Invalidation from healthcare practitioners is an experience shared by many patients, especially those marginalized or living with contested conditions (e.g., chronic pain, fibromyalgia, etc.). Invalidation can include not taking someone’s testimony seriously, imposing one’s thoughts, discrediting someone’s emotions, or not perceiving someone’s testimony as equal and competent. Epistemic injustices, that is, the disqualification of a person as a knower, are a form of invalidation. Epistemic injustices have been used as a theoretical framework to understand invalidation that occurs in the patient-healthcare (...) provider relationship. However, to date, the different recommendations to achieve epistemic justice have not been listed, analyzed, nor compared yet. This paper aims at better understanding the state of the literature and to critically review possible avenues to achieve epistemic justice in healthcare. A systematic and critical review of the existing literature on epistemic justice was conducted. The search in four databases identified 629 articles, from which 35 were included in the review. Strategies to promote epistemic justice that can be applied to healthcare are mapped in the literature and sorted in six different approaches to epistemic justice, including virtuous, structural, narrative, cognitive, and partnership approaches, as well as resistance strategies. These strategies are critically appraised. A patient partnership approach based on the Montreal Model, implemented at all levels of healthcare systems, seems promising to promote epistemic justice in healthcare. (shrink)

One of the challenges facing complex democratic societies marked by deep normative disagreements and differences along lines of race, gender, sexuality, culture and religion is how the perspectives of diverse individuals and social groups can be made effectively present in the deliberative process. In response to this challenge, a number of political theorists have argued that empathetic perspective-taking is critical for just democratic deliberation, and that a well-functioning democracy requires the cultivation in citizens of empathetic skills and virtues. In this (...) paper, we begin by distinguishing several kinds of imaginative projection and corresponding kinds of empathy. On the basis of this analysis, we suggest that genuine empathetic perspective-taking, especially across gendered, racial and embodied differences, is more challenging than is often assumed in the literature. This poses a dilemma for theorists who place great store on the role of empathetic imagination to overcome the challenges of democratic deliberation. On the one hand, placing responsibilities for empathetic perspective-taking primarily on the socially privileged raises risks of inaccurate and inappropriate projection. On the other hand, mitigating the risks of projection by calling on the socially marginalised to articulate their experiences and feelings in a way that can engage the imagination of the socially privileged, risks perpetuating epistemic injustice. We suggest that while this dilemma may be difficult to overcome, its effects can nevertheless be mitigated through both the cultivation of individual deliberative virtues and pragmatic institutional responses. (shrink)