This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research (...) of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (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)

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)

There's been a great deal of interest in epistemology regarding what it takes for a hearer to come to know on the basis of a speaker's say-so. That is, there's been much work on the epistemology of testimony. However, what about when hearers don't believe speakers when they should? In other words, what are we to make of when testimony goes wrong? A recent topic of interest in epistemology and feminist philosophy is how we sometimes fail to believe speakers due (...) to inappropriate prejudices – implicit or explicit. This is known as epistemic injustice. In this article, I discuss Miranda Fricker's groundbreaking work on epistemic injustice, as well as more recent developments that both offer critique and expansion on the nature and extent of epistemic injustice. (shrink)

Journal of Social Philosophy, EarlyView.

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical (...) conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. (...) Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

This paper offers an analysis of the structure of epistemic vice-charging, the critical practice of charging other persons with epistemic vice. Several desiderata for a robust vice-charge are offered and two deep obstacles to the practice of epistemic vice-charging are then identified and discussed. The problem of responsibility is that few of us enjoy conditions that are required for effective socialisation as responsible epistemic agents. The problem of consensus is that the efficacy of a vice-charge is contingent upon a degree (...) of consensus between critic and target that is unlikely or impossible where vice-charging is most likely to be provoked. It emerges that a robust critical practice of vice-charging is possible in principle, but very difficult in practice. (shrink)

Journal of Social Philosophy, EarlyView.

Artificial intelligence-based (AI) technologies such as machine learning (ML) systems are playing an increasingly relevant role in medicine and healthcare, bringing about novel ethical and epistemological issues that need to be timely addressed. Even though ethical questions connected to epistemic concerns have been at the center of the debate, it is going unnoticed how epistemic forms of injustice can be ML-induced, specifically in healthcare. I analyze the shortcomings of an ML system currently deployed in the USA to predict patients’ likelihood (...) of opioid addiction and misuse (PDMP algorithmic platforms). Drawing on this analysis, I aim to show that the wrong inflicted on epistemic agents involved in and affected by these systems’ decision-making processes can be captured through the lenses of Miranda Fricker’s account of hermeneutical injustice. I further argue that ML-induced hermeneutical injustice is particularly harmful due to what I define as an automated hermeneutical appropriation from the side of the ML system. The latter occurs if the ML system establishes meanings and shared hermeneutical resources without allowing for human oversight, impairing understanding and communication practices among stakeholders involved in medical decision-making. Furthermore and very much crucially, an automated hermeneutical appropriation can be recognized if physicians are strongly limited in their possibilities to safeguard patients from ML-induced hermeneutical injustice. Overall, my paper should expand the analysis of ethical issues raised by ML systems that are to be considered epistemic in nature, thus contributing to bridging the gap between these two dimensions in the ongoing debate. (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)

We investigate how epistemic injustice can manifest itself in mathematical practices. We do this as both a social epistemological and virtue-theoretic investigation of mathematical practices. We delineate the concept both positively—we show that a certain type of folk theorem can be a source of epistemic injustice in mathematics—and negatively by exploring cases where the obstacles to participation in a mathematical practice do not amount to epistemic injustice. Having explored what epistemic injustice in mathematics can amount to, we use the concept (...) to highlight a potential danger of intellectual enculturation. (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)

Researchers are studying how artificial intelligence (AI) can be used to better detect, prognosticate and subgroup diseases. The idea that AI might advance medicine’s understanding of biological categories of psychiatric disorders, as well as provide better treatments, is appealing given the historical challenges with prediction, diagnosis and treatment in psychiatry. Given the power of AI to analyse vast amounts of information, some clinicians may feel obligated to align their clinical judgements with the outputs of the AI system. However, a potential (...) epistemic privileging of AI in clinical judgements may lead to unintended consequences that could negatively affect patient treatment, well-being and rights. The implications are also relevant to precision medicine, digital twin technologies and predictive analytics generally. We propose that a commitment to epistemic humility can help promote judicious clinical decision-making at the interface of big data and AI in psychiatry. (shrink)

