Evidence-based medicine (EBM) is a clinical decision-making framework that takes into consideration (1) the best clinical evidence, (2) clinical expertise, (3) patient values and circumstances while formulating patient management plans. Patient values are understood as “the unique preferences, concerns, and expectations that each patient brings to a clinical encounter”¹. A patient’s circumstance is the clinical state of the patient and the clinical setting in which they find themselves¹. Medical epistemological systems are repositories of epistemic resources like beliefs and concepts but also “habits of cognition, attitudes towards knowers and/or any relevant sensibilities that encourage or hinder the production of knowledge”². Medical epistemological systems based on the EBM paradigm are such that the “three pillars of EBM” mentioned above play an epistemically normative role on epistemic claims about patient management. Patients must be able to fruitfully exercise their epistemic agency and produce knowledge claims about their values and clinical circumstances. These knowledge claims can then play an epistemically normative role while formulating a management plan that reflects their values and is appropriate to their clinical needs. In this paper, I will demonstrate how medical epistemological systems can play a role in causing unwarranted, and persistent infringements on the epistemic agency of the patient that amount to an epistemic form of oppression.

References:

1. Straus, Sharon E., et al. Evidence-Based Medicine. Fifth Edition ed., Elsevier Health Sciences, 2019.
2. Dotson, Kristie. “Conceptualizing Epistemic Oppression.” Social Epistemology, vol. 28, no. 2, 2014, pp. 115–138., https://doi.org/10.1080/02691728.2013.782585.