Ghent Research in Ethics, Law and Politics (GRELP), Ghent University, Blandijnberg 2, 9000, Ghent, East-Flanders, Belgium.
Bioethics Institute Ghent, Ghent University, Blandijnberg 2, 9000, Ghent, East-Flanders, Belgium.
J Bioeth Inq. 2024 Jun;21(2):225-228. doi: 10.1007/s11673-023-10314-y. Epub 2023 Nov 13.
We expand on Della Croce's ambition to interpret "epistemic injustice" as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce's attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson's concept of "contributory injustice" and Scheman's concept of "perceptual autonomy," we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy.
我们扩展了德拉·克罗切的雄心壮志，将“认知不公正”解释为在使用有影响力的四原则框架时对非恶意的具体说明。出于概念、道德和启发式的原因，这是一条诱人的思路。尽管值得称赞，但德拉·克罗切的尝试仍然是试探性的。我们对它的批评也是如此。然而，我们接受了挑战，批判性地解决了两个相互关联的问题。首先，我们扩大了分析范围，纳入了对解释性不公正的审议。我们认为，如果要对认知不公正进行充分考虑，就需要在医学中承担更多的道德义务，那么应该探讨解释性不公正的维度，将其作为一种途径，以产生这种积极的责任。其次，相关地，我们认为这可能包括超越个人层面的道德责任，即：在结构层面采取行动的积极义务。基于多森的“贡献性不公正”概念和谢曼的“感知自主性”概念，我们认为，证言和解释公正的美德不仅可以为行动的消极禁令（即不伤害）提供额外的内容，而且可以为行动的积极要求提供内容，例如尊重患者自主性。
