Epistemological Hermeneutics in the Clinic

Abstract

Sometimes, people using different epistemological strategies have to work together on a shared project. The differences between their epistemological strategies may make it difficult to share knowledge relevant to their shared goals. Especially in the context of shared projects, it is sometimes inappropriate or impractical to normatively intervene on the epistemological strategies other people are using. This might be because doing so would harm the working relationship, or because a project is time-sensitive enough that deep epistemological discussions are impossible. In this kind of case, knowledge must be 'translated' so it can be shared- knowledge justified within one epistemological system must be made intelligible in another. The parties need not agree that a particular piece of supposed knowledge is true, but they do both need to understand it in order to move forward together.

This dissertation develops a roadmap for non-ideal epistemological analysis of the conversational barriers that incompatible epistemological strategies can raise to information-sharing, with clinical bioethical communication as a guiding example. I have called this strategy epistemological hermeneutics: the practice of making one’s epistemological strategy understood. Epistemological Hermeneutics allows us to learn from people who know differently than we do in real-life conversations.

I take the insights from bioethicists and researchers looking at these cases to set up a framework of way that bridging an epistemological gap in conversation looks like. This project stays close to reports from doctors who encounter this kind of clinical conversation, reports from patients who believe in miracles, and descriptions (from bioethicists) of how to make this conversation go well. From analyses of successful conclusions to these conversations and attention to the specific epistemological differences between medical professionals and miracle-invoking patients, I backward-engineer a set of steps which will reliably lead a medical professional who is entirely ignorant of their patient's epistemology to be able to identify what their patient is trying to express and respond appropriately when they are facing a patient using an unfamiliar knowing-strategy.