Epistemic Injustice and the Ethics of Healthcare Encounters

 

Epistemic Injustice and the Ethics of Healthcare Encounters:

Evidence From Chronic Fatigue Syndrome.

Speaker: Dr Charlotte Blease, UCD.

1800 Wednesday the 14th of December 2016.

JD Seminar Room 2. The School of Law, QUB (MST/02/003).

Free to Attend. All Welcome.
As space is limited, registration is encouraged. Please email us at: contact@nief.org.uk

Click here to download a Flyer for this event [.pdf]

In her ground breaking ‘Epistemic Injustice’ the philosopher Miranda Fricker argues that ‘knowing’ has an ethical dimension. Not only is knowledge – rather than mere information – more accessible to some rather than others, the contributions individuals make to knowledge-formation activities also varies. This is not just a function of what individuals ‘know’; knowledge-formation is also influenced by social and cultural factors including individuals’ social status. Given that some aspects of the interactions between doctors and patients can be considered as involving knowledge-formation practices – e.g. diagnosis – and the fact that such encounters have an inherent power differential, there is significant potential for healthcare to be unjust from an epistemic point of view. This is particularly pertinent to the case of Chronic Fatigue Syndrome or Myalgic Encephalomyelitis (hereafter, CFS/ME).

While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate among clinical researchers, doctors, patients and patient interest groups about how CFS/ME ought to be understood. This includes disagreement about how to interpret clinical studies which look at treatments for the condition. Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors (and medical students) display uncertainty about whether or not CFS/ME is real. Such attitudes are important as they may delay the diagnosis and treatment of patients. Qualitative research also provides evidence that patients with CFS/ME often experience suspicion by health professionals, and many patients oppose psychological conceptions of their illness and treatments based on such accounts.

In view of the consensus that the causes of CFS/ME are not understood, and in light of the extensive qualitative studies on attitudes to CFS/ME, I find evidence that healthcare consultations are fora where patients with CFS/ME may be vulnerable to epistemic injustice. I argue that the (often unintentional) marginalization of many CFS/ME patients represents a failure in medical professionalism, one that may lead to further ethical and practical consequences both for progressive research into CFS/ME and for ethical care, including the delivery of existing treatments among individuals suffering from this debilitating illness.