Michaels, J. orcid.org/0000-0002-3422-7102 (2021) Potential for epistemic injustice in evidence-based healthcare policy and guidance. Journal of Medical Ethics, 47 (6). pp. 417-422. ISSN 0306-6800
Abstract
The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance-based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper I argue that, whilst the scientifically rigorous approaches of evidence-based healthcare are claimed as aspects of procedural justice that legitimize such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2020. Published by BMJ. This is an author-produced version of a paper subsequently published in Journal of Medical Ethics. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Rationing of healthcare; distributive justice; epistemic injustice; evidence-based guidelines; health outcomes; epistemic exclusion; equity |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 21 May 2020 15:01 |
Last Modified: | 18 Nov 2021 11:54 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Refereed: | Yes |
Identification Number: | 10.1136/medethics-2020-106171 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:161081 |