injustice because they discount testimonies to an unwarranted degree. But these injustices might be justified by overriding principles favoring defendants. Nonetheless, the idea of epistemic justice, more broadly understood, inspires two principles that may serve as a foundation for a future conception of epistemic justice adapted to the law. (shrink)