Diagnosing the Cause, Not the Symptoms: Epistemic Gatekeeping Injustice in Medicine and Healthcare

Aphrodite Simalas

Leibniz Universität Hannover

Much of the current debate on epistemic injustice (EI) in medicine focuses on its most visible forms: patients’ testimony is downgraded, or their experiences are difficult to articulate. These injustices are commonly conceptualized through Fricker’s (2007) concepts of testimonial and hermeneutical injustice. Yet if these concepts are treated as exhaustive, we risk mistaking symptoms for causes.
This talk builds on a conceptual review of current literature on EI in medicine, which reveals two recurrent patterns. First, women appear as particularly vulnerable to EI; second, chronic, rare, poorly understood, controversial, and underdiagnosed conditions are repeatedly discussed as affected by EI. I argue that this overlap is not accidental. Rather, these cases point to a shared problem: EI arises especially where certain forms of knowledge do not fit the dominant epistemic framework of Western medicine.
Current literature often explains EI in medicine through interpersonal prejudice or hermeneutical gaps. While important, these explanations primarily analyze EI as a wrong done to epistemic subjects, usually patients, rather than as a gatekeeping process directed at knowledge itself. My project shifts the focus to the framework itself, arguing that we must examine the epistemic structures that systematically exclude or downgrade certain forms of knowledge from research, clinical practice, and treatment guidelines.
I conceptualize this mechanism as Epistemic Gatekeeping Injustice (EGI), referring to institutionalized norms and processes within dominant medical knowledge frameworks that regulate admissible evidence and determine medical recognizability. EGI excludes knowledge that does not fit, thereby producing downstream testimonial and hermeneutical injustices. Social identity structures shape differential exposure, but the exclusion mechanism is not reducible to them.
In the talk, I introduce a model of the dominant epistemic architecture of modern medicine and its gatekeeping layers: biomedicine, reductionism, and evidence-based medicine, all shaped by an androcentric epistemology. The model shows how power affects knowledge not only by discrediting knowers, but by determining what can become medically intelligible in the first place. Endometriosis serves as a case study.

Chair: tba

Time:

Location: