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)

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)

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)

I argue that patients who suffer genital surgery to ‘disambiguate’ their sexual anatomy, a practice labelled ‘intersex genital mutilation’ by intersex advocates, can be understood as victims of hermeneutical injustice in the sense elaborated by Miranda Fricker. This claim is clarified and defended from two objections. I further argue that a particular subset of cases of IGM-based hermeneutical injustice instantiate a novel form of hermeneutical injustice, which I call deception-based hermeneutical injustice. I highlight how this differs from central types of (...) hermeneutical injustice in the literature and trace its harms. (shrink)

There are some philosophical questions that can be answered without attention to the social context in which evidence is produced and distributed.ing away from social context is an excellent way to ignore messy details and lay bare the underlying structure of the limits of inference. Idealization is entirely appropriate when one is essentially asking: In the best of all possible worlds, what am I entitled to infer? Yet, philosophers’ concerns often go beyond this domain. As an example I examine the (...) debate on mechanistic evidence and then reevaluate a canonical case study in this debate. I show that for the assessment of actual evidence, produced in a world that is far from ideal, omission of the social aspects of medical epistemology leads philosophers to draw the wrong lessons from cases they take as paradigmatic cases for their views. I close by arguing that social epistemology provides an avenue to incorporate these complications and provides the necessary framework to understand medical evidence. (shrink)

Stephen John has recently suggested that the ethics of communication yields important insights as to how values should be incorporated into science. In particular, he examines cases of “wishful speaking” in which a scientific actor endorses unreliable conclusions in order to obtain the consequences of the listener treating the results as credible. He concludes that what is wrong in these cases is that the speaker surreptitiously relies on values not accepted by the hearer, violating what he terms “the value-apt ideal”. (...) I expand on this view by integrating into it Miranda Fricker’s account of testimonial injustice. I find testimonial injustice can arise in a manner unanticipated by Fricker, specifically that a credibility excess given to a speaker typically reduces the ability of others in the epistemic community to transmit knowledge, a phenomenon I term “collateral epistemic injustice”. I argue that this possibility entails that receivers have an ethical obligation to assign credibility judiciously. A further consequence of this view is that the value-apt ideal is insufficient. Because audience members have an obligation to assign credibility judiciously, a speaker cannot merely rely on shared values, they must also be open about the extent to which their conclusions depend on those values. Thus, both wishful speaking and obscuring the value-dependent nature of a conclusion makes one an unreliable source of information. Accordingly, other community members have an ethical obligation to ignore a speaker that frequently engages in either. (shrink)