Putting "Epistemic Injustice" to Work in Bioethics: Beyond Nonmaleficence.

IF 1.8 3区 哲学 Q2 ETHICS Journal of Bioethical Inquiry Pub Date : 2024-06-01 Epub Date: 2023-11-13 DOI:10.1007/s11673-023-10314-y
S Wallaert, S Segers
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Abstract

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.

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将“认识上的不公正”应用于生命伦理学:超越非恶意。
我们扩展了Della Croce的野心,将“认识上的不公正”解释为使用有影响力的四原则框架中的非恶意行为的具体说明。从概念、道德和启发式的角度来看,这是一条诱人的思路。虽然这是值得称赞的,但德拉·克罗齐的尝试仍然是试探性的。我们对它的批判也是如此。然而,我们接受挑战,批判性地解决两个相互关联的问题。首先,我们扩大分析,包括对解释学不公正的讨论。我们认为,如果对认知不公正的适当考虑需要的不仅仅是医学中的消极伦理义务,那么应该探索解释学不公正的维度,作为达到这种积极义务的途径。其次,相关地,我们认为这可能包括超越个人层面的道德责任,即:在结构层面采取行动的积极义务。在多森的“促成性不公正”概念和图式的“感知自主性”概念的基础上,我们认为证言和解释性正义的优点不仅可以为消极的行为禁止(即非恶意行为)提供额外的内容,还可以为积极的行为要求(如尊重患者的自主性)提供额外的内容。
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来源期刊
Journal of Bioethical Inquiry
Journal of Bioethical Inquiry 医学-医学:伦理
CiteScore
5.20
自引率
8.30%
发文量
67
审稿时长
>12 weeks
期刊介绍: The JBI welcomes both reports of empirical research and articles that increase theoretical understanding of medicine and health care, the health professions and the biological sciences. The JBI is also open to critical reflections on medicine and conventional bioethics, the nature of health, illness and disability, the sources of ethics, the nature of ethical communities, and possible implications of new developments in science and technology for social and cultural life and human identity. We welcome contributions from perspectives that are less commonly published in existing journals in the field and reports of empirical research studies using both qualitative and quantitative methodologies. The JBI accepts contributions from authors working in or across disciplines including – but not limited to – the following: -philosophy- bioethics- economics- social theory- law- public health and epidemiology- anthropology- psychology- feminism- gay and lesbian studies- linguistics and discourse analysis- cultural studies- disability studies- history- literature and literary studies- environmental sciences- theology and religious studies
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