J Med Ethics. 2019 Feb;45(2):97-100. doi: 10.1136/medethics-2018-104761. Epub 2018 Oct 18.
I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting (at least) those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users' experiences. I defend this proposal against three objections.
我解释了共致不公正的概念，这是一种认识不公正，并认为它发生在精神科服务中，影响（至少）那些听到声音的人。我认为，临床医生个人努力避免这种不公正的行为是对这个问题的一个不充分的反应；减轻这种不公正需要临床医生和服务用户组织之间进行开放和有意义的对话，以及个人之间的对话。我认为，临床医生必须熟悉并认真对待服务用户社区中为理解精神困扰而开发的概念和框架，如“听见声音网络”，以及个别服务用户的概念和框架。当这些概念和框架明确与用户体验的医学或技术理解相冲突时，这一点尤其必要。我反对三个反对意见来捍卫这个建议。
