Department of Political Science, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada.
Med Health Care Philos. 2024 Sep;27(3):455-477. doi: 10.1007/s11019-024-10210-1. Epub 2024 Jun 4.
Invalidation from healthcare practitioners is an experience shared by many patients, especially those marginalized or living with contested conditions (e.g., chronic pain, fibromyalgia, etc.). Invalidation can include not taking someone's testimony seriously, imposing one's thoughts, discrediting someone's emotions, or not perceiving someone's testimony as equal and competent. Epistemic injustices, that is, the disqualification of a person as a knower, are a form of invalidation. Epistemic injustices have been used as a theoretical framework to understand invalidation that occurs in the patient-healthcare provider relationship. However, to date, the different recommendations to achieve epistemic justice have not been listed, analyzed, nor compared yet. This paper aims at better understanding the state of the literature and to critically review possible avenues to achieve epistemic justice in healthcare. A systematic and critical review of the existing literature on epistemic justice was conducted. The search in four databases identified 629 articles, from which 35 were included in the review. Strategies to promote epistemic justice that can be applied to healthcare are mapped in the literature and sorted in six different approaches to epistemic justice, including virtuous, structural, narrative, cognitive, and partnership approaches, as well as resistance strategies. These strategies are critically appraised. A patient partnership approach based on the Montreal Model, implemented at all levels of healthcare systems, seems promising to promote epistemic justice in healthcare.
医疗从业者的否定是许多患者共同经历的，尤其是那些被边缘化或患有有争议的疾病的患者（例如慢性疼痛、纤维肌痛等）。否定可能包括不认真对待某人的证词、强加自己的想法、诋毁某人的情绪，或者不认为某人的证词是平等和有能力的。知识不公正，即剥夺一个人作为知情人的资格，是一种否定形式。知识不公正已被用作理解医患关系中发生的否定的理论框架。然而，迄今为止，尚未列出、分析和比较实现知识公正的不同建议。本文旨在更好地了解文献状况，并批判性地审查在医疗保健中实现知识公正的可能途径。对现有关于知识公正的文献进行了系统和批判性的回顾。在四个数据库中的搜索确定了 629 篇文章，其中 35 篇被纳入综述。文献中描绘了可以应用于医疗保健的促进知识公正的策略，并按照六种不同的知识公正方法进行分类，包括美德、结构、叙事、认知和伙伴关系方法，以及抵抗策略。这些策略受到批判性评价。基于蒙特利尔模式的患者伙伴关系方法，在医疗保健系统的各个层面实施，似乎有望促进医疗保健中的知识公正。
