Epistemic Injustice in Diagnosis

In this post Lisa Bortolotti interviews Anke Bueter (principal investigator) and Thor Hennelund Nielsen (post-doctoral researcher) on their exciting project, “Epistemic Injustice in Diagnosis” (January 2024 – December 2025) funded by a Starting Grant of the Aarhus University Research Foundation. 

Aarhus University, credit Lars Kruse / AU Foto

Lisa: How did you become interested in this project?

Anke: This project brings together my research interests in feminist epistemology and the philosophy of medicine and psychiatry.  It focuses specifically on diagnosis, as diagnosis is both a prerequisite of successful medical treatments and susceptible to pathocentric epistemic injustices. I wanted to further explore this area after working on the phenomenon of diagnostic overshadowing, in which a previous psychiatric diagnosis leads to diagnostic delays or missed diagnoses regarding somatic diseases (Bueter 2023).

Thor: Diagnostic practices in both somatic medicine and psychiatry – their internal reasonings and capacities to change peoples’ lives for better or worse – have always interested me academically and personally. I’ve been very fortunate that this project allows me to fulfil this interest through investigating the topic of overdiagnosis.

Lisa: What are your objectives and why do you think it is important to achieve them?

Anke: My primary interest lies in avoidable diagnostic errors, which are estimated to affect 10-20% of all medical cases. The project seeks to rethink diagnosis as an (ideally) collaborative epistemic process and to explore how epistemic injustices can hinder this process. For example, I am currently examining gender biases in psychiatric diagnostic criteria, as well as the important role of trust between patients and clinicians.

Thor: Studies within the field have tended to focus on either epistemic injustices of/leading to under- or misdiagnosis but haven’t paid particularly close attention to overdiagnosis, though the epistemic harms of the latter may be equally serious. I want to show that overdiagnosis is not just a problem in terms of iatrogenic harms or lost opportunity costs but also because it fundamentally affects the overdiagnosed patient’s ability to understand themselves and be understood by others.

Lisa: Does your project involve interdisciplinary or crossdisciplinary work? If so, what disciplines are involved?

Thor: The issue of overdiagnosis is crossdisciplinary at heart. The problem itself derives from medicine but is often studied through sociological methods and additionally calls for philosophical scrutiny to elucidate the concepts themselves and the injustices they may create.

Lisa: What do you expect will be the impact of your project, within philosophy and beyond it?

Anke: A better understanding of how epistemic injustice affects diagnosis, and of the mechanisms behind these issues, is a crucial first step toward mitigation. Beyond contributing to the philosophical discussion, we aim to raise awareness among the public and medical professionals about the need for epistemic justice in health care.

Thor: The ambition is to put overdiagnosis on the map within the epistemic injustice in healthcare discussion, and, conversely, open the concept of epistemic injustice to the medical debate on overdiagnosis. Hopefully this contributes to reducing the epistemic harms of overdiagnosis in the “real world” in the long run.

Anke Bueter is Associate Professor of Philosophy in the School of Culture and Society, Aarhus University. Anke is the author of Feminist Philosophy of Science (Cambridge University Press, 2024).

Thor Hennelund Nielsen is postdoctoral researcher in the School of Culture and Society, Aarhus University. Thor is the author of "The Dynamics of Disease: Toward a Processual Theory of Health", an article published in the Journal of Medicine and Philosophy in 2024.