Epistemic injustice is a kind of injustice that arises when one’s capacity as an epistemic subject is wrongfully denied. In recent years it has been argued that psychiatric patients are often harmed in their capacity as knowers and suffer from various forms of epistemic injustice that they encounter in psychiatric services. Acknowledging that epistemic injustice is a multifaceted problem in psychiatry calls for an adequate response. In this paper I argue that, given that psychiatric patients deserve epistemic respect and have (...) a certain epistemic privilege, healthcare professionals have a pro tanto epistemic duty to attend to and/or solicit reports of patients’ first-person experiences in order to prevent epistemic losses. I discuss the nature and scope of this epistemic duty and point to one interesting consequence. In order to prevent epistemic losses, healthcare professionals may need to provide some patients with resources and tools for expressing their experiences and first-person knowledge, such as those that have been developed within the phenomenological approach. I discuss the risk of secondary testimonial and hermeneutical injustice that the practice of relying on such external tools might pose and survey some ways to mitigate it. (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)

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)

In Epistemic Injustice Miranda Fricker argues that there is a distinctively epistemic type of injustice in which someone is wronged specifically in his or her capacity as a knower. Fricker's examples of identity-prejudicial credibility deficit primarily involve gender, race, and class, in which individuals are given less credibility due to prejudicial stereotypes. We argue that children, as a class, are also subject to testimonial injustice and receive less epistemic credibility than they deserve. To illustrate the prevalence of testimonial injustice against (...) children we document examples of negative prejudicial treatment in forensic contexts where children frequently act as testifiers. These examples, along with research on the child's competence and reliability as a testifier, reveal widespread epistemic prejudice against children. Given that subjection to prejudice can have a detrimental impact on children we discuss ways to ameliorate this form of testimonial injustice. We argue that, both in formal and natural contexts, the child's testimony should be evaluated alongside the relationships that support her development as a testifier. The adult can play a central role in creating successful testimonial interactions with children by acting as a. (shrink)

Social epistemology is the study of the social dimensions of knowledge or information. There is little consensus, however, on what the term "knowledge" comprehends, what is the scope of the "social", or what the style or purpose of the study should be. According to some writers, social epistemology should retain the same general mission as classical epistemology, revamped in the recognition that classical epistemology was too individualistic. According to other writers, social epistemology should be a more radical departure from classical (...) epistemology, a successor discipline that would replace epistemology as traditionally conceived. The classical approach could be realized in at least two forms. One would emphasize the traditional epistemic goal of acquiring true beliefs. It would study social practices in terms of their impact on the truth-values of agents’ beliefs. A second version of the classical approach would focus on the epistemic goal of having justified or rational beliefs. Applied to the social realm, it might concentrate, for example, on when a cognitive agent is justified or warranted in accepting the statements and opinions of others. Proponents of the anti-classical approach have little or no use for concepts like truth and justification. In addressing the social dimensions of knowledge, they understand "knowledge" as simply what is believed, or what beliefs are "institutionalized" in this or that community, culture, or context. They seek to identify the social forces and influences responsible for knowledge production so conceived. Social epistemology is theoretically significant because of the central role of society in the knowledge-forming process. It also has practical importance because of its possible role in the redesign of information-related social institutions. (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)

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)

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)

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)

Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on quality of (...) care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states. (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)

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)

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research (...) of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (shrink)

In this chapter I identify a phenomenon that is closely allied to testimonial injustice: mnemonic injustice. Mnemonic injustice occurs when stereotypes shape memory and jointly epistemic and practical harms that constitute injustice ensue. I argue that just as people can achieve testimonial justice by combatting the negative effects of stereotypes on the process of testimonial exchange, there are ways that people can achieve mnemonic justice by addressing the impact of stereotypes on memory. It is shown that mnemonic justice, like testimonial (...) justice, can involve personal, interpersonal and structural change. It is argued that testimonial injustice and mnemonic injustice should be treated on a par, with those concerned with reducing epistemic and practical injustices driven to tackle each. (shrink)

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 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 this article, I examine stigmatizing and especially patronizing attitudes towards others’ depression that people who are well-intentioned produce. The strategy of the article is to consider the social experience of depression through two separate subfields of philosophy: epistemic injustice and phenomenology. The solution that I propose is a phenomenological account of empathy. The empathetic attitude that I argue for involves actively listening to the depressed individual and taking their depression testimony as direct evidence. The article has been written both (...) for those who seek to better support neurodiverse people in their lives and for depressives (and other neurodivergents) themselves in order to provide them with a better account for advocating for themselves against social stigma. (shrink)

Miranda Fricker’s influential concept of epistemic injustice has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is (...) therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice. (shrink)

