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)

Journal of Social Philosophy, EarlyView.

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)

ABSTRACT Current attempts to understand unusually high rates of psychiatric illness in complex, chronic illnesses can be guilty of operating within an explanatory framework whereby there are two options. Either (a) that the psychiatric predicaments are secondary to the bodily condition, and (b) that they are primary. In this paper, I draw upon philosophical work on affect, contemporary empirical work, and qualitative first-person patient data to illustrate a much messier reality. I argue that affective experience is generally more complex in (...) such conditions, and that a variety of pre- and post-morbid causal factors dynamically interact such that the resultant psychiatric predicaments do not permit to classification as strictly primary or secondary to the bodily condition. Affective scaffolding, in my view, provides an apt theoretical framework for capturing this nuance. (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)

On the 13th June 2014, the Centre for the Humanities and Health (CHH) at King’s College London hosted a one-day workshop on ‘Parentalism and Trust.’ This workshop was the sixth in a series of workshops whose aim is to provide a new model for high-quality open interdisciplinary engagement between medical professionals and philosophers. The term ‘Parentalism’ rather than paternalism is chosen and used throughout because of some of the derisory and unfortunate gender connotations associated with paternalism (and/or its counterpart ‘maternalism’). (...) Medical Parentalism is the position that unwanted interference with a patient’s choices and actions in order to protect and promote her best interests is morally justified. Whilst there are many problems with its justification and implementation, the workshop addressed how such interference depends on a trusting relationship between the doctor and patient, and the extent to which parentalist interferences might undermine this trust. (shrink)

Since its 2007 publication, Miranda Fricker’s Epistemic Injustice has sparked a vigorous conversation in analytic philosophy about how social power corrodes individual’s epistemic capacities and distorts collective meaning-making in unjust ways. Yet for all its normative insights into social silencing, I argue that Fricker’s theorization of epistemic dysfunction remains too individualized, cognitivist, and dematerialized to account for racialized imaginaries. Rather than view racisms as normal and normative in racist cultures, Fricker frames identity-driven prejudice as a troubling aberration from otherwise unblemished (...) epistemic and moral norms. This leads her into adopting an overly voluntarist and idealist theory of social change that centres training better knowers rather than unmaking racialized worlds. Ultimately, I contend that we should return to a materialist theory of ideology, following the work of Stuart Hall. Doing so jettisons the narrow focus on individual epistemic failures and instead problematizes how certain social ideas consolidate and reproduce racial hierarchies. (shrink)

People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, (...) where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed. (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)

A Professor of Medical Ethics and a theatre director, also mother and daughter, talk about health, illness, suffering, performance and practice. Using the lenses of ethical and performance theory, they explore what it means to be a patient, a spectator and a practitioner and cover many plays, texts and productions: Samuel Beckett’s Not I and All That Fall, Sarah Kane’s Crave, Tim Crouch’s An Oak Tree, Enda Walsh’s Ballyturk, Annie Ryan’s adaptation of Eimear McBride’s novel A Girl Is a Half-Formed (...) Thing, Duncan MacMillan’s People, Place and Things and Henrik Ibsen’s Hedda Gabler. These were selected because first we have seen, studied or worked with each and they have continued to inspire us. Second, they offer rich and revealing insights into the ways in which meaning is/are both negotiated and contested in relation to health and illness. It is the iterative negotiation of meaning that, it is argued, is the essence of narrative practice, be it in medicine or in the theatre. The difference and divergence of perception, response and interpretation to dramatic performance can test relationships, be they professional, creative or familial. Yet, the capacity to understand, and embrace, disagreement and uncertainty is vital; fundamental to a flourishing life. For it is by recognising our part in creating narratives, broken and otherwise, that we can begin to recognise the necessary interactionism and humanity of both medicine and theatre. (shrink)

Trust is frequently discussed with reference to the professional–patient relationship. However, trust is less explored in relation to the ways in which understanding of, and responses to, questions of ethics are discussed by both the “public” and “experts.” Public engagement activity in healthcare ethics may invoke “trust” in analysing a moral question or problem but less frequently conceives of trust as integral to “public engagement” itself. This paper explores the relationship between trust and the ways in which questions of healthcare (...) ethics are identified and negotiated by both “experts” and the public. Drawing on two examples from the author’s “public engagement” work—a radio programme for the British Broadcasting Corporation and work with a playwright and theatre—the paper interrogates the ways in which “public engagement” is often characterized. The author argues that the common approach to public engagement in questions of ethics is unhelpfully constrained by a systemic disposition which continues to privilege the professional or expert voice at the expense of meaningful exchange and dialogue. By creating space for novel interactions between the “expert” and the “public,” authentic engagement is achieved that enables not only the participants to flourish but also contributes to trust itself. (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)

