Unjust silence: Therapeutic privilege, ethical issues and epistemic exclusion

Abstract

Communication between healthcare professionals and patients typically concerns diagnoses, treatment options, and prognoses. In certain situations, however, not all relevant information is disclosed in order to prevent harm or to protect patient well-being. This practice is commonly referred to as therapeutic privilege. While therapeutic privilege has been widely discussed in relation to autonomy, beneficence, and non-maleficence, its implications for justice remain insufficiently explored. This article addresses this gap by examining therapeutic privilege through the lens of epistemic injustice. It argues that the selective withholding of information may undermine patients’ status as epistemic agents and thereby give rise to both hermeneutical and testimonial forms of injustice. The analysis focuses on three contexts in which such injustices arise: (1) the relationship between healthcare professionals and patients, (2) age-based differences in treatment, and (3) the role of family caregivers. Across these cases, the analysis argues that practices of information control can lead to forms of exclusion and unequal recognition. The article concludes that prevailing justifications of therapeutic privilege remain incomplete as long as they neglect considerations of epistemic injustice. The article therefore calls for greater attention to the conditions under which patients are recognized as epistemic participants within healthcare communication.

Keywords: Therapeutic privilege; epistemic injustice; family caregivers; doctor-patient relationship; ageism