Oral Presentation The 26th International Nursing Philosophy Conference 2023

A credibility deficit? Epistemic injustice in children and older persons' voices in healthcare. (#37)

Moira E Dunsmore 1 , Clare J Davies 1
  1. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

‘Epistemic injustice’ refers to Fricker’s (2007) concept of the wrong done to somebody in their capacity as a holder of knowledge. The Declaration of Human Rights states that all persons are born free and equal in dignity and rights, further, the Convention on the Rights of Persons with Disabilities enshrine the right to access health and social care for all persons, irrespective of disability or difference. Globally, both young and older persons are denied basic human rights and are situated as passive and powerless, particularly in the context of decision-making in health care. Fricker’s account of epistemic injustice will be used in this presentation to understand the lived experience of both children and older persons in health care. 

Older persons and children are particularly vulnerable to both testimonial and hermeneutical injustice in health care. Both occur under the umbrella of epistemic injustice: first, testimonial injustice, where the person is misjudged and perceived as less credible and second, hermeneutic injustice, where marginalisation occurs when the art of understanding or making oneself understood is inadequate, often due to a lack of or inaccessible resources. Both children and older adults experience testimonial injustice when a lower level of credibility is given to what they say. Dependence and a perceived lack of competence create judgments about credibility, irrespective of capacity or actual ability. Children may be seen as cognitively inferior, while older adults, particularly those who experience disability or ill-health, experience discriminatory stereotypes that marginalise. 

This presentation provides an overview of epistemic injustice across the lifespan, focusing on the experiences of chronically ill children in health care, and the marginalisation of older persons living with an ‘invisible’ disability, dual sensory impairment.