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Integrated Care Systems as an Arena for the Emergence of New Forms of Epistemic Injustice

Fletcher, Andrew; Clarke, Jeremy

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Authors

Andrew Fletcher

Jeremy Clarke



Abstract

Epistemic injustice has rapidly become a powerful tool for analysis of otherwise hidden social harms. Yet empirical research into how resistance to knowing and understanding can be generated and replicated in social programmes is limited. We have identified a range of subtle and not-so-subtle inflections of epistemic injustice as they play out in an intervention for people with chronic depression in receipt of disability benefits. This article describes the different ‘species’ of epistemic injustice observed and reveals how these are unintentionally produced at frontline, management, commissioning and policy levels. Most notably, there remains a privileging of clinical knowledge over other forms of knowledge, producing a ‘pathocentric epistemic complex’. This, combined with the failure of different agencies with competing ideologies to adequately understand each other, and a vicious policy context, added to the injustices already faced by people with mental health issues, generating multiple harms. This has important implications for a range of integrated care and welfare interventions – not least by drawing attention to their unintended potential for replicating epistemic injustice as an institutionalised complex. Careful evaluation and design of such programmes, applying the philosophical and epistemic resources illustrated here, can help mitigate this outcome. Further, by raising awareness of epistemic injustice among programme participants, we can generate epistemic structures that secure programme integrity locally, and promote better policy.

Citation

Fletcher, A., & Clarke, J. (2020). Integrated Care Systems as an Arena for the Emergence of New Forms of Epistemic Injustice. Ethical Theory and Moral Practice, 23(5), 723-737. https://doi.org/10.1007/s10677-020-10111-1

Journal Article Type Article
Acceptance Date Jul 24, 2020
Online Publication Date Aug 1, 2020
Publication Date 2020-11
Deposit Date Aug 12, 2020
Publicly Available Date Mar 29, 2024
Journal Ethical Theory and Moral Practice
Print ISSN 1386-2820
Electronic ISSN 1572-8447
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 23
Issue 5
Pages 723-737
DOI https://doi.org/10.1007/s10677-020-10111-1

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http://creativecommons.org/licenses/by/4.0/

Copyright Statement
Advance online version This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.





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