Shevchenko Sergei, Zhavoronkov Alexey
Institute for Philosophy and Social Theory, University of Belgrade, Kraljice Natalije 45, 11000, Beograd, Serbia.
Institut für Philosophie, Goethe-Universität Frankfurt, Norbert-Wollheim-Platz 1, 60629, Frankfurt am Main, Germany.
J Bioeth Inq. 2025 Jan 6. doi: 10.1007/s11673-024-10404-5.
Scholars usually distinguish between testimonial and hermeneutical epistemic injustice in healthcare. The former arises from negative stereotyping and stigmatization, while the latter occurs when the hermeneutical resources of the dominant community are inadequate for articulating the experience of one's illness. However, the heuristics provided by these two types of epistemic predicaments tend to overlook salient forms of epistemic injustice. In this paper, we prove this argument on the example of the temporality of patients with drug dependence. We identify three temporal dimensions of epistemic injustice affecting drug-dependent patients: the temporal features of their cognitive processes, their individual temporal experience, and the mismatch of social temporality. Notably, the last aspect, which highlights the disparity between the availability of care and its accessibility, does not fit neatly into the categories of testimonial or hermeneutical injustice. (We should note that the International Network of People Who Use Drugs (INPUD) and The Asian Network of People who use Drugs (ANPUD) consider the term "drug addiction" to be associated with disempowerment and negative stereotyping. Instead, they suggest the expression "drug dependence" (INPUD 2020). However, the concept of "drug addiction" is still being used in the current public health, philosophy, and sociology debates that concern the specific field of addiction studies. Replacing the notion of drug addiction with "drug dependence" would not eliminate existing epistemic injustices or allow us to avoid creating new ones, such as those related to ignoring pain claims (O'Brien 2011). Still, for the sake of clarity we will use the notion "drug dependence" when speaking of people while retaining the term "drug addiction" for labelling healthcare practices and the topic for philosophy of healthcare.).
学者们通常会区分医疗保健领域中证明性认知不公正和诠释性认知不公正。前者源于负面刻板印象和污名化,而后者则发生在主流群体的诠释资源不足以阐明个人疾病经历之时。然而,这两种认知困境所提供的启发式方法往往会忽视认知不公正的显著形式。在本文中,我们以药物依赖患者的时间性为例来论证这一观点。我们确定了影响药物依赖患者的认知不公正的三个时间维度:他们认知过程的时间特征、个人的时间体验以及社会时间性的不匹配。值得注意的是,最后一个方面突出了护理可及性与可获得性之间的差距,并不完全符合证明性不公正或诠释性不公正的范畴。(我们应该注意到,国际药物使用者网络(INPUD)和亚洲药物使用者网络(ANPUD)认为“药物成瘾”一词与被剥夺权力和负面刻板印象相关联。相反,他们建议使用“药物依赖”这一表述(INPUD 2020)。然而,在当前涉及成瘾研究特定领域的公共卫生、哲学和社会学辩论中,“药物成瘾”的概念仍在被使用。用“药物依赖”取代药物成瘾的概念并不能消除现有的认知不公正,也无法让我们避免产生新的不公正,比如与忽视疼痛诉求相关的不公正(奥布赖恩2011)。不过,为了表述清晰,我们在提及人群时将使用“药物依赖”这一概念,而在描述医疗保健实践及医疗保健哲学主题时仍保留“药物成瘾”这一术语。)