EPIC Seminar Series

The Project EPIC team are pleased to announce our seminar series which takes place on the last Monday of each month at 14:00 (UK time). The talks are streamed online and are open to anybody who would like to engage with the project.

Our first talk back in March was by Professor Miranda Fricker, whose 2007 book Epistemic Injustice: Ethics and the Power of Knowing catalysed the field we now know as Epistemic Injustice.

 

Miranda Fricker

Fricker spoke to us about epistemic injustice through the lens of the memoir of mental ill-health written by the British actor David Harewood, Maybe I Don’t Belong Here: A Memoir of Race, Identity, Breakdown and Recovery (2021). His personal story explores how experiences of racism, growing up in Britain in the seventies and as a young man in the eighties, sowed the seeds of personal fracture and psychological disconnect that later expressed themselves in psychosis.

Fricker argued that many psychiatrists and therapists see their own work as including the amelioration of precisely these forms of epistemic injustice: aiming to create a therapeutic relationship in which credibility is not withheld, and shared intelligibility of experience is cultivated, with the result that the service-user may come to express themselves without needing to truncate or restyle what they want to say. 

You can watch the recording of Miranda's talk here.

Our April talk was by Professor Lauren Freeman, who spoke to us about microaggressions and epistemic harm in medicine. This talk, which you can watch here, drew on her recently published book which has been co-authored with Heather Stewart. Lauren and Heather recently wrote a project blog for us about the aims of their book which you can read here.

 

Lauren Freeman

In May, we were joined by Dr Maru Mormina. Maru spoke to us about epistemic injustice and epistemic responsibility in evidence-informed policymaking and used expert decision-making through the Covid-19 crisis as a case study to show that scientific expertise was selectively mobilised, leading to systemic ignorance which had significant consequences for the development of policy. 

Watch Maru's talk here. 

Maru Mormina

Our final talk for the semester was given by Dr Naomi Kloosterboer on the topic of how to take people with extreme beliefs seriously. Naomi advocated for a kind of epistemic openness which allows us to acknowledge and confront how our own position distorts our understanding of others in various ways. This epistemic openness, she argued, can be useful when thinking about how clinicians should approach apparent extreme beliefs in mental health service users. 

Watch Naomi's talk here. 

Naomi Kloosterboer

Our seminar series will resume online in September, and the details of all of the upcoming talks will be published on our project website under 'events' > 'seminar series'. We are thrilled to first be welcoming Professor Richard Pettigrew, who is based in Bristol. 

Towards epistemic justice in the biomedical paradigm

Epistemic injustice occurs when credibility is inappropriately attributed due to prejudices. It could be described as a failure concept (by analogy with “success” verbs such as knowing, finishing, and achieving). 

There are numerous ways to fail at the same task (for example, multiple ways to be late for work on a rainy morning), as well as numerous ways to succeed. Thus, there are several ways in which medicine and healthcare fail to take the views of individuals in care seriously. Many philosophical and, increasingly, medical works demonstrate cases of epistemic injustice.

I am interested in the ways to succeed in giving appropriate credibility - on how epistemic justice might be realised in specific contexts of medical research or care. This is connected in part to my work on the concept of trust in healthcare institutions (with reference to vaccination hesitancy prior to the pandemic). I believe that epistemic justice can significantly improve this trust relationship (this is currently just an idea that I hope to develop soon). 

Partly, I am interested in focusing on ways to achieve epistemic justice rather than failures because, for several years, I have collaborated with doctors and people working in the healthcare system or in research, and from the inside, I see more and more willingness to accept different types of evidence on illness and people's health. Perhaps it's also because I'm an optimist.

Moving on to less abstract topics. In the EPIC project, I will be working with psychologist Rabih Chattat at the University of Bologna, analysing situations of epistemic injustice in dementia patients using a qualitative research methodology. We want to examine whether and how (in specific ways) healthcare providers fail to give credibility to people with dementia, and then suggest feasible solutions, or epistemic justice strategies.

At the same time, I am lucky to be working on another two interdisciplinary medical research projects. One is the DARE-Digital lifelong prevention project, which aims to provide support and a regulatory framework for e-health prevention technologies being developed in Italy, such as AI-based models for clinicians to understand a person's risk of a specific disease, as well as apps for patients to monitor their personal risk, for example the risk of falls for an elderly person with fragile bones. 

We know that these technologies pose a considerable risk of epistemic injustice. However, I feel it is worthwhile exploring how apps or AI-based systems might serve as strategies for achieving epistemic justice. How? In short, my fall-risk app can assist me in explaining to the doctor and family members why I feel unsafe while walking; the data it displays will can help validate my experience in addition to translating it into "medical speak." It is undoubtedly not the subjective experience that is directly taken at face value, but this translation. However, it could be a step forward towards epistemic justice. This will be discussed in a draft paper I am now working on. 

