Queensland Bioethics Centre, Australian Catholic University - Brisbane Campus, Banyo, Queensland, Australia
Department of Medicine, University of Cape Town, Cape Town, South Africa.
J Med Ethics. 2023 May;49(5):325-334. doi: 10.1136/jme-2022-108291. Epub 2023 Jan 19.
The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change.
对全球南方的认识论、理论、原则、价值观、概念和经验的压制，构成了生物伦理学中一种特别恶劣的认识不公正。我们纠正这种不公正的共同责任应该是道德议程的首要任务。但事实并非如此，或者只是部分如此，这存在很大问题，并危及整个领域的可信度。作为重新调整该领域的第一步，本文为全球健康伦理中的认识公正提供了一个全面的论述。我们首先介绍了几种不同的与知识相关的正义和非殖民化概念，有意借鉴了来自南方和北方的工作。然后，我们将这些概念应用于全球健康伦理背景下，以生成该领域认识公正的三个层面的描述：谁在生产伦理知识；应用于产生伦理知识的理论和概念是什么；以及谁的声音被寻求、记录和用于产生伦理知识。这些层面反映了该领域跨越了概念和经验研究。最后，我们提出，为了在每个层面实现更大的认识公正，并帮助全球健康伦理非殖民化，未来有三个途径是关键：即理解问题、对话和结构变革。
