Believing Women with Autoimmune Diseases: Correcting Testimonial Injustice in Healthcare Open Access
Terrebonne, Katherine (Spring 2026)
Abstract
For many women living with autoimmune diseases, simply being believed is one of the most challenging obstacles to receiving quality healthcare. Epistemic injustice, Miranda Fricker’s term for a wrong done to a person in their capacity as a knower, is partly to blame. This thesis focuses on a subtype of epistemic injustice known as testimonial injustice, which refers to wrongs that occur when a listener’s biases or prejudices incorrectly deflate the credibility of a speaker’s word. In clinical settings, acts of testimonial injustice are exceptionally harmful and have widespread implications for patient health and well-being. Female patients reporting common symptoms of autoimmune disease (i.e., fatigue, brain fog, joint pain, unusual bodily sensations, etc.) to healthcare providers are frequently subjected to acts of testimonial injustice, especially when they inhabit marginalized social identities. A growing body of bioethical scholarship supports an urgent need to address the problem of testimonial injustice in the healthcare setting. In this thesis, I argue that (1) entrenched healthcare biases (i.e., gender bias, pathocentric prejudices, objectivity bias in evidence-based medicine (EBM), etc.) leave women living with autoimmune diseases particularly vulnerable to this type of epistemic injustice, (2) clinicians have professional duties and ethical obligations to work toward correcting testimonial injustice in healthcare, and (3) “rightly” believing patients (i.e., assigning patients appropriate credibility that is not wrongly deflated due to prejudice or bias) is a plausible method for lessening the frequency and severity of these acts against women with autoimmune disorders. Believing patients rightly can be achieved through the cultivation and authentic embodiment of certain intellectual and moral virtues by providers, for example, epistemic humility, epistemic solidarity, open-mindedness, patience, curiosity, and compassion. Future research should focus on resolving implementation challenges so that women with autoimmune disorders can (1) assume their rightful place as credible testifiers of their embodied illness experience and co-creators of medical knowledge, and (2) fairly access the healthcare resources they are rightly owed.
Table of Contents
Contents
Acknowledgements vi
Introduction 1
Chapter 1 Testimonial Injustice 8
Chapter 2 Why Change is Necessary 20
Chapter 3 Clinical Obligations 41
Chapter 4 Recommendations 64
Chapter 5 Objections 89
Conclusion 96
Bibliography 101
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