Literature on testimonial injustice and ways that perpetrators might combat it have flourished since Miranda Fricker’s ground-breaking work on testimonial injustice. Less attention has been given, however, to the role of bystanders. In this paper, I examine the accountability that bystanders may have for their omissions to redress testimonial injustice. I argue that bystander accountability applies in cases where it is opportune for bystanders to intervene, and if they are also sufficiently equipped and able to redress the testimonial injustice. Moreover, (...) I recommend that we move beyond virtue responsibilism for ameliorative thinking about testimonial injustice. (shrink)

Self-ascriptions of one's current mental states often seem authoritative. It is sometimes thought that the authority of such self-ascriptions is, in part, a matter of their indubitability. However, they do not seem to be universally indubitable. How, then, should claims about self-ascriptive indubitability be qualified? Here I consider several such qualifications from the literature. Finding many of them wanting, I nevertheless settle on multiple specifications of the thesis that self-ascriptions are authoritatively indubitable. Some of these specifications concern how other agents (...) ought to treat one's self-ascriptions, while a final specification concerns how one is entitled to respond to others’ doubts about one's self-ascriptions. The result is a pluralistic view of self-ascriptive indubitability: different types of mental state self-ascriptions are indubitable in different ways, and for different people. (shrink)

Who is morally permitted to tell jokes about Jews? Poles? Women? Only those in the group? Only those who would be punching up? Anyone, since they are just jokes? All of the standard approaches are too broad or too narrow. In on the Joke provides a more sophisticated approach according to which each person possesses "joke capital" that can serve as "comic insurance" covering certain jokes in certain contexts. When Bob tells a joke about Jews, we can never know exactly (...) what Bob is intending since we cannot see inside Bob’s mind. But we could reasonably infer, if we knew Bob himself was Jewish, if he worked tirelessly for Jewish causes, or was a card-carrying Neo-Nazi. Each would affect his joke capital, and, in certain circumstances, we would have a moral standing to demand to see his ledger to see how much joke capital he had with respect to Jews. The permissibility of that joke depends upon four factors: the joke, the teller of the joke, the audience, and the setting. The view developed in In on the Joke is the only view that clearly explains how each of these components work together in an integrated, effective ethic of humor. (shrink)

Disabled people face obstacles to participation in epistemic communities that would be beneficial for making sense of our experiences and are susceptible to epistemic oppression. Knowledge and skills grounded in disabled people's experiences are treated as unintelligible within an ableist hermeneutic, specifically, the dominant conception of disability as lack. My discussion will focus on a few types of epistemic oppression—willful hermeneutical ignorance, epistemic exploitation, and epistemic imperialism—as they manifest in some bioethicists’ claims about and interactions with disabled people. One of (...) the problems with the epistemic phenomena with which I am concerned is that they direct our skepticism regarding claims and justifications in the wrong direction. When we ought to be asking dominantly situated epistemic agents to justify their knowledge claims, our attention is instead directed toward skepticism regarding the accounts of marginally situated agents who are actually in a better position to know. I conclude by discussing disabled knowers’ responses to epistemic oppression, including articulating the epistemic harm they have undergone as well as ways of creating resistant ways of knowing. (shrink)

A significant proportion of the U.S. population exhibits low health literacy. Evidence suggests that low health literacy is correlated with higher medical costs and poorer health outcomes. Even more concerning, evidence suggests that low health literacy threatens patients’ and families’ autonomy and exacerbates injustices in patients who are already vulnerable to difficulties navigating the health care system. There is also, however, increasing evidence that health literacy interventions—including initiatives such as plain language practices and teach-back—improve comprehension and usefulness of health care (...) information. I show how health literacy best practices can enhance the work of clinical ethicists in their primary roles of policy, consultation, and education. In the final section, I suggest ways health literacy initiatives may be enhanced with insights from clinical ethicists. (shrink)

