Health Care Injustice Research Articles

Exploring the Experience of Healthcare-Related Epistemic Injustice among People with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) is a chronic, disabling yet clinically “contested” condition, previously theorised through a lens of epistemic injustice. Phenomena conceptually close to epistemic injustice, including stigma, are known to have deleterious consequences on a person’s health and life-world. Yet, no known primary studies have explored how people with ME/CFS experience healthcare through a lens of epistemic injustice, whilst a dearth of research explicitly exploring healthcare-related injustice from a patient perspective has been noted. This qualitative study seeks to address this gap. Semi-structured interviews and interpretative phenomenological analysis (IPA) were used to explore the experiences of five people with ME/CFS in the UK, vis-à-vis healthcare-related epistemic injustice. One superordinate theme is presented, “Being de-centred in patient-centred care,” alongside two sub-themes: “Struggling for epistemic-existential validation” and “Negotiating socio-epistemic hierarchies, politics and ‘power’.” Findings suggest that healthcare-related epistemic injustice may differentially impact according to the patient’s social positionality (here, notably gender), and that a potential pathway of existential harm operates through threats to identity and personhood. Findings also indicate that cultural and political factors may further epistemic injustice in healthcare. Finally, epistemic injustice impacting as a chronic stressor cannot be ruled out and is worthy of further research. The experience of healthcare-related epistemic injustice can carry far-reaching yet varied consequences for patients. Future research should consider drawing upon more socio-demographically diverse samples and an intersectional approach is recommended. Further exploration of structural drivers of epistemic injustice may highlight a need for politically and socio-culturally cognisant clinical approaches.

The Supreme Court’s decision in McCulloch v Forth Valley Health Board: Does it condone healthcare injustice?

The UK Supreme Court’s recent judgement in McCulloch v Forth Valley Health Board clarifies the standard for the identification of ‘reasonable’ alternative medical treatments. The required standard is that of...

Algorithmic bias in artificial intelligence is a problem—And the root issue is power

BackgroundArtificial intelligence (AI) in health care continues to expand at a rapid rate, impacting both nurses and communities we accompany in care. PurposeWe argue algorithmic bias is but a symptom of a more systemic and longstanding problem: power imbalances related to the creation, development, and use of health care technologies. MethodsThis commentary responds to Drs. O’Connor and Booth’s 2022 article, “Algorithmic bias in health care: Opportunities for nurses to improve equality in the age of artificial intelligence.” DiscussionNurses need not ‘reinvent the wheel’ when it comes to AI policy, curricula, or ethics. We can and should follow the lead of communities already working ‘from the margins’ who provide ample guidance. ConclusionIts neither feasible nor just to expect individual nurses to counter systemic injustice in health care through individual actions, more technocentric curricula, or industry partnerships. We need disciplinary supports for collective action to renegotiate power for AI tech.

Epistemic Injustice and Nonmaleficence

Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for describing and assessing morally problematic situations in healthcare. However, surprisingly scarce attention has been devoted to how epistemic injustice relates to physicians’ professional duties on a conceptual level. I argue that epistemic injustice, specifically testimonial, collides with physicians’ duty of nonmaleficence and should thus be actively fought against in healthcare encounters on the ground of professional conduct. I do so by fleshing out how Fricker’s conception of testimonial injustice conflicts with the duty of nonmaleficence as defined in Beauchamp and Childress on theoretical grounds. From there, I argue that testimonial injustice produces two distinct types of harm, epistemic and non-epistemic. Epistemic harms are harms inflicted by the physician to the patient qua knower, whereas non-epistemic harms are inflicted to the patient qua patient. This latter case holds serious clinical implications and represent a failure of the process of due care on the part of the physician. I illustrate this through examples taken from the literature on fibromyalgia syndrome and show how testimonial injustice causes wrongful harm to patients, making it maleficent practice. Finally, I conclude on why nonmaleficence as a principle will not be normatively enough to fully address the problem of epistemic injustice in healthcare but nevertheless may serve as a good starting point in attempting to do so.

