Weill Cornell Medical College, New York, NY, USA.
Philos Ethics Humanit Med. 2021 Oct 26;16(1):9. doi: 10.1186/s13010-021-00110-0.
Epistemic injustice sits at the intersection of ethics, epistemology, and social justice. Generally, this philosophical term describes when a person is wrongfully discredited as a knower; and within the clinical space, epistemic injustice is the underlying reason that some patient testimonies are valued above others. The following essay seeks to connect patterns of social prejudice to the clinical realm in the United States: illustrating how factors such as race, gender identity, and socioeconomic status influence epistemic credence and associatively, the quality of healthcare a person receives.After describing how epistemic injustice disproportionately harms already vulnerable patients, I propose a narrative therapy intervention. This intervention can help providers re-frame their relationships with patients, in such that they come to view patients as valuable sources of unique knowledge. Though I identify this intervention as a valuable step in addressing clinical epistemic injustice, I call upon medical educators and practitioners to further uplift the voices, perspectives, and stories of marginalized patients.
认知不公正处于伦理学、认识论和社会正义的交叉点。一般来说，这个哲学术语描述的是，当一个人作为知识者被错误地诋毁时；而在临床领域，认知不公正就是某些患者的证言比其他证言更有价值的根本原因。本文试图将社会偏见的模式与美国的临床领域联系起来：说明种族、性别认同和社会经济地位等因素如何影响认知可信度，并相应地影响一个人所接受的医疗保健质量。在描述了认知不公正如何不成比例地伤害已经脆弱的患者之后，我提出了一种叙事治疗干预措施。这种干预可以帮助提供者重新构建他们与患者的关系，使他们将患者视为具有独特知识的有价值的来源。虽然我认为这种干预措施是解决临床认知不公正的一个有价值的步骤，但我呼吁医学教育者和从业者进一步提升边缘化患者的声音、观点和故事。
