In this analysis of the ethical dimensions of doctors’ participation in macroallocation we set out to understand the skills they use, how they are acquired, and how they influence performance of the role. Using the principles of grounded moral analysis, we conducted a semi-structured interview study with Australian doctors engaged in macroallocation. We found that they performed expertise as argument, bringing together phronetic and rhetorical skills founded on communication, strategic thinking, finance, and health data. They had made significant, purposeful efforts (...) to gain skills for the role. Our findings challenge common assumptions about doctors’ preferences in argumentation, and reveal an unexpected commitment to practical reason. Using the ethics of Paul Ricoeur in our analysis enabled us to identify the moral meaning of doctors’ skills and learning. We concluded that Ricoeur’s ethics offers an empirically grounded matrix for ethical analysis of the doctor’s role in macroallocation that may help to establish norms for procedure. (shrink)

A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special (...) obligations and a traditional ethic for contemporary healthcare, we need a deeper examination of what the traditional ethic of special obligations really means. Here we offer a conception of ‘doubly distributed’ special obligations. Physicians and similarly minded healing professionals abiding by a traditional ethic have always spread their devotion and attention across multiple patients and have shared responsibilities with physician and non-physician colleagues in much the same way devoted parents have frequently distributed their special obligations across multiple children and across multiple parents. By taking up the extended analogy of parent we argue that doubly distributing special obligations need not contradict the possibility of special obligations in restructured collective forms of healthcare delivery and financing. (shrink)

Miranda Fricker maintains that testimonial injustice is a matter of credibility deficit, not excess. In this article, I argue that this restricted characterization of testimonial injustice is too narrow. I introduce a type of identity-prejudicial credibility excess that harms its targets qua knowers and transmitters of knowledge. I show how positive stereotyping and prejudicially inflated credibility assessments contribute to the continued epistemic oppression of marginalized knowers. In particular, I examine harms such as typecasting, compulsory representation, and epistemic exploitation and consider (...) what hearers are obligated to do in response to these injustices. I argue that because epistemic harms to marginalized knowers also arise from prejudicially inflated assessments of their credibility, the virtue of testimonial justice must be revised to remedy them. (shrink)

Miranda Fricker’s book Epistemic Injustice calls attention to an important sort of moral and intellectual wrongdoing, that of failing to give others their intellectual due. When we fail to recognize others’ knowledge, or undervalue their beliefs and judgments, we fail in two important respects. First, we miss out on the opportunity to improve and refine our own sets of beliefs and judgments. Second—and more relevant to the term “injustice”—we can deny people the intellectual respect they deserve. Along with describing the (...) wrong of epistemic injustice, Fricker proposes that epistemic justice is a virtue we “can, and should, aim for in practice”. But I argue that there are two major problems. First, it is not clear that it is reasonable to imagine there is any such stable disposition—that is, any such virtue—as the sort of justice she imagines. Second, even if there could be such a virtue, her theory of epistemic justice does not provide good guidance for avoiding epistemic injustice. While it could.. (shrink)

The deliberative turn in political philosophy sees theorists attempting to ground democratic legitimacy in free, rational, and public deliberation among citizens. However, feminist theorists have criticized prominent accounts of deliberative democracy, and of the public sphere that is its site, for being too exclusionary. Iris Marion Young, Nancy Fraser, and Seyla Benhabib show that deliberative democrats generally fail to attend to substantive inclusion in their conceptions of deliberative space, even though they endorse formal inclusion. If we take these criticisms seriously, (...) we are tasked with articulating a substantively inclusive account of deliberation. I argue in this article that enriching existing theories of deliberative democracy with Fricker's conception of epistemic in/justice yields two specific benefits. First, it enables us to detect instances of epistemic injustice, and therefore failures of inclusion, within deliberative spaces. Second, it can act as a model for constructing deliberative spaces that are more inclusive and therefore better able to ground democratic legitimacy. (shrink)

In this paper, I explore the relationship of virtue, argumentation, and philosophical conduct by considering the role of the specific virtue of intellectual humility in the practice of philosophical argumentation. I have three aims: first, to sketch an account of this virtue; second, to argue that it can be cultivated by engaging in argumentation with others; and third, to problematize this claim by drawing upon recent data from social psychology. My claim is that philosophical argumentation can be conducive to the (...) cultivation of virtues, including humility, but only if it is conceived and practiced in appropriately ‘edifying’ ways. (shrink)