Patient Population Diversity: Culturally Competent Care and the Importance of Adjusting Practice to Promote Inclusivity

Features| February 2023 Patient Population Diversity: Culturally Competent Care and the Importance of Adjusting Practice to Promote Inclusivity Dennis M. O'Brien, DNP, MS, CRNA; Dennis M. O'Brien, DNP, MS, CRNA Search for other works by this author on: This Site PubMed Google Scholar Omonele O. Nwokolo, MD, FASA Omonele O. Nwokolo, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor February 2023, Vol. 87, 18–19. https://doi.org/10.1097/01.ASM.0000919532.32287.7e Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Dennis M. O'Brien, Omonele O. Nwokolo; Patient Population Diversity: Culturally Competent Care and the Importance of Adjusting Practice to Promote Inclusivity. ASA Monitor 2023; 87:18–19 doi: https://doi.org/10.1097/01.ASM.0000919532.32287.7e Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: culturally competent care Positive patient outcomes are dependent on the provision of culturally competent care. Providers must consider the diverse beliefs, attitudes, values, and behaviors governing personal health care choices. This article offers an inquiry into challenges to consider with our modern population, conscientious practice adjustments needed to accommodate inclusivity, and the benefits of equitable delivery of care. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Dr. Martin Luther King Jr., at the 2nd National Convention of the Medical Committee for Human Rights, March 25, 1966 The subtleties of language are timeless; however, as the narrative on health care delivery continues to morph, organizations and individual providers find themselves wanting to be more accountable. Systemically, conversations include ongoing assessment and commitment to change when addressing social disparities and the health care needs of marginalized communities. This dialog has provided an opportunity for delivering effective, quality... You do not currently have access to this content.

Automated opioid risk scores: a case for machine learning-induced epistemic injustice in healthcare

Artificial intelligence-based (AI) technologies such as machine learning (ML) systems are playing an increasingly relevant role in medicine and healthcare, bringing about novel ethical and epistemological issues that need to be timely addressed. Even though ethical questions connected to epistemic concerns have been at the center of the debate, it is going unnoticed how epistemic forms of injustice can be ML-induced, specifically in healthcare. I analyze the shortcomings of an ML system currently deployed in the USA to predict patients’ likelihood of opioid addiction and misuse (PDMP algorithmic platforms). Drawing on this analysis, I aim to show that the wrong inflicted on epistemic agents involved in and affected by these systems’ decision-making processes can be captured through the lenses of Miranda Fricker’s account of hermeneutical injustice. I further argue that ML-induced hermeneutical injustice is particularly harmful due to what I define as an automated hermeneutical appropriation from the side of the ML system. The latter occurs if the ML system establishes meanings and shared hermeneutical resources without allowing for human oversight, impairing understanding and communication practices among stakeholders involved in medical decision-making. Furthermore and very much crucially, an automated hermeneutical appropriation can be recognized if physicians are strongly limited in their possibilities to safeguard patients from ML-induced hermeneutical injustice. Overall, my paper should expand the analysis of ethical issues raised by ML systems that are to be considered epistemic in nature, thus contributing to bridging the gap between these two dimensions in the ongoing debate.

A market for diagnostic devices for extreme point-of-care testing: Are we ASSURED of an ethical outcome?

The World Health Organisation (WHO) is leading a global effort to deliver improved diagnostic testing to people living in low-resource settings. A reliance on the healthcare technologies marketplace and industry, shapes many aspects of the WHO project, and in this situation normative guidance comes by way of the ASSURED criteria - Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free, and Delivered. While generally improving access to diagnostics, I argue that the ASSURED approach to distributive justice - efficiency - and assessment of worth - productivity - may constrain efforts to deliver timely and accurate diagnosis in the developing world equitably by holding back new and innovative diagnostics and indirectly encouraging program and device design that may unfairly discriminate against certain groups. Even as we try to overcome the problem of global healthcare injustice, we may be entrenching disadvantage. I present my critique of ASSURED by 1) referencing Boltanski and Thévenot's theory of orders of worth to highlight the industrial and market foundations of the ASSURED guidelines; 2) comparing ASSURED with other normative guides that elevate the importance of civic responsibility in evaluations of distributive justice; 3) presenting a case study of the failed promise of microfluidic diagnostic devices. I conclude that a new approach to normative guidance is required to assess the value of developing world diagnostics, preferably, one that does not force global public goods into the marketplace.

