Peña-Guzmán David M, Reynolds Joel Michael
Kennedy Inst Ethics J. 2019;29(3):205-242. doi: 10.1353/ken.2019.0023.
This paper argues that epistemic errors rooted in group- or identity-based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four primary mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice.
本文认为，医学错误文献中对源于群体或身份偏见（尤其是与残疾相关的偏见）的认知错误缺乏充分的理论探讨。在概述了医学错误的主流分类之后，我们转向社会认识论领域，以理解认知模式在导致对边缘化社会群体患者产生不成比例影响的医学错误中所起的作用。我们通过对能力主义的详细案例研究来考察这种不平等分布的影响。能力主义的认知模式通过四种主要机制扭曲了非残疾医生与残疾患者之间的沟通：证言不公、认知过度自信、认知抹除和认知脱轨。总体而言，应对认知不公正，尤其是应对基于模式的医学错误，最终是正义问题，必须在医疗实践的各个层面得到更好的解决。
