Epistemic injustice in healthcare: a philosophial analysis
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In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker (Epistemic injustice. Power and the ethics of knowing. Oxford University Press, Oxford, 2007). Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice.
KeywordsEpistemic injustice Illness Patient experience Phenomenology Patient toolkit
This paper was written during Havi Carel’s British Academy Fellowship. She is grateful to the British Academy for enabling this period of research leave. Ian James Kidd wrote this paper during an Addison Wheeler Fellowship. We are also grateful to Miranda Fricker for her encouragement and to the men and women who generously shared their illness testimonies with us.
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