Nielsen Kasper Møller, Nordgaard Julie, Henriksen Mads Gram
Center for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300, Copenhagen, Denmark.
Psychiatry East, Region Zealand, Smedegade 16, 4000, Roskilde, Denmark.
Med Health Care Philos. 2025 Jun;28(2):291-301. doi: 10.1007/s11019-025-10259-6. Epub 2025 Mar 7.
The research field of epistemic justice in healthcare has gained traction in the last decade. However, the importation of Miranda Fricker's original philosophical framework to medicine raises several interrelated issues that have largely escaped attention. Instead of pushing forward, crafting new concepts or exploring other medical conditions, we suggest that it is time to take stock, reconsider, and articulate some fundamental issues that confront the field of epistemic injustice in healthcare. This paper articulates such fundamental issues, which we divide into scientific, conceptual, and theoretical issues. Scientifically, the research field is confronted by a lack of empirical evidence. It relies on cases, making generalizations impossible and the field vulnerable to bias. Conceptually, many of the claims advanced in the literature are presented as facts but are merely hypotheses to be tested. Moreover, a criterion for applying the concept of testimonial injustice in medicine is lacking, impeding the development of a construct to empirically measure said injustices. Theoretically, many of the cases discussed in the literature do not prima facie qualify as cases of testimonial injustice, since they lack necessary components of testimonial injustice in Fricker's framework, i.e., being unintentional and caused by identity prejudices in the hearers. If epistemic injustice is as pervasive as it is claimed in this literature, it should be of concern to us all. Addressing the issues raised here may strengthen the conceptualization of epistemic injustice in healthcare and lead to development of constructs that finally can explore its empirical basis.
在过去十年中，医疗保健领域的认知正义研究领域受到了广泛关注。然而，将米兰达·弗里克最初的哲学框架引入医学引发了几个相互关联的问题，而这些问题在很大程度上被忽视了。我们建议，现在不是继续推进、构建新概念或探索其他医疗状况的时候，而是应该进行评估、重新思考并阐明医疗保健领域认知不公正所面临的一些基本问题。本文阐述了这些基本问题，我们将其分为科学、概念和理论问题。从科学角度来看，该研究领域面临着缺乏实证证据的问题。它依赖于案例，这使得进行概括变得不可能，并且该领域容易受到偏见的影响。从概念上讲，文献中提出的许多主张被当作事实呈现，但实际上仅仅是有待检验的假设。此外，在医学中应用证言不公正概念的标准缺失，这阻碍了构建一个用于实证衡量此类不公正的结构的发展。从理论上讲，文献中讨论的许多案例表面上并不符合证言不公正的案例，因为它们缺乏弗里克框架中证言不公正的必要组成部分，即无意性且由听众的身份偏见导致。如果认知不公正像该文献所声称的那样普遍存在，那么它应该引起我们所有人的关注。解决这里提出的问题可能会加强医疗保健领域认知不公正的概念化，并导致最终能够探索其实证基础的结构的发展。