Domestic violence and abuse (DVA) are at last coming to be recognised as serious global public health problems. Nevertheless, many women with personal histories of DVA decline to disclose them to healthcare practitioners. In the health sciences, recent empirical work has identified many factors that impede DVA disclosure, known as barriers to disclosure. Drawing on recent work in social epistemology on testimonial silencing, we might wonder why so many people withhold their testimony and whether there is some kind of epistemic (...) injustice afoot here. In this paper, I offer some philosophical reflections on DVA disclosure in clinical contexts and the associated barriers to disclosure. I argue that women with personal histories of DVA are vulnerable to a certain form of testimonial injustice in clinical contexts, namely, testimonial smothering, and that this may help to explain why they withhold that testimony. It is my contention that this can help explain the low rates of DVA disclosure by patients to healthcare practitioners. (shrink)

The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it – a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine – the study of the interpretation of human experience in medical terms – has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms are interpreted as representative of particular conditions. This (...) paper examines the hermeneutical activity of symptom-construction more closely. I propose a fourfold account of the clinical function of symptoms: as theoretical entities; as tools for communication; as guides to palliative intervention; and as candidates for medical explanation or intervention. I also highlight roles they might play in illness experience. I use this framework to discuss four potential failures of symptom-interpretation: failure of symptom-type and symptom-token recognition; loss of the complete picture of illness experience through overwhelming emphasis on its symptomatic interpretation; and intersubjective feedback effects of symptom description altering the ill person’s own perceptions of their phenomenal experience. I conclude with some suggestions of potential remedies for failures in the process of symptom-construction. (shrink)

Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)

This article examines the relationship between epistemic freedom, and epistemic injustice and epistemic oppression. I situate epistemic freedom within the larger project of epistemic decolonisation and argue that epistemic freedom is central to both its positive and negative programme. Through exploring the intersections of the notion of epistemic freedom and the scholarship on epistemic injustice and oppression, I argue that one can think of epistemic injustices and oppression as infringements on epistemic freedom. I identify shared themes between the theorisation of (...) epistemic freedom and the literature on epistemic injustice and epistemic oppression, including silencing, active ignorance, and epistemic exploitation. I briefly explore each of these themes, identifying both intersections and divergences. Lastly, I draw on the literature on epistemic injustice and oppression to sharpen Ndlovu-Gatsheni’s (2018. Epistemic Freedom in Africa: Deprovincialization and Decolonization. London: Routledge) general conception of epistemic freedom and develop a tripartite structure for what substantial epistemic freedom entails. I argue that being epistemically free entails being able to choose one’s epistemic endeavours, having the means to pursue them, as well as being able to meaningfully partake in the shared endeavours of the epistemic communities that one belongs to. (shrink)

The COVID-19 pandemic crisis has had profound effects on global health, healthcare, and public health policy. It has also impacted education. Within undergraduate healthcare education of doctors, nurses, and allied professions, rapid shifts to distance learning and pedagogic content creation within new realities, demands of healthcare practice settings, shortened curricula, and/or earlier graduation have also challenged ethics teaching in terms of curriculum allotments or content specification. We propose expanding the notion of resilience to the field of ethics education under the (...) conditions of remote learning. Educational resilience starts in the virtual classroom of ethics teaching, initially constituted as an “unpurposed space” of exchange about the pandemic’s challenging impact on students and educators. This continuously transforms into “purposed space” of reflection, discovering ethics as a repertory of orientative knowledge for addressing the pandemic’s challenges on personal, professional, societal, and global levels and for discovering (and then addressing) that the health of individuals and populations also has moral determinants. As such, an educational resilience framework with inherent adaptability rises to the challenge of supporting the moral agency of students acting both as professionals and as global citizens. Educational resilience is key in supporting and sustaining professional identify formation and facilitating the development of students’ moral resilience and leadership amid moral complexity and potential moral transgression—not only but especially in times of pandemic. (shrink)

My aim in this paper is to identify the wrong that is done in all cases of testimonial injustice, if there is one. Miranda Fricker (2007) proposes one account of this distinctive wrong, and Gaile Pohlhaus Jr. (2014) offers another. I think neither works. Nor does an account based on giving due respect to the testifier's epistemic competence. Nor does an account based on exposing the testifier to substantial risk of harm. Rachel Fraser (2023) describes a further account, and the (...) proposal I favour is a slight amendment of this. (shrink)

