Journal of Bioethical Inquiry

, Volume 14, Issue 1, pp 31–42 | Cite as

Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain

  • Daniel Z BuchmanEmail author
  • Anita Ho
  • Daniel S Goldberg
Symposium: Public Trust in Expert Knowledge


Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management.


Chronic pain Epistemic injustice Trust Expertise bioethics Stigma 



We would like to thank Nigel Hee, Research Associate at the Centre for Biomedical Ethics, Yong Loo Lin School of Medicine at the National University of Singapore, for his editorial support. We also thank our anonymous reviewers and editors for their very helpful suggestions.


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Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2016

Authors and Affiliations

  • Daniel Z Buchman
    • 1
    Email author
  • Anita Ho
    • 2
  • Daniel S Goldberg
    • 3
  1. 1.University Health Network, Bioethics Program, Joint Centre for Bioethics and Dalla Lana School of Public Health, University of TorontoTorontoCanada
  2. 2.Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore and W. Maurice Young Centre for Applied Ethics, University of British ColumbiaSingaporeSingapore
  3. 3.Center for Bioethics and Humanities, University of Colorado Anschutz Medical CampusAuroraUnited States

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