A Primer on Epistemic Injustice and Patients with Non-English Language Preference

AbstractEpistemic injustice is a concept capturing the way people are treated as knowers. In healthcare, epistemic injustice involves evaluation of a series of underlying knowledge-based conditions at the core of patient interactions. This article describes a case study demonstrating different forms of epistemic injustice as it manifests for Hispanic and Spanish-speaking people in healthcare settings characterized by English language dominance. The analysis provided here differentiates epistemic injustice in terms of hermeneutical injustice, testimonial injustice (including testimonial smothering), epistemic oppression, and epistemic colonialism. This discussion is tailored to provide a resource for bioethicists and clinical teams at the bedside and to advance an increased voice for patients and families in U.S. healthcare. While potential avenues for pursuing and assuring epistemic justice in healthcare systems are beyond the scope of this examination, we focus on using epistemic injustice to name oppression and opportunities for resistance in the current healthcare environment. An overview of how patients can be treated unfairly as knowers is also situated within a broader national discourse about other forms of injustice and is imperative to redress U.S. health disparities.