Virtue signaling—using public moral discourse to enhance one’s moral reputation—is a familiar concept. But, what about profile pictures framed by “Vaccines work!”? Or memes posted to anti-vaccine groups echoing the group’s view that “Only sheep believe Big Pharma!”? These actions don’t express moral views—both claims are empirical (if imprecise). Nevertheless, they serve a similar purpose: to influence the judgments of their audience. But, where rainbow profiles guide their audience to view the agent as morally good, these acts guide their audience (...) to view the agent as epistemically good. They are instances of epistemic virtue signaling. The first goal of this paper is to offer an account of epistemic virtue signaling. I argue that epistemic virtue signaling occurs through both behavioral and propositional signals, and serves purposes similar to those of moral virtue signaling across a wide variety of discourses. The second is to show that there is much work for this concept to do. In particular, this concept illuminates a double bind faced by those who suffer from and seek to overcome testimonial injustice. I close by demonstrating how this double bind arises in the dissolution of medical autonomy, focusing on the care gap faced by pregnant women of color in the United States today, as compared with their white counterparts. (shrink)

The 2007 publication of Miranda Fricker’s celebrated book Epistemic Injustice: Power and the Ethics of Knowing gave way to a burgeoning area of study in philosophy of education. The book’s arguments create a context for expanding the scope of work on epistemic issues in education by moving beyond direct explorations of the distribution of epistemic goods and the role of power in curriculum development. Since that time, the rich scholarship on epistemic injustice in philosophy of education examines a variety of (...) topics, including the impact of epistemic injustice on the experiences of teachers and learners more broadly (focussing mostly on students who are marginalized along lines of race, gender, class, and ability, amongst others) and the implications of epistemic injustice for educational research, policy, and practice. This special issue extends this line of work by compiling a set of articles that address a broad range of topics, some of which are well established in the literature and some of which open new lines of inquiry in the field. In doing so, the issue aims to establish the intersection of epistemic injustice and education as a distinct area of study that holds great significance and potential. In this paper, A. C. Nikolaidis and Winston C. Thompson introduce the issue by discussing these contributions, explaining why education is central to the study of epistemic injustice (and vice versa), and exploring the complex nature of epistemic injustice and education as revealed in the articles that comprise this collection—namely, education’s simultaneous complicity as a perpetrator and promise as a disruptor of epistemic injustice. (shrink)

Spanish Translation of "He/She/They/Ze" (Ergo, 2018).

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which can be (...) instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

This article defends the counterintuitive conclusion that public assignments of credibility – including statements, by hearers, of ‘that’s right’, ‘she is credible’, or ‘I believe you’ – can actually constitute a pernicious form of epistemic wrong. Sometimes referred to colloquially as ‘lip service’, the wrong occurs when, owing to ethically poisonous epistemic failures, hearers outwardly validate testifiers’ credibility despite not fully or duly believing them. To explain this wrong, I introduce a distinction between performed and internal credibility assignments (PCA and (...) ICA) and describe an epistemic dysfunction in which they misalign. I focus on cases in which misaligned PCA of ‘credible’ falsely – although sometimes non-deliberately – signal to testifiers and bystanders that testifiers have been believed; Republican hearers’ positive reception of Christine Blasey Ford’s 2018 testimony serves as a central case. Although some misaligned PCA are not wrongful, when epistemic and ethical failures including forms of identity prejudice and pernicious ignorance lead PCA of ‘credible’ to misalign, the PCA wrong testifiers in their capacities as knowers. These epistemic wrongs are particularly pernicious because the PCA conceal that testimony has not been efficacious, inflicting and exacerbating distinct harms. (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)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences (...) of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

When are we obligated to believe someone? To what extent are people authorities about their own experiences? What kind of harm might we enact when we doubt? Questions like these lie at the heart of many debates in social and feminist epistemology, and they’re the driving issue behind a key conceptual framework in these debates—gaslighting. But while the concept of gaslighting has provided fruitful insight, it's also proven somewhat difficult to adjudicate, and seems prone to over-application. In what follows, I (...) argue that Katherine Hawley's theory of trust can provide a useful alternative lens for looking at contested testimony. To do this, I focus on a particularly complex—but increasingly popular—application of gaslighting: the physician/patient relationship, and the idea of ‘medical gaslighting’. I argue that, even though patients can experience harm when they are disbelieved, there are nevertheless good reasons for physicians not to trust patients about at least some of their own narratives. (shrink)

