Somatic Overdiagnosis and Hermeneutical Injustice

Abstract Overdiagnosis has increasingly been recognized as a severe issue within medicine because it leads to iatrogenic harms and issues of distributive justice without corresponding benefit of treatment. This article attempts to show that overdiagnosis is also a matter of epistemic injustice. Through qualitative empirical studies, it argues that overdiagnosed patients without symptoms, who do not stand to benefit from medical examination and treatment, are wronged by being perceived and treated as sick by themselves and others. This knowledge, which the overdiagnosed lack the proper resources to understand and interpret, distorts sense-making abilities and creates hermeneutical marginalization. The problem of overdiagnosis arises due to structural rather than individual issues, such as specific institutional practices of medicine, different conceptualizations of health and disease, and given health cultures, and thereby constitutes a hermeneutical rather than testimonial injustice. Ultimately, these considerations raise the question whether the case of overdiagnosis constitutes a novel form of epistemic injustice where the harm lies in the presence rather than absence of knowledge that the victim of the injustice does not possess the proper means of interpreting or understanding.