Drożdżowicz Anna
Department of Philosophy, Classics, History of Art and Ideas, University of Oslo, Oslo, Norway
J Med Ethics. 2021 Feb 19. doi: 10.1136/medethics-2020-106679.
Epistemic injustice is a kind of injustice that arises when one's capacity as an epistemic subject (eg, a knower, a reasoner) is wrongfully denied. In recent years it has been argued that psychiatric patients are often harmed in their capacity as knowers and suffer from various forms of epistemic injustice that they encounter in psychiatric services. Acknowledging that epistemic injustice is a multifaceted problem in psychiatry calls for an adequate response. In this paper I argue that, given that psychiatric patients deserve epistemic respect and have a certain epistemic privilege, healthcare professionals have a to attend to and/or solicit reports of patients' first-person experiences in order to prevent epistemic losses. I discuss the nature and scope of this epistemic duty and point to one interesting consequence. In order to prevent epistemic losses, healthcare professionals may need to provide some patients with resources and tools for expressing their experiences and first-person knowledge, such as those that have been developed within the phenomenological approach. I discuss the risk of secondary testimonial and hermeneutical injustice that the practice of relying on such external tools might pose and survey some ways to mitigate it.
认知不公正指的是当一个人的认知主体能力（如认知者、推理者）被不当剥夺时所产生的一种不公正。近年来，有人认为精神科患者作为认知者的能力常常受到损害，并在精神科服务中遭受各种形式的认知不公正。认识到认知不公正在精神病学中是一个多方面的问题，需要做出适当的回应。在本文中，我认为，鉴于精神科患者理应得到认知尊重且拥有一定的认知特权，医疗保健专业人员有责任关注和/或征求患者第一人称经历的报告，以防止认知损失。我讨论了这一认知责任的性质和范围，并指出一个有趣的结果。为了防止认知损失，医疗保健专业人员可能需要为一些患者提供表达其经历和第一人称知识的资源和工具，比如那些在现象学方法中开发出来的资源和工具。我讨论了依赖此类外部工具的做法可能带来的二次证言不公正和解释不公正风险，并探究了一些减轻这种风险的方法。