In contemporary paternalism literature, persuasion is commonly not considered paternalistic. Moreover, paternalism is typically understood to be problematic either because it is seen as coercive, or because of the insult of the paternalist considering herself superior. In this paper, I argue that doctors who persuade patients act paternalistically. Specifically, I argue that trying to persuade a patient (here understood as aiming for the patient to consent to a certain treatment, although he prefers not to) should be differentiated from trying to (...) convince him (here understood as aiming for the patient to want the treatment) and recommending (the doctor merely providing her professional opinion). These three forms of influence are illustrated by summaries of video-recorded hospital encounters. While convincing and recommending are generally not paternalistic, I argue that persuasion is what I call communicative paternalism and that it is problematic for two reasons. First, the patient’s preferences are dismissed as unimportant. Second, the patient might wind up undergoing treatment against his preferences. This does not mean that persuasion always should be avoided, but it should not be undertaken lightly, and doctors should be aware of the fine line between non-paternalism and paternalism. The fact that my analysis of paternalism differs from traditional accounts does not imply that I deem these to be wrong, but rather that paternalism should be considered as a more multi-faceted concept than previous accounts allow for. (shrink)

Machine learning (ML) systems play an increasingly relevant role in medicine and healthcare. As their applications move ever closer to patient care and cure in clinical settings, ethical concerns about the responsibility of their use come to the fore. I analyse an aspect of responsible ML use that bears not only an ethical but also a significant epistemic dimension. I focus on ML systems’ role in mediating patient–physician relations. I thereby consider how ML systems may silence patients’ voices and relativise (...) the credibility of their opinions, which undermines their overall credibility status without valid moral and epistemic justification. More specifically, I argue that withholding credibilitydue tohow ML systems operate can be particularly harmful to patients and, apart from adverse outcomes, qualifies as a form of testimonial injustice. I make my case for testimonial injustice in medical ML by considering ML systems currently used in the USA to predict patients’ risk of misusing opioids (automated Prediction Drug Monitoring Programmes, PDMPs for short). I argue that the locus of testimonial injustice in ML-mediated medical encounters is found in the fact that these systems are treated asmarkers of trustworthinesson which patients’ credibility is assessed. I further show how ML-based PDMPs exacerbate and further propagate social inequalities at the expense of vulnerable social groups. (shrink)

Theoretical tools aimed at making explicit the injustices suffered by certain socially disadvantaged groups might end up serving purposes which were not foreseen when the tools were first introduced. Nothing is inherently wrong with a shift in the scope of a theoretical tool: the popularization of a concept opens up the possibility of its use for several strategic purposes. The thesis that we defend in this paper is that some public figures cultivate a public persona for whom the conditions of (...) the notion of testimonial injustice might be taken to apply, and this situation is exploited to their advantage, as a means to advance their political agendas. More specifically, they take advantage of this to generate situations of crossed disagreements, which in turn foster polarization. (shrink)

Journal of Social Philosophy, EarlyView.

To verify the occurrence of a singular instance of testimonial injustice three facts must be established. The first is whether the hearer in fact has an identity prejudice of which she may or may not be aware; the second is whether that prejudice was in fact the cause of the unjustified credibility deficit; and the third is whether there was in fact a credibility deficit in the testimonial exchange. These three elements constitute the facts of the matter of testimonial injustice. (...) In this essay we argue that none of these facts can be established with any degree of confidence, and therefore that testimonial injustice is an undetectable phenomenon in singular instances. Our intention is not to undermine the idea of testimonial injustice, but rather to set limits to what can be justifiably asserted about it. According to our argument, although there are insufficient reasons to identify individual acts of testimonial injustice, it is possible to recognize recurrent patterns of epistemic responses to speakers who belong to specific social groups. General testimonial injustice can thus be characterized as a behavioral tendency of a prejudiced hearer. (shrink)