Doing epistemic justice in sustainable development: Applying the philosophical concept of epistemic injustice to the real world

AbstractOriginally conceptualized by the philosopher, Miranda Fricker, epistemic injustice—unfair treatment of individuals and groups in knowledge‐related and communicative practices—is increasingly being employed to delineate individual and collective injustice in healthcare, information sciences, education and sustainable development. Embedded in many other forms of social injustice and inequality, epistemic injustice is a particularly serious problem for sustainable development, undermining the global community's ability to deal with ‘wicked’ problems. Building on the more conceptually developed, philosophical framework of epistemic injustice and recent research from other fields, this article develops a holistic action‐oriented framework of epistemic justice, namely fair treatment in knowledge‐related and communicative practices, for sustainable development and beyond. It also adds to the current framework of individual and collective injustice by including a range of new insights on structural and systemic epistemic injustice, such as linguistic injustice and epistemicide.

Orthopaedic Diagnoses in the Black Pediatric Population.

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.

Medical students’ knowledge of race-related history reveals areas for improvement in achieving health equity

BackgroundMedical schools have increasingly integrated social justice, anti-racism, and health equity training into their curricula. Yet, no research examines whether medical students understand the complex history of racial injustice. We sought to investigate the relationship between medical students’ historical knowledge and their perceptions regarding health equity.MethodsMedical students at one large urban medical school self-rated their familiarity and importance of various racially-significant historical events and persons, as well as their agreement with statements regarding health equity, education, and preparedness to act. Descriptive and multivariate analyses were conducted in R.ResultsOf 166 (RR=31.3%) participants, 96% agreed that understanding historical context is necessary in medicine; yet 65% of students could not describe the historical significance of racial events or persons. Only 57% felt that they understood this context, and the same percentage felt other medical students did not. A minority of students felt empowered (40%) or prepared (31%) to take action when they witness racial injustice in healthcare. Multiracial identity was significantly associated with increased knowledge of African American history (p<0.01), and a humanities background was significantly associated with increased knowledge of Latin American history (p=0.017). There was a positive, significant relationship between advocacy statements, such as “I have taken action” (p<0.001) and “I know the roots of racism” (p<0.001) with mean familiarity of historical events.ConclusionsThis study demonstrates that while students agree that racism has no place in healthcare, there remains a paucity of knowledge regarding many events and figures in the history of American race relations and civil rights, with implications for future physicians’ patient care and health equity efforts.

Address by the Chair of the ADEA Board of Directors

Address by the Chair of the ADEA Board of Directors

Former Obama Advisor Prods Psychiatrists to Fight Health Care Injustice

Former Obama Advisor Prods Psychiatrists to Fight Health Care Injustice

Scope and Utility of Ayurveda in Rural and Primary Health Care

The population of India is 1.38 billion, of which 65.07% live in rural areas. Health care injustice is a universal phenomenon in rural India and the condition of rural and primary health care in India remains unsatisfactory even after 75 years of independence. Modern health facilities are very poor in rural areas and about 65% of the population lives in rural areas, using Ayurveda and medicinal plants as their primary health care needs. The holisticapproach of Ayurveda can provide most of the health services in rural India from its own resources such as preventive and promotive health care. Non-pharmacological remedies of Ayurveda like Sadvrittaand Swasthyavritta, Achara Rasayana and Yogaand the use of kitchen spices and common medicinal plants available in rural areas are better alternatives to primary health care in rural areas.

Diverse community leaders\u2019 perspectives about quality primary healthcare and healthcare measurement: qualitative community-based participatory research

BackgroundHealthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location. Redressing healthcare inequities, including measurement of and reimbursement for healthcare quality, requires partnering with communities historically excluded from decision-making. Quality healthcare is measured according to insurers, professional organizations and government agencies, with little input from diverse communities. This community-based participatory research study aimed to amplify the voices of community leaders from seven diverse urban communities in Minneapolis-Saint Paul Minnesota, view quality healthcare and financial reimbursement based on quality metric scores.MethodsA Community Engagement Team consisting of one community member from each of seven urban communities —Black/African American, Lesbian-Gay-Bisexual-Transgender-Queer-Two Spirit, Hmong, Latino/a/x, Native American, Somali, and White—and two community-based researchers conducted listening sessions with 20 community leaders about quality primary healthcare. Transcripts were inductively analyzed and major themes were identified.ResultsListening sessions produced three major themes, with recommended actions for primary care clinics.#1: Quality Clinics Utilize Structures and Processes that Support Healthcare Equity.#2: Quality Clinics Offer Effective Relationships, Education, and Health Promotion.#3: Funding Based on Current Quality Measures Perpetuates Health Inequities.ConclusionCommunity leaders identified ideal characteristics of quality primary healthcare, most of which are not currently measured. They expressed concern that linking clinic payment with quality metrics without considering social and structural determinants of health perpetuates social injustice in healthcare.

ORAL ABSTRACTS: O3 BALANCING DESIRE TO ENHANCE EQUITABLE ACCESS TO CONTRACEPTIVE CARE WITH THE RISK OF PERPETUATING REPRODUCTIVE HEALTHCARE INJUSTICE: A NATIONAL COMPARATIVE CASE STUDY OF INPATIENT POSTPARTUM CONTRACEPTIVE CARE IMPLEMENTATION

ORAL ABSTRACTS: O3 BALANCING DESIRE TO ENHANCE EQUITABLE ACCESS TO CONTRACEPTIVE CARE WITH THE RISK OF PERPETUATING REPRODUCTIVE HEALTHCARE INJUSTICE: A NATIONAL COMPARATIVE CASE STUDY OF INPATIENT POSTPARTUM CONTRACEPTIVE CARE IMPLEMENTATION

Role-play simulation to teach nursing students how to provide culturally sensitive care to transgender patients

ObjectiveIncrease student knowledge and comfort with caring for a transgender individual and confronting colleagues when exhibiting poor cultural intelligence. BackgroundTransgender patients often experience health care inequities, including heteronormative microaggressions in communication and policies. Simulation has been a successful means of providing students with the education, tools, and experience necessary to combat systemic injustice in health care. Simulation is an interactive pedagogy that allows nursing students to practice assessment, patient care, and difficult conversations in a controlled, risk-free environment. Design/ MethodsPrelicensure nursing students role-played a simulation created as an interactive learning strategy to promote culturally sensitive assessment of a transgender patient and their caregiver, including assessing for pronouns and providing patient-centered care. The simulation included preforming a difficult conversation between nurses to cultivate an environment of being an upstander. The simulation demonstrated holistic methods of assessing and supporting unique patient needs for the patient who is transgender. ResultsNursing students reported they felt that their comfort with advocacy and ability to communicate with transgender patients, as well as with their families, and health care team members was enhanced after completing the simulation. ConclusionSimulation has the ability to reduce discomfort and discrimination in health care for transgender patients by equipping students with culturally sensitive and inclusive communication tools and providing them with risk-free environment where they can learn to provide care for this vulnerable population in preparation for successful future encounters.

The Journey Toward Health Equity: Are We Nearing an Abyss or Ascending a Peak?

The Journey Toward Health Equity: Are We Nearing an Abyss or Ascending a Peak?

Structural Justice Ethics in Health Care

Structural Justice Ethics in Health Care

Clashing Consciousness

In this paper, I consider practical strategies for resolving the epistemic injustice that ill persons face when seeking medical treatment. My arguments will expand upon those initially made by Havi Carel and Ian James Kidd in “Epistemic Injustice in Healthcare: A Philosophical Analysis.” My approach to this problem is twofold. First, I will demonstrate how the phenomenological toolkit, as it currently stands, emphasizes the patient’s experience and leaves the doctor’s experience unadjusted. After this, I will explain how the toolkit can be improved to include the doctor’s perspective.

Clashing Consciousness

In this paper, I consider practical strategies for resolving the epistemic injustice that ill persons face when seeking medical treatment. My arguments will expand upon those initially made by Havi Carel and Ian James Kidd in “Epistemic Injustice in Healthcare: A Philosophical Analysis.” My approach to this problem is twofold. First, I will demonstrate how the phenomenological toolkit, as it currently stands, emphasizes the patient’s experience and leaves the doctor’s experience unadjusted. After this, I will explain how the toolkit can be improved to include the doctor’s perspective.