Susan has been profoundly deaf since childhood. She is a hearing aid wearer, and likes to use the induction loops built into some public spaces, such as theaters and cinemas, to help cut down the background noise that can make hearing speech very difficult. But this depends on the building having an induction loop fitted and properly maintained. Like many other induction loop users, Susan frequently finds that the advertised loop system is either working poorly or not working at all. (...) Almost as often, she then has the experience of making a complaint about it only to have the problem denied. If she persists, she is often then met... (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)

Recent philosophical literature on epistemic harms has paid little attention to the difference between deliberate and non-deliberate harms. In this paper, I analyze the “Curare Case,” a case from the 1940’s in which patient testimony was disregarded by physicians. This case has been described as an instance of epistemic injustice. I problematize this description, arguing instead that the case shows an instance of “epistemic disadvantage.” I propose epistemic disadvantage indicates when harms result from warranted asymmetric relations that justifiably exclude individuals (...) from hermeneutical participation. Epistemic disadvantage categorizes harms that result from justifiable exclusions, are non-deliberate, and result from poor epistemic environments. This analysis brings out a meaningful difference between accidental and deliberate harms in communicative exchanges. (shrink)

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (‘open notes’). However, even in countries that (...) have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

Public engagement is one of the fundamental pillars of the European programme for research and innovation _Horizon 2020_. The programme encourages engagement that not only fosters science education and dissemination, but also promotes two-way dialogues between scientists and the public at various stages of research. Establishing such dialogues between different groups of societal actors is seen as crucial in order to attain epistemic as well as social desiderata at the intersection between science and society. However, whether these dialogues can actually (...) help attaining these desiderata is far from obvious. This paper discusses some of the costs, risks, and benefits of dialogical public engagement practices, and proposes a strategy to analyse these argumentative practices based on a three-tiered model of epistemic exchange. As a case study, we discuss the phenomenon of vaccine hesitancy, arguably a result of suboptimal public engagement, and show how the proposed model can shed new light on the problem. (shrink)

Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices and (...) biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or misrepresent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles. (shrink)

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)

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)

Journal of Social Philosophy, EarlyView.

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)

In this essay, I argue that certain injustices faced by mentally disabled persons are epistemic injustices by drawing upon epistemic injustice literature, especially as it is developed by Miranda Fricker. First, I explain the terminology and arguments developed by Fricker, Gaile Pohlhaus, Jr., and Kristie Dotson that are useful in theorizing epistemic injustices against mentally disabled people. Second, I consider some specific cases of epistemic injustice to which mentally disabled persons are subject. Third, I turn to a discussion of severely (...) mentally disabled persons who, because they are unable to share information or develop interpretations of shared social experiences, may fall outside Fricker’s discussion of epistemic injustice. Fourth and finally, following arguments given by Kristie Dotson and Christopher Hookway, I define and explain a type of epistemic injustice: intimate hermeneutical injustice that I believe supplements other discussions of epistemic injustice. (shrink)

Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding and remembering their (...) treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of indirect evidence suggests these benefits are unlikely to accrue without supplementation from internet-based resources. Using such routes to augment interpretation of the data and notes housed in electronic health records, however, comes with trade-offs in terms of exposing sensitive patient information to internet corporations. Furthermore, increased work burdens on clinicians, including the unique demands of ORA, combined with the easy availability and capability of a new generation of large language model (LLM)-powered chatbots, create a perfect collision course for exposing sensitive patient information to private tech companies. This paper surveys how ORA intersects with internet associated privacy risks and offers a variety of multilevel suggestions for how these risks might be better mitigated. (shrink)

The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence-based healthcare (...) are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes. (shrink)

In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al 1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour and beyond pregnancy-related care. (...) One feature of their model for adequate informed consent is trust in the systems in which prenatal and labour and delivery care are provided. Yet, for some pregnant persons, mistrust in health systems is a reasonable sequela of experiences like racism and epistemic injustice. For a programme in which trust is central to adequate consent, it is important to identify—and counter—forms of mistrust toward pregnant persons within healthcare and acknowledge and rectify reasonable mistrust of pregnant persons toward healthcare. Like other kinds of healthcare disparities, van der Pijl et al note that ‘the burden of unconsented procedures is not evenly distributed over groups’ and tracks with ‘racial, socioeconomic and other disparities in maternity care’. They are drawing on data from a less diverse context than the one …. (shrink)