In this article, I apply the concept of solidarity to collective knowledge practices in healthcare. Generally, solidarity acknowledges that people are dependent on each other in many respects, and it captures those support practices that people engage in out of concern for others in whom they recognise a relevant similarity. Drawing on the rich literature on solidarity in bioethics and beyond, this article specifically discusses the role that epistemic solidarity can play in healthcare. It thus focuses, in particular, on solidarity’s (...) relationship with justice and injustice. In this regard, it is argued (1) that justice and solidarity are two equally important and complementary values that should both be considered in healthcare practices and institutions and (2) that solidarity often arises in unjust situations and can be a means to bring about justice. I transfer these ‘general’ insights about solidarity to knowledge practices in healthcare and link them to the discussion about epistemic injustices in healthcare and how to overcome them. I argue that epistemic solidarity can play an important role in overcoming epistemic injustices as well as—and independently from its contribution to justice—in knowledge production in medicine more generally. To demonstrate how epistemic solidarity can add to our understanding of collective knowledge practices, I discuss two examples: patients sharing their medical data for research purposes and healthcare professionals’ engagement with patients to better understand their afflictions. (shrink)

Deep Self views of moral responsibility have been criticized for positing mysterious concepts, making nearly paradoxical claims about the ownership of one’s mental states, and promoting self-deceptive moral evasion. I defend Deep Self views from these pervasive forms of skepticism by arguing that some criticism is hasty and stems from epistemic injustice regarding testimonies of experiences of alienation, while other criticism targets contingent features of Deep Self views that ought to be abandoned. To aid in this project, I provide original (...) naturalistic analyses of “Self” and “internality” that replace the view’s metaphorical language with common-sensical concepts that make clear their usefulness. (shrink)

ABSTRACT What, if anything, should we do when someone says they don’t believe in anthropogenic climate change? Or that they worry that a COVID-19 vaccine might be dangerous? We argue that in general, we face an epistemic duty to object to such assertions, qua instances of science denial and science sceptical discourse, respectively. Our argument builds on recent discussions in social epistemology, specifically surrounding the idea that we ought to speak up against (epistemically) problematic assertions so as to fulfil an (...) important epistemic obligation – namely, preventing epistemic harms in others. We show that both science denial (SD) and vaccine hesitant (VH) discourses are harmful in a distinctively epistemic sense, and as such generate an especially strong duty to voice our disagreement. As we also argue, this obligation is nonetheless defeasible: depending on the situational features of those involved, voicing an objection to VH discourse may actually end up doing more harm than good. We conclude by tracing what seems like a promising path towards restoring well-placed public trust in scientific testifiers. Doing so is key in order to guarantee equitable access to warranted beliefs about important subject matters, such as the safety of vaccines, to all segments of society. (shrink)

In this paper, my goal is to use an epistemic injustice framework to extend an existing normative analysis of over-medicalization to psychiatry and thus draw attention to overlooked injustices. Kaczmarek has developed a promising bioethical and pragmatic approach to over-medicalization, which consists of four guiding questions covering issues related to the harms and benefits of medicalization. In a nutshell, if we answer “yes” to all proposed questions, then it is a case of over-medicalization. Building on an epistemic injustice framework, I (...) will argue that Kaczmarek’s proposal lacks guidance concerning the procedures through which we are to answer the four questions, and I will import the conceptual resources of epistemic injustice to guide our thinking on these issues. This will lead me to defend more inclusive decision-making procedures regarding medicalization in the DSM. Kaczmarek’s account complemented with an epistemic injustice framework can help us achieve better forms of medicalization. I will then use a contested case of medicalization, the creation of Premenstrual Dysphoric Disorder in the DSM-5 to illustrate how the epistemic injustice framework can help to shed light on these issues and to show its relevance to distinguish good and bad forms of medicalization. (shrink)

