Topic Summary

Epistemic thinking refers to a cognitive and metacognitive process by which we reason about ‘knowledge’. Here, we aim to discuss the nature of ‘knowledge’ insofar as it connects with our relational and intellectual ethics (in other words, how our conceptualizations of this thing we call “knowledge” relates to the intellectual values upon which we base ‘how we interact with others & ideas in real life’).

  • What constitutes knowledge?
  • How is it generated?
  • Do specific social agents (i.e individuals) possess more epistemic authority?
  • Why? Why not?
  • What attributes of epistemic reasoning (in other words, what epistemic attitudes or higher order epistemic constructs) are conducive to identifying theories or ideas of relevance?
  • What are the limitations of ‘knowledge’ and thinking about how we think about what constitutes ‘knowledge’?
  • What ethical implications do epistemics and meta-epistemics have in connection to professional knowledge domains and the practice of everyday living?
  • What ethical issues are implicit in social systems, where some individuals agents have more epistemic & decision-making power than those whom they serve?

Take the mental health domain: DSM categories not only lack reliability and predictive validity, reflecting flaws in the structure of the ontological model itself, but they also have enormous implications for how power is distributed in social systems.

So, what kind of ethical implications does this have for patient-provider interactions? At a time when diagnoses still lack sufficient prognostic utility, what are our ethics around evaluation, treatment, and communication with clients? Do we have some questions that we need to address with respect to how we conceptualize and implement diagnostic practices?

Do you think the evaluation and treatment process (at large) is more likely to be driven by the institutional desire to manage risk rather than to relationally engage ? Is it ethical to make such diagnostic determinations in light of such conceptual & computational gaps?

If a diagnosis must be made for practical reasons (insurance, for instance), then how should a ‘diagnosis’ be communicated?  To be clear, we are not saying that professionals who engage in the act of diagnosis are behaving unethically: not only is the intent of diagnosis to shed light on the pathophysiology of disorder in order to identify and implement ways to lessen the harmful dysfunction (though, we could certainly debate the extent to which this process does or does not function in this way), many clients seek closure and comfort in diagnoses. The needs of providers and client stakeholders are critically important; however, what if an excessive psychological need for closure, actually undermines the capacity for critical thinking & balanced appraisals in some situations? What if a pervasive psychological intolerance of uncertainty undermines individual and collective capacities for sense-making? Here, the specific pain point that we seek to address is the problem that presents when diagnostic claims are made in the absence of enough information to make such claims.

Barring clear structural damage (you know, shattered bones, dead tissue, etc), most health information is rarely so simple and unidimensional . Appraising ‘diagnosis’ as ‘predictive prognosis’ might be a comforting crutch, but should it be normative to prioritize psychological safety over intellectual honesty & validity? Perhaps the point at which scientific and medical information is communicated, is where we need to consider an ethic of ambiguity upon which to deploy the use of appropriate language that would allow us to receive, integrate, and express messages about the strengths & limitations of our knowledge. Maybe it is in the light such an honest ‘unknowing’, that we could learn to find meaning, value, and maybe even some creative solutions, to our continuous problems.

Bibliography

Han, Paul K. J. 2013. “Conceptual, Methodological, and Ethical Problems in Communicating Uncertainty in Clinical Evidence.” Medical Care Research and Review : MCRR 70 (1 0): 14S-36S. https://doi.org/10.1177/1077558712459361.

Relevant References

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