Putting Epistemic Injustice to Work in Bioethics: Beyond Nonmaleficence

We expand on Della Croce's ambition to interpret epistemic injustice as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce's attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson's concept of contributory injustice and Scheman's concept of perceptual autonomy, we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy.

Automated summary

This article expands on Della Croce's ambition to interpret epistemic injustice as a specification of non-maleficence within the influential four-principle framework. While commendable, both Della Croce's attempt and our critique of it remain tentative. However, the article takes on the challenge to critically address two main points: broadening the analysis to include deliberations about hermeneutical injustice and exploring the potential moral responsibilities beyond the individual level.