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Epistemic injustice or safety first?

Published online by Cambridge University Press:  02 January 2018

Manhal M. Zarroug
Affiliation:
Higher Trainee in Psychiatry (ST5), email: Manhal.Zarroug@swlstg-tr.nhs.uk
Dieneke Hubbeling
Affiliation:
South West London and St George's NHS Trust London, UK
Robert Bertram
Affiliation:
South West London and St George's NHS Trust London, UK
Corresponding
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Abstract

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Creative Common License - CCCreative Common License - BY
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © 2017 The Author

Crichton et al Reference Crichton, Carel and Kidd1 discussed the problem of testimonial epistemic injustice that has been historically prevalent and overlooked in both physical and mental healthcare settings. However, in the third example, the notion of epistemic injustice in the patient's compulsory detention is not clear. The patient was admitted after standing near the edge of a cliff for more than an hour, but his community psychiatric nurse argued at the tribunal hearing that this man had had suicidal thoughts for several years and should never have been placed on a section.

In this case, the argument to keep the patient under section was made in light of apparent risks, without the background knowledge subsequently provided by the care coordinator. This is not the same as epistemic injustice, where the patient is not believed because of prejudice.

The admitting team's decision to detain under Section 2 does not appear to be secondary to epistemic injustice but rather a clinical decision following assessment of risk during a crisis presentation. These decisions often have to be made when there is limited time available, when one cannot contact the community psychiatric nurse and when one does not have access to a detailed written care plan. In such situations, the patient's safety is of overriding importance.

In our opinion this case represents epistemic contextualism – whereby one requires more certainty if the stakes are high – rather than epistemic injustice per se. Reference Cohen2

References

1 Crichton, P, Carel, H, Kidd, IJ. Epistemic injustice in psychiatry. BJPsych Bull 2016, in press; published online ahead of print 25 August 2016 – DOI: 10.1192/pb.bp.115.050682.CrossRefGoogle Scholar
2 Cohen, S. Contextualism, skepticism and the structure of reasons. Philos Perspect 1999; 13: 5789.Google Scholar
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