This week's blogpost is from Kasper Møller Nielsen, Julie Nordgaard, and Mads Gram Henriksen on their recent publication Fundamental issues in epistemic injustice in healthcare (Medicine, Health Care and Philosophy, 2025).
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| Kasper Møller Nielsen, Julie Nordgaard, and Mads Gram Henriksen |
In this blogpost, we sketch some key points from our recent article “Fundamental issues in epistemic injustice in healthcare” (Nielsen et al., 2025), calling for more conceptual clarity, methodological rigor, and empirically balanced claims in this research field. In the article, we focus on Miranda Fricker’s (2007, p. 28) concept of testimonial injustice, which she defines as a person receiving “a credibility deficit owing to identity prejudice in the hearer”. In our context, testimonial injustice is a form of transactional injustice, i.e., an injustice occurring in patient-clinician relations.
We report, to our own surprise and dismay, that core claims about epistemic injustice in healthcare, though often presented as facts, are not based on any empirical evidence. These core claims concern, for example, the widespread presence of testimonial injustice in somatic and psychiatric settings as well as the nature of the identity prejudices that clinicians are said to harbor toward the patients they treat. We could not identify any empirical study examining or supporting these claims. The research, typically, revolves around cases – which have merits of their own – but generalizability is not one of them. Furthermore, it is often not possible to ascertain that these cases even meet criteria for testimonial injustice.
On Fricker’s account, testimonial injustice is, as stated, caused to someone (here, a patient), owing to identity prejudice in the hearer (here, a clinician). Moreover, Fricker (2017) has argued that such identity prejudices must be produced unintentionally by the hearer. Looking at the reported cases from a Frickerian perspective, one is often left wondering what identity prejudice, if any, the clinician was supposed to harbor toward the patient. This is a matter of concern as the identity prejudice is supposed to be responsible for the credibility deficit ascribed to the patient, and this credibility deficit must be produced unintentionally by the clinician.
While nobody is out to deny that mistakes or inappropriate behavior occur in healthcare, also in patient-clinician relations, not all mistakes or injustices can be subsumed under the heading of epistemic injustice. In the research field of epistemic injustice in healthcare, conceptual analysis – clearly delineating the boundaries of, e.g., testimonial injustice – is just as important as methodological rigorous, empirical studies.
Our critical remarks are not intended to downplay the potential importance of epistemic injustice in healthcare. As we conclude in the article, “If epistemic injustice in healthcare exists in the form or degree hypothesized in the literature, it should be of significant concern to us all. Consequently, this topic must be explored thoughtfully and with methodological rigor”. Addressing the fundamental issues we discuss in the article may help move the field forward.