The concept of epistemic injustice is the latest philosophical tool with which to try to theorise what goes wrong when mental health service users are not listened to by clinicians, and what goes right when they are. Is the tool adequate to the task? It is argued that, to be applicable at all, the concept needs some adjustment so that being disbelieved as a result of prejudice is one of a family of alternative necessary conditions for its application, rather than (...) a necessary condition all on its own. It is then argued that even once adjusted in this way, the concept does not fit well in the area where the biggest efforts have been made to apply it so far, namely the highly sensitive case of adult patients suffering from delusions. Indeed it does not serve the interests of service users struggling for recognition to try to apply it in this context, because there is so much more to being listened to than simply being believed. However, the concept is found to apply smoothly in many cases where the service users are children, for example, in relation to children’s testimony on the efficacy of treatment. It is suggested that further research would demonstrate the usefulness of the concept in adult cases of a similar kind. There are no data in this work. (shrink)

In moral and political philosophy, topics like the distributive inequities conferred via special partial relationships – family relationships, for example – have been frequently debated. However, the epistemic dimensions of such partiality are seldom discussed in the ethical context, and the topic of partial relationships rarely feature in the realm of social epistemology. My view is that the role of partial relationships is worth exploring to enrich our understanding of epistemic injustice and its transmission. I claim that epistemic features typical (...) of partial relationships make phenomena like epistemic injustice easier to mask, more difficult to identify, and harder to correct. (shrink)

For the last eighteen months, I have worked with a group of disability and health policy researchers. I began this interview-based project trying to learn how these researchers’ disability identities shaped their work. How did their disability standpoint contribute to the liberatory nature of their research? I found that the disability standpoint of these researchers was in fact hard-won and grew not just out of their own disability experiences but out of their connections with the larger disability community. These connections, (...) for the most part, helped researchers come to “claim crip,” and that later influenced their research. (shrink)

ABSTRACT This paper offers an account of institutional testimonial justice and describes one way that it breaks down, which we call institutional opacity. An institution is opaque when it becomes resistant to epistemic evaluation and understanding by its agents and users. When one cannot understand the inner workings of an institution, it becomes difficult to know how to comport oneself testimonially. We offer an account of an institutional ethos to explain what it means for an institution to be testimonially just; (...) we then describe how an ethos of institutional testimonial justice can break down when the institution becomes opaque. An opaque institution is especially problematic for individuals and groups already rendered epistemically vulnerable during their interactions with that institution, which we call epistemically vulnerabilised individuals. We articulate the features of an encounter between an epistemically vulnerabilised individual and an opaque institution. We end by tracing ameliorative strategies that could help repair a deteriorated institutional ethos of testimonial justice. (shrink)

This paper addresses epistemic aspects of the phenomenon of obstetric violence—which has been described as a kind of gender violence—mainly from the perspective of recent theories on epistemic injustice. I argue that what is behind the dismissal of women’s voices in labor is mainly how the birthing subject, in general, is conceived. Thus, I develop a link between the phenomenon of testimonial injustice in labor and the marked irrationality that is seen as a core characteristic of birthing subjects: an irrationality (...) that appears to be always at odds with the kind of knowledge that is, wrongly, privileged within medicalized childbirth. I use Miranda Fricker’s analysis to argue that a central part of obstetric violence involves laboring women being “wrongfully undermined specifically in their capacity as knowers” : they are disbelieved in the labor room because of a double prejudice, one deriving simply from their condition as women, the second involving the kind of knowledge that many women find useful in the process of birthing. Women in labor thus suffer from both systematic and incidental kinds of testimonial injustice. (shrink)

People experiencing mental distress and illness are frequently on the receiving end of stigma, epistemic injustice, and social isolation. A range of strategies are required to alleviate the subsequent marginalisation. We ran a series ‘philosophy of mind’ workshops, in partnership with a third-sector mental health organisation with the aim of using philosophical techniques to challenge mental health stigma and build resources for self-understanding and advocacy. Participants were those with lived experience of mental distress, or unusual beliefs and experiences; mental health (...) advocates; and mental health service providers. We draw on a shared perspective as a participant and facilitator of the workshop series to assess their impact. We discuss the following benefits: the opportunity for structured discussion of experiences and models; dialogue across different mental health backgrounds; the potential to reduce self-stigma and to increase self-understanding and advocacy; and the potential to alleviate epistemic injustice. We invite researchers and mental health practitioners to consider further opportunities to investigate the potential benefits of philosophy groups in mental health settings to establish whether they generalise. (shrink)

