336 1. Introduction This chapter explores the relation of epistemic injustice to medicine and healthcare as they arise from epistemic asymmetries and differential power relations. Healthcare systems rely on complex structures of epistemic norms and expectations, both implicit and explicit, that create knowledge asymmetries – for instance, privileging the knowledge derived from medical training and theory, rather than that potentially rooted in patient experience, which effec- tively limits epistemic authority to healthcare practitioners. The privileging of certain forms of experience amplifies this by creating experiential asymmetries: phenomenologists of illness have disclosed how ill persons experience both their illness and the social world, includ- ing healthcare environments (Toombs 1987). Chronically ill patients, in particular, expe- rience their illness not as localized biological dysfunction, but as ongoing, pervasive, perhaps all-encompassing – a definitive ‘mode of being’. Although illness may be only one aspect of that ‘mode’ or way of life, it can come to dominate their identity either as they conceive it, or, more significantly, as others do. By contrast, most practitioners can leave the world of illness, at the end of the day, phys- ically and psychologically, experiencing it through the context of a professionalised domain (see Kalanithi 2016; Klitzman 2007). The power structures of healthcare systems can also indirectly affect the epistemic confidence and capacities of ill persons. Many are vulnerable and fragile in various ways – physically, emotionally, socially – as a result of their condition and treatment, and the difficulties of life as an ill person in an often uncooperative, uncom- passionate social world. Such fragility is apt to challenge the autonomy and dignity that epistemic agency requires – for instance, patients often require permission for everyday tasks, such as receiving a visitor or eating certain foods. 1 Similarly, epistemic agency can be chal- lenged through one’s being complexly dependent on friends and family, healthcare staff, or even strangers. We suggest that such asymmetries, dependencies, and power relations can increase the vulner- ability of patients to epistemic injustice. In this chapter, we describe some of the relevant struc- tural and epistemic features of medicine and healthcare, and indicate some potential ameliorative strategies (see Carel and Kidd 2014; Kidd and Carel 2016). 32 EPISTEMIC INJUSTICE IN MEDICINE AND HEALTHCARE Havi Carel and Ian James Kidd 15031-0737-FullBook.indd 336 2/20/2017 10:29:35 PM