Last but not least, I am working on an EU Horizon Cancer Mission project called PREMIO COLLAB, which stands for personalised response monitoring in oncology: co-creating clinical trials in advanced breast cancer. This is a multicenter trial to determine which imaging modality is best for monitoring advanced breast cancer. What is the relevance of epistemic injustice in this context? While there has been much discussion about involving patients in treatment decisions, patients are almost never included in diagnostic decisions such as how many tests to perform, how frequently, and which ones. 

Diagnostics is in the hands of doctors. We will carry out qualitative study on patient preferences related to this in PREMIO COLLAB. We plan to convert our results into helpful recommendations for medical professionals regarding how to engage in a discussion regarding diagnostic options. These, in my opinion, can also be strategies for succeeding or achieving epistemic fairness from within the biomedical paradigm. 

Elisabetta Lalumera

Elisabetta Lalumera works at the Department for Life Quality Studies, University of Bologna, Italy. 

She is a project partner for EPIC, working on the Discounting Dementia case study.

Reservations about Epistemic Injustice

The concept of epistemic injustice undoubtedly applies in mental healthcare contexts, because people get ignored in these contexts as sources of knowledge when they shouldn’t be. As a result, the concept is frequently invoked, especially perhaps in the overlap between academia and service-user advocacy. Still, I want to express two reservations about it.

Identity prejudice

The first is about the connection between epistemic – specifically, testimonial - injustice and ‘identity prejudice’, which occurs when someone’s testimony is discounted because of a prejudice against a group they belong to. Fricker made this connection in her book, which of course launched the concept: epistemic injustice occurs when a ‘negative identity-prejudicial stereotype’ (p. 35) undermines credibility.

But does it only occur then? Suppose my teacher dismisses my contributions to class, whether they are knowledgeable or not, while other students’ similar contributions get a fair hearing. That sounds like injustice, and presumably if it’s injustice of any sort, it’s epistemic. But surely the teacher may just dislike me personally, not because of any group I belong to. Fricker acknowledged this objection in a follow-up piece, while maintaining that negative stereotyping is the core case. But is it? Who knows if negative stereotype-based epistemic injustices are more common than ‘merely personal’ ones? There are, after all, a lot of people. 

Personal and identity prejudice

Negative stereotype-based epistemic injustice is morally especially troubling. But is it thereby the core of the phenomenon? Consider the notion of a racially aggravated offence. Here, group-based hostility compounds an independently specifiable offence such as assault. Applying the analogy, the ‘merely personal’ case looks epistemically just like the negative stereotype-based case, i.e. I am undeservedly discounted as a source of knowledge because the teacher’s evaluation of my epistemic standing tracks a feature (her dislike of me) that is epistemically irrelevant. 

So the negative stereotype-based case comes out as racially (or whatever) aggravated form of a core epistemic phenomenon that’s independent of stereotyping. It’s probably a verbal choice whether we relax the link between epistemic injustice and prejudice or (my preference) relax the link between prejudice and group membership. The point is that the same injustice occurs whether negative stereotyping is present or not.

Borrowing authority

My second reservation is based only on a personal impression, that some campaigning literature is seeking to borrow authority from philosophy – whatever authority it really has to offer - by affixing the word ‘epistemic’ to the word ‘injustice’. But even where mental health professionals fail to listen to service users when they should, it’s not always a case of epistemic (testimonial) injustice: that concept only applies when utterance aims to secure belief, and service users say things to mental health professionals for expressive reasons, or because they need the experience of being listened to. 

Moreover mental healthcare is arguably a context for multiple injustices unrelated either to knowledge or to listening (or failing to listen) - e.g. involuntary detention in hospital. My worry is that the uncritical overuse of an (in its place) useful concept may distract us from thinking carefully about potential non-epistemic injustices.

Edward Harcourt

Edward Harcourt is Professor of Philosophy at the University of Oxford. 

His research interests include child development, ethical dimensions of psychoanalysis and psychotherapy, and the philosophy of mental health and mental illness. 

Some of the ideas in this post are discussed in his article in the Journal of Medical Ethics.

Credibility attributions in healthcare

In this post, Kathleen Murphy-Hollies interviews Carme Isern Mas on a new exciting project, on the cognitive bases of epistemic injustice in healthcare. 

Kathleen: Can you tell us a little bit about your project?

Carme: This is a project funded by a Grífols Research Grant in Bioethics from the Fundació Víctor Grífols i Lucas. The main aim of this project is to explore whether people with somatic and psychiatric conditions are given less credibility than their healthy counterparts due to identity prejudice, and if so, to investigate under which conditions this is the case. To achieve this, we plan to use experimental methodology, particularly through vignette-based studies. 

