Moral Experts, Ethico-Epistemic Processes, and Discredited Knowers: An Epistemology for Bioethics

Abstract

I argue that the very question of whether or not there are ‘moral experts’ is misguided—not because of arguments from disagreement or other objections to the possibility of moral experts—but because the concept of moral expertise itself disguises a number of mistaken assumptions. This essay aims to shift the terrain of the debate. Drawing on feminist and decolonialist critiques of epistemology and ethics, I argue that both the aims and the model of ethical reasoning need to be reconceptualized. The idea of moral expertise assumes a particular kind of knower, the autonomous, disinterested, objective knower of mainstream epistemology and science. This picture of the reliable knower is now widely contested. Recent work by Miranda Fricker, Jose Medina, and Kristie Dotson show myriad ways in which people’s credibility and voices are denied, silenced, and erased by structurally-encoded conditions for listening to ‘different’ and ‘other’ people than the advantaged and privileged in society. An adequate model of moral epistemology in bioethics needs to actively create and sustain the space for those whose voices are discredited to bear witness to their experiences, needs, and suffering. With respect to psychiatry, that especially includes the voices of patients with mental disorders. I offer a model that a psychiatrist and I have developed over the years, of collaborative, on-the-ground epistemic and ethical engagement to illustrate a different way of thinking about how ethical knowing can occur in the clinic.