How do persons with dementia experience 'epistemic injustice'?

Abstract

Whenever we hear a speaker assert something, we form judgments both about the credibility of the speaker and of what they said. When a hearer attributes too little credibility to a speaker, perhaps due to a prejudice they hold, the speaker is said to suffer an injustice. This kind of injustice is epistemic in nature: the speaker is harmed in their capacity as a 'knower'. Philosopher Miranda Fricker (2007) calls this 'epistemic injustice'. This theoretical concept has had recent uptake across health fields, including in dementia care. Whilst the concept is a useful tool to considering the injustice a person may experience, Fricker offers only a theoretical exploration of how epistemic injustice might manifest in everyday life, often using literary examples. Similarly, the existing work in epistemic injustice and dementia often relies on anecdotal evidence to support claims about the injustice persons with dementia experience. The aim of this paper is to demonstrate that one way to confirm, elaborate or indeed challenge the assumptions embodied in the concept of epistemic injustice would be to look to analysis of everyday interactions involving persons with dementia, using a Conversation Analytic approach. Heritage (2013), in his work on 'the epistemics of interaction', offers an empirically grounded method to exploring how interactants negotiate their relative epistemic positions ... in and through turns at talk and sequences of interaction (p. 556). There appears to be a compatibility between the concepts of epistemic injustice and epistemics of interaction. Although the concepts come from disparate fields of thought (i.e., philosophy and conversation analysis), both are concerned with how persons do or do not do justice to each other. Considered together, these concepts may illuminate how epistemic injustice manifests in the everyday lives of persons with dementia.