Epistemic injustice, disposability, and disrespect in inquests and fitness to practise proceedings

In this post, Professor Sara Ryan discusses the epistemic problems of public engagement in legal processes intended to facilitate listening. 

Inquest and fitness to practise processes are both fundamentally designed for the public good; the former involving a coroner-led investigation into unexpected deaths and the latter, an examination into the skills, knowledge, character and health of individual health or social care professionals by their relevant regulatory body such as the General Medical Council or the Nursing Midwifery Council. My research with members of the public involved in these processes found that each at times generated avoidable secondary trauma. This finding undermines their aims to safeguard life, ensure accountability, and uphold standards and confidence.

Public members play a central role in these processes, typically motivated by preventing others from having similar experiences. Families come to these unfamiliar spaces as novices with the expectation that their stories and their personhood matter. Instead, disrespect is repeated and amplified. Entangled within both processes is ignorance and epistemic injustice as the knowledge of families is discounted by the coroner and regulatory bodies. For example, coroners may not understand the context of a young autistic person and prioritise the views of an expert witness who works within a medical deficit model, focusing on what was ‘wrong’ with the person rather than their actual life. A fracture is generated between public expectations that they will be listened to and the aims of coroners and regulatory bodies which hold the power to make key decisions about what is and is not included in hearings and how participants are treated. 

The core focus for regulatory bodies is the construction of a robust case against the registrant and ensuring relevant people in the moment are in place to perform their role as witnesses. We found families are subjected to disposability and dismissal; of their evidence in statement form and spoken word, and are consequently treated with a lack of humanity and care. The coroner seeks to answer a small set of questions in relation to the person who died, and while family wellbeing is a central consideration, this does not always translate in practice. Inquests can become overly detached and expert-dominated – a form of technocratic accountability – which means the person who died can be dehumanised and their family excluded from being fully involved in the process of finding out what happened and why.

Accountability and change are key drivers for bereaved families, yet discrediting the person who died, or family members, seems to be an accepted strand of current practices suggesting epistemic injustice can be the default mode of  these processes. Experiences could leave participants so dissatisfied or distressed they questioned the purpose of getting involved. One participant, for example, described her experience as a witness in a fitness to practise hearing more distressing than the death of her child, while another described feeling ‘rock bottom’. 

Both contexts are, in effect, contested epistemic arenas. Overt, subtle and mundane mechanisms, including inequalities around legal funding and epistemic authority, silence families, underlining their overall lack of institutional power. A lack of information, support and expectation management can generate pre-hearing feelings of frustration and foreboding. We found evidence of what Sarah Ahmed calls ‘words that get under the skin as the use of language, or wrong spelling of a name, caused distress. Forms of communication were problematic as the name of the deceased person was spelled wrong and regulatory staff were described as ‘computer people’ offering no dialogue or acknowledgement of the harm participants had experienced. 

We found little evidence of kindness and empathy. Instead, families are expected to endure patterns of micro-violences including the insensitive and adversarial actions of legal representatives and court formalities. The epistemic landscape in both contexts can be further dominated by independent experts’ epistemic privilege in relation to their professional position, regardless of what they know or understand. For example, a lack of understanding of autism, mental health issues or even the Mental Capacity Act was raised by some participants.

We conclude that coronial inquests and fitness to practise hearings, as currently constituted, are inherently unjust. Far from delivering truth or accountability for the public good, they become sites of further dehumanisation, compounding original harm through epistemic injustice, dismissal, disposability and micro-violences. These processes will continue to generate avoidable secondary trauma until systemic reform centres respect, kindness, empathy, and genuine care instead of procedural ends.

Ahmed, S., 2021. Complaint!, Duke University Press.

Ryan S, Ribenfors F, Mikulak M, Coles D. Between epistemic injustice and therapeutic jurisprudence: Coronial processes involving families of autistic people, people with learning disabilities and/or mental ill health. Sociol Health Illn. 2025 Feb;47(2):e13855. https://doi.org/10.1111/1467-9566.13855. 

Sara Ryan is a Professor of Social Care, Manchester Metropolitan University, and her research focuses on the lives and deaths of people with learning disabilities and autistic people.