In this paper, I argue that recent discussions of culprit-based epistemic injustices can be framed around the intellectual character virtue of open-mindedness. In particular, these injustices occur because the people who commit them are closed-minded in some respect; the injustices can therefore be remedied through the cultivation of the virtue of open-mindedness. Describing epistemic injustices this way has two explanatory benefits: it yields a more parsimonious account of the phenomenon of epistemic injustice and it provides the underpinning of a virtue-theoretical (...) structure by which to explain what it is that perpetrators are culpable for and how virtues can have normative explanatory power. (shrink)

In Epistemic injustice, Miranda Fricker makes a tremendous contribution to theorizing the intersection of social epistemology with theories of justice. Theories of justice often take as their object of assessment either interpersonal transactions (specific exchanges between persons) or particular institutions. They may also take a more comprehensive perspective in assessing systems of institutions. This systemic perspective may enable control of the cumulative effects of millions of individual transactions that cannot be controlled at the individual or institutional levels. This is true (...) not only with respect to the overall distribution of such goods as income and wealth, but also with respect to the goods of testimonial and hermeneutical justice. Cognitive biases that may be difficult for even epistemically virtuous individuals to correct on their own may be more susceptible to correction if we focus on the principles that should govern our systems of testimonial gathering and assessment. Hence, while Fricker’s focus on individual epistemic virtue is important, we also need to consider what epistemic justice as a virtue of social systems would require. My paper will indicate some directions forward on this front, focusing on the need for integration of diverse institutions and persons engaged in inquiry. (shrink)

With her conception of epistemic injustice, Miranda Fricker has opened up new normative dimensions for epistemology; that is, the injustice of denying one?s status as a knower. While her analysis of the remedies for such injustices focuses on the epistemic virtues of agents, I argue for the normative superiority of adapting a broadly republican conception of epistemic injustice. This argument for a republican epistemology has three steps. First, I focus on methodological and explanatory issues of identifying epistemic injustice and argue, (...) against Fricker, that identity prejudice fails to provide a sufficient explanatory basis for the spread and maintenance of such systematic epistemic injustice. Second, this systemic basis can be found not so much in the psychological attitudes of individual knowers, but in the relations of domination among groups and individuals in a society. Third, if such a presence of domination plays a primary explanatory role in all forms of epistemic injustice, it is likely that those who suffer from epistemic injustice will also suffer other forms of injustice and loss of status via the exercise of other forms of power and exclusion. (shrink)

Miranda Fricker's important study of epistemic injustice is focussed primarily on testimonial injustice and hermeneutic injustice. It explores how agents' capacities to make assertions and provide testimony can be impaired in ways that can involve forms of distinctively epistemic injustice. My paper identifies a wider range of forms of epistemic injustice that do not all involve the ability to make assertions or offer testimony. The paper considers some examples of some other ways in which injustice can prevent someone from participating (...) in inquiry. (shrink)

Professionalism requires that physicians uphold the best interests of patients while simultaneously insuring just use of health care resources. Current articulations of these obligations like the American Board of Internal Medicine Foundation's Physician Charter do not reconcile how these obligations fit together when they conflict. This is the problem of dual agency. The most common ways of dealing with dual agency: “bunkering”—physicians act as though societal cost issues are not their problem; “bailing”—physicians assume that they are merely agents of society (...) and deliver care typically based on a strongly consequentialist public health ethic; or “balancing”—a vaguely specified attempt to uphold both patient welfare and societal need for judicious resource use simultaneously—all fail. Here I propose how the problem of dual agency might begin to be addressed with rigor and consistency. Without dealing with the dual agency problem and getting more specific about how to reconcile its norms when they conflict, the expectations of professionalism risk being written off as cute, nonbinding aphorisms from the medical profession. (shrink)

A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special (...) obligations and a traditional ethic for contemporary healthcare, we need a deeper examination of what the traditional ethic of special obligations really means. Here we offer a conception of ‘doubly distributed’ special obligations. Physicians and similarly minded healing professionals abiding by a traditional ethic have always spread their devotion and attention across multiple patients and have shared responsibilities with physician and non-physician colleagues in much the same way devoted parents have frequently distributed their special obligations across multiple children and across multiple parents. By taking up the extended analogy of parent we argue that doubly distributing special obligations need not contradict the possibility of special obligations in restructured collective forms of healthcare delivery and financing. (shrink)