This article develops an account of distributive epistemic justice in the production of scientific knowledge. We identify four requirements: (a) science should produce the knowledge citizens need in order to reason about the common good, their individual good and pursuit thereof; (b) science should produce the knowledge those serving the public need to pursue justice effectively; (c) science should be organized in such a way that it does not aid the wilful manufacturing of ignorance; and (d) when making decisions about (...) epistemic risks, scientists should make sure that there aren’t social groups or weighty interests that are neglected. After discussing these requirements, we examine the relationship between discriminatory and distributive epistemic injustice in science and argue that they often compound each other. (shrink)

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)

In this paper, I argue that Jonathan Glover, a prominent advocate of human genetic engineering, relies on a limited naturalistic account of normal human function in his defense of genetic engineering as a means of decreasing future instances of disability. I show that his concept of disability and the normative argument informed by it in his Choosing Children: Genes, Disability, and Design fails to incorporate the phenomenological dimension of embodiment, and that this dimension should be included in any account of (...) disability and human flourishing. Such inclusion, however, requires us to consider seriously the counterintuitive view that racial minorities are constitutionally disabled in racist societies. (shrink)

Black women and their babies matter. In this commentary, we explore the current challenges that Black women face when pregnant and what is needed to ensure an anti-racist approach to prenatal and p...

Journal of Social Philosophy, EarlyView.

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various (...) social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on). (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

Ensuring patient participation in healthcare decision making remains a difficult task. Factors such as a lack of time in the consultation, medical objectivation, or the difficulties of translating individual patient experience into the treatment plan have been shown to limit patient contributions. Little research attention has focused however on how emotions experienced by both the patient and the healthcare provider may affect the ability of the patient to participate. In this research, patient’s and healthcare provider’s emotions were identified and analysed. (...) The research method showed fear as a prominent emotion experienced. This included patient’s fears both inside and outside the consultation, as well as the healthcare provider’s fears in their professional practice. Using Martha Nussbaum’s cognitive-evaluative theory of emotions as an additional means of analysis, the research looked at what this emotion could show about the importance of the object of this fear to the person’s eudaimonia (flourishing). At the end of the article, several solutions were proposed to help mitigate this fear to keep it from becoming a destructive force in the healthcare provider—patient relationship. (shrink)

Journal of Social Philosophy, EarlyView.

Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs gained through particular (...) interventions. Utilitarian reasoning mandates that policymakers maximize QALYs gained per unit cost.Although many scholars have explored the problems of distributive justice that arise from this system... (shrink)

Volume 19, Issue 11, November 2019, Page 32-34.

While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader (...) implications for just and equitable healthcare delivery. (shrink)

The concepts of disease, illness and sickness capture fundamentally different aspects of phenomena related to human ailments and healthcare. The philosophy and theory of medicine are making manifold efforts to capture the essence and normative implications of these concepts. In parallel, socio-empirical studies on patients’ understanding of their situation have yielded a comprehensive body of knowledge regarding subjective perspectives on health-related statuses. Although both scientific fields provide varied valuable insights, they have not been strongly linked to each other. Therefore, the (...) article aims to scrutinise the normative-ethical implications of patient perspectives in building a bridge to the empirical ethics debates. Three potential fields of tension between the illness and the disease perspective are presented. Consequently, findings from empirical research examining patient perspectives on illness are displayed and the practical implications and associated ethical issues which arise are discussed. This leads to the conclusion that an explicit and elaborate empirical-ethical methodology is needed to deal appropriately with the complex interaction between patients’ views and the medico-professional view of disease. Kon’s four-stage model of normative-empirical collaboration is then applied against the background of empirical data on patient perceptions. Starting from this exemplary approach, the article suggests employing empirical-ethical frameworks for further research on the conceptual and normative issues, as they help to integrate perspectives from the philosophy of medicine with socio-empirical research. The combination of theoretical and empirical perspectives suggested contributes to a more nuanced discussion of the normative impact of patients’ actual understanding of illness. Further empirical research in this area would profit from explicitly considering potential ethical issues to avoid naturalistic fallacies or crypto-normative conclusions that may compromise healthcare practice. Vice versa, medico-theoretical debates could be enriched by integrating subjective views of those people who are immediately affected. (shrink)