Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Eleanor Alexandra Byrne

doi:10.1007/s11019-020-09945-4

Abstract

Miranda Fricker’s influential concept of epistemic injustice (Oxford University Press, Oxford, 2007) has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.

Highlights

This paper investigates tensions that can arise when the concept of epistemic injustice is applied to healthcare, where a delicate balance must be struck between attributing appropriate degrees of respect and epistemic authority to both patients and medical professionals
I have highlighted two problems with how the concept of testimonial injustice might be applied to healthcare, using the example of CFS/Myalgic Encephalopathy/Encephalomyelitis’ (ME)
A useful concept which has already aptly shown how CFS/ME patients are vulnerable to suffering from epistemic harm, I have resisted claims that identify testimonial injustices where the epistemic problem can be just as plausibly explained by the medical professional exercising appropriate medical sensitivity within the context of a vast conceptual impoverishment

Summary

Introduction

This paper investigates tensions that can arise when the concept of epistemic injustice is applied to healthcare, where a delicate balance must be struck between attributing appropriate degrees of respect and epistemic authority to both patients and medical professionals. Blease et al (2016) argue that hermeneutic injustice affects CFS/ME patients because the conceptual impoverishment about CFS/ME is responsible for the lack of framework within which patients and medical professionals can make sense of the condition.

Results

Conclusion