Uncertainty-Driven Healthcare Epistemic Injustice: Evidence from Chronic Fatigue Syndrome
Hugh Robertson-Ritchie
Abstract
In this thesis, I critique inappropriate and unhelpful responses to radical epistemic uncertainties in medicine, which, I argue, significantly contribute to epistemic injustice in some healthcare encounters. This uncertainty-driven explanation for healthcare epistemic injustice is additional to explanations already identified by other commentators in the literature; that is to say, the imbalance of power between patients and healthcare professionals, the effects of the differences in their phenomenological and professional perspectives, and prejudice.
In order to illustrate this critique and this argument, I use the example of the disputed, stigmatising, and inadequately-understood medical condition(s), chronic fatigue syndrome (CFS) and myalgic encephalomyopathy (ME) (which are often conflated as CFS/ME or ME/CFS), and similar medical conditions, about which there is uncertainty about causes and pathological mechanisms, where there are no curative treatments, and where there are disputes about the effectiveness or otherwise of symptomatic treatment recommendations. Many CFS patients and some of their healthcare professionals have dichotomous and oppositional responses to those uncertainties. These patients declare that their illness is biomedical (BMM), because of their phenomenological experience; therefore, psychological and behavioural treatments are inappropriate and harmful. Contrastingly, some health professionals see that the absence of objective evidence of disease in CFS patients implies that there is no disease process, and that treatments should be biopsychosocial (BPS). I argue that these conflicting responses, along with the rejection of opposing responses, lead to disputes and healthcare epistemic injustice within CFS healthcare encounters regarding conceptualisations of CFS and treatments recommendations for the symptoms.
In this thesis, I show that CFS is indeed subject to radical epistemic uncertainties, which explain those differing responses. I argue that each response is not unreasonable, bearing in mind those uncertainties; however, I also argue that the rejection of the opposing response is not epistemically virtuous.
The methodology that I use in this thesis is the logical analysis of the evidence for explanations for healthcare epistemic uncertainty, with the examination of evidence to support my argument that healthcare epistemic injustice can be significantly exacerbated by responses to epistemic uncertainty.
For amelioration, I propose two alternative conceptualisations for CFS, the network of symptoms model and the persistent physical symptoms model, each of which is additional rather than oppositional to both BMM and BPS.
In order to support my arguments, I introduce, promote, or find novel applications for, a number of concepts that are insufficiently highlighted elsewhere in the literature: firstly, the applicability of the economists’ concept of radical uncertainty to medical knowledge; secondly, the existence of radical uncertainty regarding knowledge about some medical conditions; thirdly, a network of uncertainties hampering some medical research; fourthly, the distinction between uncertainty regarding a medical condition and uncertainty regarding the medical problems of a particular individual in a healthcare encounter; fifthly radical uncertainty as an explanation for some healthcare epistemic injustice; sixthly, the applicability of the concepts of epistemic virtue to responses to medical uncertainty; seventhly, the under-acknowledged persistence of inappropriate medical disease dualism; eighthly, the applicability of the network of symptoms model to non-psychiatric illness; and, ninthly, the applicability of the persistent physical symptoms model of illness to under- explained medical conditions. These concepts have wider applicability to medical epistemology, disease ontology, healthcare ethics, and healthcare epistemic justice, thus demonstrating how the philosophical study of one medical condition (and similar conditions) can contribute to the philosophy of medicine, and some ways in which philosophy of medicine can benefit the practice of medicine.
PDF | University of Kent | Thesis
Hugh Robertson-Ritchie
Abstract
In this thesis, I critique inappropriate and unhelpful responses to radical epistemic uncertainties in medicine, which, I argue, significantly contribute to epistemic injustice in some healthcare encounters. This uncertainty-driven explanation for healthcare epistemic injustice is additional to explanations already identified by other commentators in the literature; that is to say, the imbalance of power between patients and healthcare professionals, the effects of the differences in their phenomenological and professional perspectives, and prejudice.
In order to illustrate this critique and this argument, I use the example of the disputed, stigmatising, and inadequately-understood medical condition(s), chronic fatigue syndrome (CFS) and myalgic encephalomyopathy (ME) (which are often conflated as CFS/ME or ME/CFS), and similar medical conditions, about which there is uncertainty about causes and pathological mechanisms, where there are no curative treatments, and where there are disputes about the effectiveness or otherwise of symptomatic treatment recommendations. Many CFS patients and some of their healthcare professionals have dichotomous and oppositional responses to those uncertainties. These patients declare that their illness is biomedical (BMM), because of their phenomenological experience; therefore, psychological and behavioural treatments are inappropriate and harmful. Contrastingly, some health professionals see that the absence of objective evidence of disease in CFS patients implies that there is no disease process, and that treatments should be biopsychosocial (BPS). I argue that these conflicting responses, along with the rejection of opposing responses, lead to disputes and healthcare epistemic injustice within CFS healthcare encounters regarding conceptualisations of CFS and treatments recommendations for the symptoms.
In this thesis, I show that CFS is indeed subject to radical epistemic uncertainties, which explain those differing responses. I argue that each response is not unreasonable, bearing in mind those uncertainties; however, I also argue that the rejection of the opposing response is not epistemically virtuous.
The methodology that I use in this thesis is the logical analysis of the evidence for explanations for healthcare epistemic uncertainty, with the examination of evidence to support my argument that healthcare epistemic injustice can be significantly exacerbated by responses to epistemic uncertainty.
For amelioration, I propose two alternative conceptualisations for CFS, the network of symptoms model and the persistent physical symptoms model, each of which is additional rather than oppositional to both BMM and BPS.
In order to support my arguments, I introduce, promote, or find novel applications for, a number of concepts that are insufficiently highlighted elsewhere in the literature: firstly, the applicability of the economists’ concept of radical uncertainty to medical knowledge; secondly, the existence of radical uncertainty regarding knowledge about some medical conditions; thirdly, a network of uncertainties hampering some medical research; fourthly, the distinction between uncertainty regarding a medical condition and uncertainty regarding the medical problems of a particular individual in a healthcare encounter; fifthly radical uncertainty as an explanation for some healthcare epistemic injustice; sixthly, the applicability of the concepts of epistemic virtue to responses to medical uncertainty; seventhly, the under-acknowledged persistence of inappropriate medical disease dualism; eighthly, the applicability of the network of symptoms model to non-psychiatric illness; and, ninthly, the applicability of the persistent physical symptoms model of illness to under- explained medical conditions. These concepts have wider applicability to medical epistemology, disease ontology, healthcare ethics, and healthcare epistemic justice, thus demonstrating how the philosophical study of one medical condition (and similar conditions) can contribute to the philosophy of medicine, and some ways in which philosophy of medicine can benefit the practice of medicine.
PDF | University of Kent | Thesis
