In this article, we discuss the case of Michael Johnson, an African-American man who sought treatment for respiratory distress due to COVID-19, but who was adamant that he did not want to be intubated due to his belief that ventilators directly cause death. This case prompted reflection about the ways in which a false belief can create uncertainty and complexity for clinicians who are responsible for evaluating decision-making capacity (DMC). In our analysis, we consider the extent to which Mr. Johnson demonstrated capacity according to each of Appelbaum's criteria.1 Although it was fairly clear that Mr. Johnson lacked DMC on the basis of both understanding and appreciation, we found ourselves reflecting upon the false belief that seemed to motivate his refusal. This led us to further consider the ways in which our current social and political environment can complicate evaluations of patients' preferences and reasons for declining life-sustaining interventions. In particular, we consider the impact of the role of misinformation and systemic racism in preparing the grounds for false beliefs. In this article, we discuss the case of Michael Johnson, an African-American man who sought treatment for respiratory distress due to COVID-19, but who was adamant that he did not want to be intubated due to his belief that ventilators directly cause death. This case prompted reflection about the ways in which a false belief can create uncertainty and complexity for clinicians who are responsible for evaluating decision-making capacity (DMC). In our analysis, we consider the extent to which Mr. Johnson demonstrated capacity according to each of Appelbaum’s criteria.1 Although it was fairly clear that Mr. Johnson lacked DMC on the basis of both understanding and appreciation, we found ourselves reflecting upon the false belief that seemed to motivate his refusal. This led us to further consider the ways in which our current social and political environment can complicate evaluations of patients’ preferences and reasons for declining life-sustaining interventions. In particular, we consider the impact of the role of misinformation and systemic racism in preparing the grounds for false beliefs.

Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care (Peterson et al. 2021). We agree with Peterson et al. that patients ...

Within the evidence-based medicine (EBM) construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians' primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the "best" evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients.

This chapter explicates and evaluates the concept of medical error. Unlike standard philosophical approaches to analyzing medical phenomena in the abstract, it instead addresses medical error specifically within the context of an embodied social world. It illustrates how, as a deeply contextual concept, medical error is inextricably tied to the social conditions—and concrete, powerful interests—of the particulars in which it is found. The chapter begins with an analysis that demonstrates the relational quality of medical error as a functional, outcome-oriented concept, evaluating the origin and context of the term's emergence, and connecting it to a similarly contextual concept, "standard of care." It moves on to note the concerning implications of medical error identification and measurement when viewed through an intersectional standpoint. Intersectional approaches, the chapter explains, focus on how intersections of social identity can unmask social structures that negatively impact groups and individuals. It seems that disparities in social goods (social standing, education, wealth) complicate our identification of medical error, itself, and compound concerns of equity and access to medical goods for those who have diminished expectations for health.

To claim a disability is not something one ought to do lightly. Pregnancy, however, presents a very difficult and interesting case. Pain, discomfort, and inconvenience are often daily aspects of pregnancy, and pregnancy itself can cause physical, as well as social, impediments that substantially interfere with one's day-to-day work and life. The kind of "pregnancy-related disability'' that is built into current laws falls short of addressing the real question of whether pregnancy itself, rather than certain conditions brought on by pregnancy, ought to be understood as a temporary disability. I suggest here that pregnancy may, at present, warrant such designation.

In order to arbitrate conflicting propositional knowledge claims-such as when two individuals claim to know the height of a tree in the yard-there is (ostensibly) a "fact of the matter" about who is correct. Experiential, non-propositional knowledge, on the other hand, is not so obviously mediated. For one, experiential knowledge is-at least partially-subjective; one of its virtues is that it matters what a person's background is, socially, etc., when determining the legitimacy of their claims. But this suggests a question: Flow do we decide whose experience of an event is right, when two individuals differ in their accounts of a single event?In this paper I present the concept of experiential knowledge, asserting that this knowledge is frequently nonpropositional. I argue that accepting experiential knowledge is fundamental to issues of social justice, specifically when it is precisely the claims of those who have the least social or political "authority" who are in danger of having their experiences and the knowledge gained from those experiences, discounted. I address worries over the arbitration of experiential knowledge, and conclude that in cases where necessary, arbitration is both possible and often morally required.