The dominant discourse in chronic disease management centres on the ideal of person-centred healthcare, with an empowered patient taking an active role in decision-making with their healthcare provider. Despite these encouraging developments toward healthcare democracy, many person-centred conceptions of healthcare and programming continue to focus on the healthcare institution’s perspective and priorities. In these debates, the patient’s voice has largely been absent. This article takes the example of patient empowerment to show how the concept has been influenced by a variety (...) of competing and shifting influences that have led to conceptualisations and programming designed for the patient, but developed without the patient. The framework of epistemic injustice is proposed to unravel the complexity of these omissions. The concept can be defined as a wrong done to someone specifically in their capacity as a knower. It occurs when a person is ignored or not believed due to a prejudice of some kind. It has been applied to healthcare in order to better understand barriers for patient participation and will be used to better understand the problems with current empowerment definitions and implementation strategies. The article will end by proposing some methodologies to facilitate patient-developed concepts of empowerment. (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)

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)

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. 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 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)

Myalgic encephalomyelitis or chronic fatigue syndrome is a contested illness category. This paper investigates the common claim that patients with ME/CFS—and by extension, ME/CFS patient organizations —exhibit “militant” social and political tendencies. The paper opens with a history of the protracted scientific disagreement over ME/CFS. We observe that ME/CFS POs, medical doctors, and medical researchers exhibit clear differences in opinion over how to conceptualize this illness. However, we identify a common trope in the discourse over ME/CFS: the claim of “militant” (...) patient activism. Scrutinizing this charge, we find no compelling evidence that the vast majority of patients with ME/CFS, or the POs representing them, have adopted any such militant political policies or behaviours. Instead, we observe key strategic similarities between ME/CFS POs in the United Kingdom and the AIDs activist organizations of the mid-1980s in the United States which sought to engage scientists using the platform of public activism and via scientific publications. Finally, we explore the contours of disagreement between POs and the medical community by drawing on the concept of epistemic injustice. We find that widespread negative stereotyping of patients and the marginalization and exclusion of patient voices by medical authorities provides a better explanation for expressions of frustration among patients with ME/CFS. (shrink)

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

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)

: Psychogenic pain is considered to be pain that has a psychological origin. In this paper, I provide a brief history of the ways in which such pain has been interpreted and classified, highlighting the problem that psychogenic pain is typically defined by excluding organic evidence that could account for the sufferer’s experience. This has led to ambiguous disease classifications, which challenges the authenticity of the patient’s suffering. Today psychogenic pain is no longer considered a valid diagnosis, because it is (...) deemed to stigmatize the patient by implying that their pain is imaginary. But such stigmatization continues in the modern approach to chronic pain. Addressing this issue requires us to understand the relationship between “emotional” and “physical” pain and acknowledge the reality of all suffering. Radden tackles these issues by showing that even though pain and suffering can be accompanied by mistaken beliefs, such experiences cannot be delusional. Keywords: Psychogenic Pain; Imaginary Pain; Chronic Pain; IASP; DSM Dolore psicogeno e dolore immaginario Riassunto: Con dolore psicogeno si intende un dolore di origine psicologica. In questo lavoro presento una breve storia delle interpretazioni e classificazioni di questa forma di sofferenza, evidenziando che queste si sono fondate perlopiù sull’esclusione di evidenze organiche a giustificazione dell’esperienza del sofferente. Ciò ha portato ad ambigue classificazioni di malattia che mettono in discussione l’autenticità della sofferenza del paziente. Oggi, quella di dolore psicogeno non è più considerata una diagnosi valida perché ritenuta stigmatizzante, implicando che il dolore del paziente sia immaginario. Ciononostante, la stigmatizzazione persiste nell’approccio odierno al dolore cronico. Affrontare questo problema comporta la comprensione della relazione tra dolore “emozionale” e dolore “fisico” ed il riconoscimento della realtà di tutte le forme di sofferenza. Nel suo lavoro, Radden esamina queste tematiche mostrando che, sebbene esperienze di dolore e sofferenza possano essere accompagnate da credenze errate, le esperienze stesse non possono essere illusorie. Parole chiave: Dolore psicogeno; dolore immaginario; dolore cronico; IASP; DSM. (shrink)

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)

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...

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)

Las herramientas teóricas destinadas a señalar las injusticias que sufren ciertos grupos socialmente oprimidos pueden acabar siendo utilizadas con propósitos completamente opuestos a los iniciales. Modificar el alcance de una herramienta teórica no es necesariamente problemático: la popularización de un concepto abre las puertas a que se utilice estratégicamente para diferentes fines. La tesis que defendemos en este artículo es que algunos personajes públicos cultivan una imagen particular de sí mismos que parece satisfacer los requisitos de la noción de injusticia (...) testimonial y utilizan esta situación como medio para obtener beneficio político de ella. Más concretamente, estos personajes públicos se benefician de esta condición para generar situaciones de desacuerdos cruzados, que están estrechamente relacionados con el aumento de la polarización. (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)