In particular, we ask whether epistemic injustice in people with clinical diagnoses is influenced by the effect of the label of the diagnosis, the epistemic privileging of scientific and medical evidence, and the effect of the clinical context. We hope that this will allow us to complement the existing empirical evidence gathered through interviews, conversation analysis and questionnaires, among other methods.

Kathleen: Is your project interdisciplinary? How do you think that is helpful/valuable?

Carme: Yes, our project is interdisciplinary, and we believe this approach adds significant value to our research and to the broad discussion around epistemic injustice in healthcare. In particular, we aim to contribute to this philosophical and ethical discussion by exploring one of its main empirical claims, namely, that the testimony of people with somatic and psychiatric conditions is given less credibility than that of healthy people because of an identity prejudice. 

Therefore, our project aligns with the research programs of experimental philosophy (x-phi) and, more specifically, experimental bioethics (bio-x-phi), both deeply interdisciplinary. To that end, our team is composed of qualified researchers, including Alfred Archer, Ivar R. Hannikainen, and myself, with expertise in applied ethics, moral psychology, bioethics and experimental methodology.

Kathleen: What do you hope the project will accomplish/change?

Carme: There is a need for empirical research that studies the scope of epistemic injustice towards people with medical conditions and the factors that contribute to it. This project aims to fill this gap by conducting several studies based on vignettes that manipulate an agent’s kind of medical condition, their specific diagnosis, or the context in which they share their testimony, among other things. 

By examining the impact of these manipulations on credibility attributions, we aim to shed light on the role of negative stereotypes in shaping such attributions. In addition, this project might help us understand how credibility attributions vary in different contexts, including medical and non-medical settings, and across different psychiatric conditions. The results of this research might have implications for healthcare professionals, policy makers, and other stakeholders interested in promoting more equitable and fair practices in healthcare. 

By highlighting the mechanisms underlying epistemic injustice toward people with medical conditions, this study can inform the development of interventions aimed at reducing bias and improving the quality of care for these individuals.

Kathleen: What are the future plans for the project?

Carme: In addition to conducting studies, we aim to disseminate our findings through academic publications, conferences and other relevant platforms. We might also explore potential collaborations with healthcare professionals and institutions to include their valuable feedback and insights in our research.

Carme Isern Mas is an assistant professor at the University of the Balearic Islands, specializing in moral psychology, and applied ethics. 

Her research interests lie in topics such as blame, empathy, moral motivation and self-deception. She is also interested in the bioethics of mental health and the ethics of fame. 

Is there a right to silence?

Silence is often perceived as politically harmful and something that has to be broken. But what if silence can also be politically beneficial in democracies and we have good reasons to protect our right to stay silent?

Specifically, is speech always better than staying silent in situations of compelled speech and possibly compelled lies due to social pressure? Is speech better than silence when the audience might misinterpret or deconstruct what we way?

In our article (open access in Philosophical Quarterly, 2024), Dan Degerman and I address the political importance of being able to hold to one’s silence and we argue that a democratic right to silence can be motivated by politically relevant epistemic reasons.

Generally, the right to stay silent is seen within the legal context as the right one has to protect oneself against self-incrimination. However, we can broaden this and argue in favour of the right to silence as the entitlement one has to stay silent, either by not speaking or by not speaking about something in particular.

The right to silence so formulated can have many benefits, but specifically we can focus on some epistemic benefits silence can bring. The first is that silence can prevent the risk of jeopardising the individual’s credibility and spreading falsehood while undermining the notion of truth. This is the case when someone might be compelled to lie in public. These situations can be present due to political, legal, and social pressure. Cases of this kind are show trials, but we can also imagine contexts related to free speech on the internet or in public spaces. A robust right to silence can allow individuals to adhere to it while avoiding the epistemic harms that can be generated by publicly admitting what is known to be false

The second benefit is the one of preventing the misconstruction of what someone might say when they are faced with an audience that pressures them to speak. This case can be seen in cases of compulsory representation when someone is asked to speak in quality of representing a given minority and whatever is said risks being misinterpreted. The epistemic damage in these cases is not limited to the epistemic agency of the speaker but also that of the group they are taken to represent. Again, in the context of internet and speed news, it is not difficult to imagine a case in which someone’s option might be misconstructed or re-interpreted for given purposes. As we argue, in both these cases silence is a better option.

How can we implement the right to silence? The answer is not simple and many steps have to be taken politically and legally. However, we believe that a first step can be seen in making people comfortable with their right to be silent in situations of pressure or in which their status as epistemic agents might be compromised. And our paper aims to guide them to do so.

Francesca Bellazzi is Teaching Fellow in Philosophy in the Department of Philosophy, Theology and Religion at the University of Birmingham and Honorary Visiting Fellow in Philosophy at the University of Bristol.

Francesca works in the metaphysics and philosophy of science and in applied philosophy and ethics.