Testimonial injustice: considering caregivers in paediatric behavioural healthcare.
Testimonial injustice: considering caregivers in paediatric behavioural healthcare.
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DOI：
10.1136/medethics-2021-107937
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发表时间：
2021-11
影响因子：
4.1
通讯作者：
Lazaro-Munoz, Gabriel
中科院分区：
文献类型：
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作者：
Pham, Michelle Trang;Storch, Eric A.;Lazaro-Munoz, Gabriel
Harcourt认为，在临床背景下，患有精神健康疾病的儿童和青少年（CYP）可能会经历认知，特别是证词，不公正，当他们的观点被卫生服务提供者不可否认地打折时。[1]我们在这篇评论中的目的是说明护理人员，一个重要的组成部分，治疗三联体（患者-护理人员-临床医生），也可以参与对治疗患者的不公正的证词。当一个人（1）遭受信誉赤字和（2）信誉赤字是基于偏见时，证词不公正就会发生。[2] Harcourt扩展了Fricker对证词不公正的解释，他认为，对于CYP，临床医生归因于他们的可信度不足，例如，可能是由于CYP被认为对自己的病情有不可靠的了解。哈考特写道：“作为一个医生被视为一个启发式的认识不可靠性在广泛的领域，包括临床设置。”因此，哈考特对弗里克的解释的扩展包括了认识上的傲慢，作为除了偏见之外的另一个必要条件，以适用证明不公正的概念。我们认为哈考特的论点也可以扩展到照顾者，他们是治疗三联体的核心。我们说明了这可能是如何从我们进行的研究，以了解临床医生和未来的家庭，照顾者和强迫症（OCD）的儿科患者的观点，使用脑深部电刺激（DBS）的可能性，难治性强迫症的儿科病例，如果它是一种选择。DBS神经外科手术涉及将电极植入特定的大脑区域，以提供电刺激，帮助管理神经/神经精神症状。目前，在美国，DBS治疗强迫症用于临床试验中或在美国食品药品监督管理局人道主义器械豁免的诊所中患有严重治疗难治性表现的成人。对于儿科强迫症患者来说，这不是一个可用的选择，尽管该疾病潜在的临床复杂性导致大量青少年出现难治性表现。[3]我们在下面提供的简短、初步的数据显示了一幅复杂的图景，说明各种利益相关者如何相互作用，并可能参与证词不公正。我们的主要观点是，就像哈考特对临床医生的讨论一样，在某些情况下，由于认识上的傲慢，照顾者可能会最大限度地减少儿科患者的偏好和经验。
Harcourt argues that in clinical contexts, children and young people (CYPs) with mental health illness can experience epistemic, specifically testimonial, injustice when their perspectives are unjustifiably discounted by health service providers. 1 Our goal in this commentary was to illustrate how caregivers, a critical component of CYP treatment triad (patient–caregiver–clinician), can also engage in testimonial injustice towards CYP patients. Testimonial injustice occurs when one (1) suffers a credibility deficit and (2) that credibility deficit is based on prejudice. 2 Harcourt expands Fricker’s account of testimonial injustice by arguing that for CYPs, the credibility deficits attributed to them by clinicians, for example, may result from epistemic arrogance in that CYPs are viewed as having unreliable knowledge about their condition. Harcourt writes:‘Being a CYP is treated as a heuristic for epistemic unreliability across a wide range of domains’(p3), including clinical settings. Harcourt’s expansion of Fricker’s account thus includes epistemic arrogance as an alternative necessary condition, in addition to prejudice, to apply the concept of testimonial injustice. We think Harcourt’s argument can also be extended to caregivers, who are central to the CYP treatment triad. We illustrate how this may be the case by drawing from research we conducted to understand the perspectives of clinicians and prospective families, both caregivers and paediatric patients with obsessive–compulsive disorder (OCD) about the possibility of using deep brain stimulation (DBS) for paediatric cases of refractory OCD if it were an option. DBS neurosurgery involves electrodes being implanted in specific brain regions to provide electrical stimulation that can help manage neurological/neuropsychiatric symptoms. Currently, in the USA, DBS for OCD is used in adults who have severe treatment refractory presentations in clinical trials or in clinics with a Food and Drug Administration humanitarian device exemption. It is not an available option for patients with paediatric OCD, despite the potential clinical complexities of the condition, which contribute to a significant number of youth with refractory presentations. 3 The brief, preliminary data we present below suggest a complicated picture of how various stakeholders interact and may engage in testimonial injustice. Our main point is that, like Harcourt’s discussion of clinicians, caregivers may in some cases minimise the preferences and experiences of paediatric patients because of epistemic arrogance.
影响因子：
4.1
作者：
Harcourt, Edward
通讯作者：
Harcourt, Edward