Epistemic injustice in healthcare: a philosophial analysis
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
- Biggs J. and N. Boulton 2011. Voices from the shadows. DVD documentary. UK.Google Scholar
- Dennett, D. 1981. Brainstorms. Cambridge MA: MIT Press.Google Scholar
- Carel, H. 2008. Illness. Stocksfield: Acumen.Google Scholar
- Carel, H. 2013. Bodily doubt. Journal of Consciousness Studies 20(7–8): 178–197.Google Scholar
- Cegłowski, M. 2012. No evidence of disease. http://idlewords.com/2012/09/no_evidence_of_disease.htm.
- Coady, D. 2012. Critical reply to “Culpability for epistemic injustice: Deontic or aretaic?”. Social Epistemology Review and Reply Collective 1(5): 3–6.Google Scholar
- Coulter, A., and J. Ellins 2006. Patient focused interventions: A review of the evidence. London: The Health Foundation. www.health.org.uk.
- Feldman, M.D. 2004. Playing sick? Untangling the web of Munchausen syndrome, Munchausen by proxy, malingering, and factitious disorder. New York: Brunner-Routledge.Google Scholar
- Frank, A. 2010. The wounded storyteller: Body, illness, and ethics. Chicago: University of Chicago Press.Google Scholar
- Goldacre, B. 2012. Bad pharma. London: Fourth Estate.Google Scholar
- Greener, I. 2009. Healthcare in the UK: Understanding continuity and change. Bristol: The Policy Press.Google Scholar
- Heidegger, M. 1962 . Being and time. Oxford: Basil Blackwell.Google Scholar
- Husserl, E. 1999 . Cartesian meditations. D. Cairns (trans.). Dordrecht, The Netherlands: Kluwer.Google Scholar
- Kidd, I.J 2013. A pluralist challenge to ‘integrative medicine’: Feyerabend and Popper on the cognitive value of alternative medicine. Studies in History and Philosophy of Biological and Biomedical Science 44(3): pp.392–400.Google Scholar
- Kleinman, A. 1980. Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, CA: University of California Press.Google Scholar
- Kleinman, A. 1988. The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.Google Scholar
- Korsch, B.M., et al. 1968. Gaps in doctor-patient communication: Doctor-patient interaction and patient satisfaction. Pediatrics 42: 855–871.Google Scholar
- Leontiou, J.F. 2010. What do the doctors say? New York: iUniverse.Google Scholar
- McIver, S. 2011. User perspectives and involvement. In: K. Walshe and J. Smith (Eds.), Healthcare management 2nd ed. (pp. 354–372) Maidenhead: Open University Press.Google Scholar
- Medina, J. 2012. The epistemology of resistance: Gender and racial oppression, epistemic injustice, and the social imagination. Oxford: Oxford University Press.Google Scholar
- Merleau-Ponty, M. 1962 . Phenomenology of perception. New York: Routledge.Google Scholar
- NHS Constitution: http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the-nhs-constitution-for-england-2013.pdf (accessed March 17, 2014).
- Patients Association: http://patients-association.com/Default.aspx?tabid=41 (accessed March 17, 2014).
- Patient Charter (1991/1995/1997) see: Department of Health (1991) The Patient’s Charter (London: HMSO) (accessed July 15, 2013).Google Scholar
- Ratcliffe, M. 2012. Phenomenology as a form of empathy. Inquiry 55(5). doi:10.1080/0020174X.2012.716196.
- Saks, E. 2007. The center cannot hold. My journey through madness. New York: Hyperion.Google Scholar
- Savino, A.C., and J.S. Fordtran. 2006. Factitious disease: Clinical lessons from case studies at Baylor University Medical Center. Proceedings of Baylor University Medical Center 19: 195–208.Google Scholar
- Scrutton, A. (forthcoming) ‘Two Christian theologies of depression: An evaluation and discussion of clinical implications’. Philosophy, Psychiatry, & Psychology.Google Scholar
- Toombs, S.K. 1999. The meaning of illness: a phenomenological account of the different perspectives of physician and patient. Amsterdam: Kluwer.Google Scholar
- Wanderer, J. 2012. Addressing testimonial injustice: Being ignored and being rejected. The Philosophical Quarterly 62(246): 148–169.Google Scholar
- Wootton, D. 2007. Bad medicine. Oxford: Oxford University Press.Google Scholar