Noemi Paciscopi

Effective communication is widely recognized as a cornerstone of successful medical treatment, as extensively documented in prior research. The doctor-patient relationship relies on clear, accurate information exchange to ensure precise diagnoses, treatment adherence, and patient satisfaction. Yet misunderstandings can seriously undermine this process, creating barriers to optimal care and weakening the therapeutic alliance—a critical element of effective healthcare. Consequently, identifying, understanding, and addressing these misunderstandings is essential. This paper introduces a novel approach to detecting and analyzing such misunderstandings in clinical interactions by drawing on concepts from the philosophy of language. Specifically, we present the ToUCAN Codebook, a structured framework designed to systematically classify and examine instances of textual miscommunication in doctor-patient dialogues. By offering a clear methodology for identifying and preventing potential communication breakdowns, the ToUCAN Codebook contributes to improved healthcare outcomes and a deeper understanding of the dynamics that shape medical discourse.

This article examines the pathologisation and over-medicalisation of pregnancy, arguing that pregnancy should not be classified as a disease. While medical interventions are essential in managing pregnancy-related complications, excessive medicalisation can undermine maternal autonomy and contribute to unnecessary interventions. We trace the historical shift from midwifery-led childbirth to obstetric control, highlighting how pregnancy came to be viewed as a clinical condition requiring constant medical oversight. Drawing on philosophical theories of disease, we analyse the debate surrounding pregnancy’s classification, considering naturalistic, normative, and pragmatic perspectives. Using focus group data from midwives, we provide concrete examples of over-medicalisation, including the routine overuse of procedures such as induction and episiotomy. We argue that a balanced approach is needed – one that acknowledges pregnancy’s physiological nature while ensuring access to medical care when appropriate. Avoiding both excessive medicalisation and rigid naturalisation can better support pregnant individuals’ well-being and decision-making autonomy.

In this paper, I argue that silencing testimonies causes an epistemic harm that is particularly severe when those silenced possess the epistemic resources to articulate specific phenomena or are inclined to develop these resources. Marginalized groups possess a unique privilege in understanding phenomena that directly affect them. When their testimonies are systematically dismissed through forms of epistemic injustice, society loses valuable insights. To grasp the nature of this privilege, I refer to a recent distinction in the literature on standpoint theory between two types of privilege: advantage and standpoint (Toole, 2023). This distinction illustrates that while one need not be marginalized to develop certain epistemic resources, marginalization provides a distinct advantage. Understanding the extent of the epistemic harm caused by epistemic oppression toward marginalized groups underscores the necessity of challenging these injustices, and addressing them would also yield ethical benefits for those who suffer from them.