title: Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain.
abstract: 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.
authors.affiliation: University Health Network, Bioethics Program, Joint Centre for Bioethics and Dalla Lana School of Public Health, University of Toronto, 399 Bathurst Street, McLaughlin Block, 8th Floor, Room 443, Toronto, ON, M5S 2S8, Canada. daniel.buchman@utoronto.ca.
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Buchman
authors.affiliation: 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 Columbia, Block MD11, Clinical Research Centre, 10 Medical Drive, Singapore, 117597, Singapore.
authors.forename: Anita
authors.initials: A
authors.lastname: Ho
authors.affiliation: Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Fullginiti Pavilion Room 205, 13080 E. 19th Avenue, Aurora, CO, 80045, United States.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Goldberg
mesh_terms: D059350:Chronic Pain / Q000523:psychology*; D003695:Delivery of Health Care / Q000941:ethics* / Q000592:standards; D006801:Humans; D026684:Personal Autonomy; D010686:Philosophy, Medical; D010817:Physician-Patient Relations / Q000941:ethics*; D011361:Professional Competence / Q000592:standards*; D012935:Social Justice / Q000941:ethics*; D035502:Trust
keywords: Chronic pain; Epistemic injustice; Expertise; Stigma; Trust; bioethics