Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in (...) diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits. (shrink)

Abstract25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with (...) LEP. We define a framework to tease out public health responsibilities given some populations’ limited proficiency in a society’s predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP. (shrink)

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)

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)

Linguistic discrimination is a complex phenomenon. How should it be investigated? Evidential pool is of key importance. In this paper, we present specific conceptual and methodological challenges in the study of linguistic discrimination, with a focus on linguistic discrimination resulting from implicit attitudes and the steadily growing research on biases and structural approaches to social injustice. We conclude by proposing that a productive and comprehensive way to investigate linguistic discrimination rooted in implicit attitudes should seek to incorporate first-person perspectives and (...) testimonies from the linguistically harmed individuals, and discuss some arguments in support of this view. (shrink)

Public debates on linguistic integration as a socially desired outcome often share a prevailing sentiment that newcomers ought to “learn the language.” But the intensity of that sentiment is rarely accompanied by an equally robust understanding of what, precisely, it means in practice. This results in a notion of linguistic integration with an inbuilt tension between a seemingly pragmatic and commonsensical appearance, on the one hand, and a minimal action‐guidance capacity, on the other hand. This paper explores this intriguing tension, (...) and it identifies three moral and practical challenges that this challenge presents to the normative theorizing of the practical ethics of linguistic integration: (1) a predicament of arbitrary treatment; (2) the interpersonal structure of social and linguistic learning; and (3) the affective dimension of linguistic integration. (shrink)

Breast Cancer (BC) is a debilitating disease with the global mortality rate of 13.0 per 100,000 of population (Globocan, 2018). BC affects the physical, mental, and emotional well-being and quality...

Although there is now a substantial body of literature exploring the effects of language diversity in international management contexts, little attention has been paid to the ethical dimensions of language diversity at work. This conceptual paper draws on the concept of epistemic injustice in order to explore how language, and in particular corporate language policies, may act as a source of epistemic injustice within the workplace. It demonstrates how language competence affects credibility judgements about a speaker, and also considers how (...) corporate language policies can create situations of hermeneutic injustice, in which marginalised groups are denied the vocabularies to understand their own experiences. Finally, ways in which such epistemic harms can be reduced are discussed, and the possibilities for management education to create epistemically responsible managers are highlighted. (shrink)