Emily Bingeman

The aim of this dissertation is to build a concept of epistemic responsibility that takes seriously insights from feminist epistemology, addiction studies, and disability theory. I use John Greco’s knowledge-as-achievement account as a starting point, and demonstrate how an ability-centred account such as Greco’s can be undergirded with these insights to create a concept of epistemic responsibility that better captures the complex social and political nature of our epistemic practices. I begin in Chapter 1 by outlining the contours of the project and making an argument for the importance of projects that create porousness between feminist epistemology and mainstream epistemology. In Chapter 2 I outline five key insights in feminist epistemology that I use both in assessing Greco’s theory and in guiding reconstruction. I argue that accommodating these insights will require, at a minimum, a thoroughly social/non-individualistic concept of epistemic responsibility. The strategy that I take to build such a concept is threefold. First, in Chapter 3, I provide a theoretical background of currently existing social/non-individualistic concepts of responsibility that serve to lay a groundwork for my notion of epistemic responsibility. The goal is not to provide a comprehensive survey of the work on responsibility, but rather to draw out tools and frameworks that are helpful in thinking through epistemic responsibility. Second, in Chapter 4, I develop an extended analysis of a concrete phenomenon that I take to be a thoroughly social/non-individualistic context of responsibility ascription: responsibility for addiction, or rather for the harms associated with drug use. And finally, in Chapter 5, taking all of the insights and tools that I have gathered in Chapters 2-4, I embark on the project of theory reconstruction. I begin by outlining the strengths and weaknesses in Greco’s theory with respect to the insights I have highlighted. I then bring in disability theory in order to shore up the notion of ability operative in Greco’s account which I argue allows us to better account for the social and political complexities of epistemic practice.

Since its inception in the early 1990s, evidence-based medicine (EBM) has become the dominant epistemic framework for Western medical practice. However, in light of powerful criticisms against EBM, alternatives such as casuistic medicine have been gaining support in both the medical and philosophical community. In the absence of empirical evidence in support of the claim that EBM improves patient outcomes, and in light of considerations that it is unlikely that such evidence will be forthcoming, another standard is needed to assess EBM against its alternatives. In this paper, I propose a set of criteria for this purpose based on Helen Longino's criteria for assessing the objectivity of a knowledge productive community. I then apply these criteria to assess EBM against a casuistic framework for medical knowledge. I argue that EBM's strict adherence to a hierarchical organization of knowledge can reasonably be expected to block it from fulfilling a high level of objectivity. A casuistic framework, on the other hand, because it emphasizes critical evaluation in conjunction with the flexibility of a case-based approach, could be expected to better facilitate a more optimal epistemic community.