How can you avoid epistemic prejudice in clinical practice?
The journal Bioethics will shortly release a special issue focusing on the theme of “migration, health and ethics”. One of the papers in the issue addresses the underexplored topic of language barriers in clinical practice.
In her paper “Language barriers and epistemic injustice in healthcare settings”, McGill University linguist Yael Pelad explores how both barriers within languages and barriers between languages can impede everything from diagnosis and treatment to consultation and termination of treatment.
Pelad suggests that communicative factors such as a patient’s accent can introduce subtle bias into a clinician's mind, particularly if the accent is often associated with less educated populations. Alternatively, patients from linguistically diverse backgrounds may struggle to translate illness-related concepts from their native language into a lingua franca such as English. The English language concepts of “pain” and “ache”, Pelad observes, are indistinguishable in Russian, while “depression” is variously conceptualised in different cultures.
Pelad advocates a series of steps to remedy what philosophers call “epistemic injustice”, or unfairness and bias that arises due to aspects of knowledge or communication.
Specifically, doctors should be sensitive to the limits introduced by culture and language, and be more willing to tolerate and work with the cultural ambiguities inherent in our conceptions of disease and illness.
“…Even when patients do not expect to be treated in their own language, there are nevertheless certain linguistic actions that can contribute to a more positive rapport and therefore better care delivery, such as a bilingual greeting, the recognition of one’s linguistic identity, the acknowledgement of language needs, and the effort of pronouncing a patient’s name correctly”.
Overcoming language barriers and linguistic prejudice in medicine
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