title: Epistemic injustice in healthcare: a philosophial analysis.
abstract: 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.
authors.affiliation: Department of Philosophy, University of Bristol, Cotham House, Bristol, BS6 6JL, UK, havi.carel@bristol.ac.uk.
authors.forename: Havi
authors.initials: H
authors.lastname: Carel
authors.forename: Ian James
authors.initials: IJ
authors.lastname: Kidd
mesh_terms: D003695:Delivery of Health Care / Q000941:ethics*; D004194:Disease / Q000523:psychology; D006801:Humans; D019359:Knowledge; D010686:Philosophy, Medical; D012935:Social Justice / Q000941:ethics
references.citation: Pediatrics. 1968 Nov;42(5):855-71
references.pmid: 5685370
references.citation: N Engl J Med. 1969 Mar 6;280(10):535-40
references.pmid: 5764453
references.citation: J Med Philos. 2012 Apr;37(2):96-113
references.pmid: 22474139
references.citation: Lancet Respir Med. 2013 Aug;1(6):441-2
references.pmid: 24429239
references.citation: Proc (Bayl Univ Med Cent). 2006 Jul;19(3):195-208
references.pmid: 17252033
references.citation: Stud Hist Philos Biol Biomed Sci. 2013 Sep;44(3):392-400
references.pmid: 23859834
references.citation: N Engl J Med. 2012 Nov;367(18):1755-9
references.pmid: 23113489
references.citation: J Med Philos. 1987 Aug;12(3):219-40
references.pmid: 3668399
references.citation: Ann Intern Med. 1984 Nov;101(5):692-6
references.pmid: 6486600
references.citation: JAMA. 1992 Apr 22-29;267(16):2221-6
references.pmid: 1556799