Putting "Epistemic Injustice" to Work in Bioethics: Beyond Nonmaleficence

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.

Epistemic Injustice in Late-Stage Dementia: A Case for Non-Verbal Testimonial Injustice

The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression is a common feature of some forms of neurocognitive disorders such as 'intellectual disabilities', autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society.

Patient Engagement in Medical Education During the COVID-19 Pandemic: A Critical Reflection on an Epistemic Challenge

This article was migrated. The article was marked as recommended. Epistemic injustices are defined as power inequalities in the access, recognition and production of knowledge. Their persistence in medical education, especially to the detriment of patients and their specific knowledge, has been documented by several authors. Patient engagement is a new paradigm that involves fostering meaningful patient collaboration at different levels of the healthcare system. Since it is fundamentally based on the recognition of the value and relevance of patients' experiential knowledge, patient engagement in medical education is generally recognized as a desirable strategy to address epistemic injustices in the field. Patient engagement is challenged in the context of COVID-19 where most Canadian medical schools have had to quickly modify their teaching models, stop in-person classes and redirect most activities online. This article presents a critical reflection on the issues raised by COVID-constrained teaching strategies and their impact on epistemic injustices in medical education. It also suggests strategies to favour epistemic justice in medical education despite the pandemic turmoil and online shift. It therefore adds an epistemic perspective to the reflection on the effects of the pandemic on medical education and training, which has been little discussed so far.

A philosophy of birth: if you want to change the world, change the conversation

This essay is about why and how we should introduce birth into the canon of subjects explored by philosophy. Birth care brings to the fore fascinating philosophical questions: is a woman in labour a subject with full rights in practice as well as in theory? Can a labouring woman exercise her autonomy in a situation of maximum vulnerability but also maximum lucidity and awareness, as characterises the work of giving birth? What is the relationship between agency, capacity, and pain during and between contractions? Birth care proposes key questions relating to knowledge, freedom, and what it means to be a human being. Nonetheless, giving birth continues to be a blind spot in contemporary prevailing philosophy. My approach to a philosophy of birth aligns with one of the aims of contemporary philosophy; I explore the relationship between knowledge and emancipatory action in the relatively unchartered waters of birth and delivery, to create an epistemology that is sensitive to feminism and embodiment. What I propose to achieve through a philosophy of birth is a new logos for genos -a radically new meditation on origin and birth. How we understand our origin and the practices that bring us into being reveals our humanity. The lived experiences of women and their  situated knowledge challenge widely-held assumptions about rationality, about what it is to be a birthing woman and what it is to have agency and capacity in the delivery suite. A philosophy of birth enables us to navigate the stormy waters of contemporary obstetric practice towards a new and radical  logos for  genos -an embodied genealogy which not only redresses imbalances of gender, but also addresses life and happiness.