This chapter considers some epistemic aspects of interactions with those who are believed to be delusional. The chapter makes five main claims: first, for the day-to-day purposes of most individuals, it is helpful to understand delusions as extreme epistemic failures, failures that all are guilty of to some degree. Second, one should be cautious when attributing delusions to others because to call someone delusional can act to discredit them, and this can be especially dangerous when applied to members of oppressed (...) groups. Third, delusional individuals can indeed be wronged by epistemic injustice. Fourth, epistemic responsibility for delusions needs to be extended beyond the individual holding delusional beliefs to the conditions that shape those beliefs. Finally, the virtue of epistemic humility offers several important epistemic benefits in interactions with delusional others. (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)

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

Manuel Padilla Cruz has written an excellent response piece (Padilla Cruz 2019) to my initial article (Cull 2019) on dismissive incomprehension, where he raises a number of interesting issues and has put forward a number of excellent ideas for avenues for further research. Here I seek to deepen our understanding of the phenomenon by developing some responses that have come forward in thinking about and discussing dismissive incomprehension, especially in reference to what Padilla Cruz has said. Hopefully this adds to (...) his analysis and helps to provoke the further research we are both interested in seeing. (shrink)

This article is an introduction to the special issue on philosophy of medicine. Philosophy of medicine is a field that has flourished in the last couple of decades and has become increasingly institutionalized. The introduction begins with a brief overview of some of the most central recent developments in the field. It then describes the six articles that comprise this issue.

This thesis contextualises academic writing in EAP (English for Academic Purposes) and subjects it to an interdisciplinary (educational and philosophical) analysis in order to argue that what makes writing academic are its socio-academic practices and values, not its conventional forms. In rejecting dominant discourses that frame academic writing as a transferable skill which can be reduced to conventional forms, I show that academic writings are varied and evolve alongside changing writer agencies and textual environments. This accounts for the emergence of (...) a diverse academic writing landscape that enacts diverse socio-academic practices and that does not reduce writing to predictable static surface features. My methodology resists traditional disciplinary classifications and is in line with the reflective and interpretative approaches associated with the humanities. Rather than ‘filling a gap’ in academic writing research, I challenge writing conventions in EAP by questioning assumptions. This is because EAP is influential in shaping discourses about academic writing and, as such, it must not mislead students and practitioners about the evolving purposes, forms and possibilities for academic expression. The thesis is divided into three parts, each containing two chapters. Part 1 is concerned with explaining what academic writing is in EAP and how EAP can misrepresent it. Part 2 delves into the history of writing and literacy to tease out the ideologies shaping writing practices. Part 3 proposes a model based on philosophical theories of mind and sociology that lays the foundation for a macro theory of academic writing and a future writing pedagogy. The model re-imagines academic writing as an affordance within a non-linear, emergent and complex social open system. This system can be referred to as an organic unity and requires a shift from conceiving writing as a ‘transferable skill’. When re-imagined as an affordance, change and diversity in academic writing practices become possible. (shrink)

The US Food and Drug Administration (FDA) is fraught with controversies over the role of values and politics in regulatory science, especially with drugs in the realm of reproductive health. Philosophers and science studies scholars have investigated the ways in which social context shapes medical knowledge through value judgments, and feminist scholars and activists have criticized sexism and injustice in reproductive medicine. Nonetheless, there has been no systematic study of values and gender norms in FDA drug regulation. I focus on (...) three questions about values in regulatory science. First, how have societal values and gender norms shaped the way that the FDA regulates drugs in the realm of reproductive health, specifically with drug labels? Second, what are the ethical, epistemic, and social consequences of these influences on regulation for women and other marginalized groups? Third, which societal values and gender norms ought to influence drug regulation about reproductive health, and how ought this happen? Integrating philosophical analysis with historical archival research and in-depth interviews, I conduct three case studies of drug labeling about reproductive health: (1) the “drug fact” about the mechanism of the morning-after pill; (2) the package inserts for patients about the health risks of oral contraceptives; and (3) the special physician labels made for prescribing drugs to pregnant women. I identify three challenges for the FDA and suggest ways to reduce the influence of sexist values and facilitate feminist alternatives. First, across these cases, I have found that there are many ways in which other concerns in reproductive medicine (such as zygotic life, fetal health, and population control) have devalued women’s health. Second, both knowledge and ignorance xvi about their reproductive health have contributed to women’s oppression, especially poor women and women of color. Finally, by avoiding the epistemic dimensions of ethics, powerful, mostly male parties in medicine (such as doctors, pharmaceutical companies, and religious institutions) have misused “informed consent,” “religious freedom,” and “paternalism” for unethical purposes. For improvement, I suggest extracting sexist values and gender norms from regulatory science that cause epistemic injustices, and I point to success stories for reforming sexism with feminism at the FDA. (shrink)