Recognizing epistemic injustice in healthcare: a case for methodological pluralism

Nielsen et al. (2025) recently presented a critique of the current scholarship on epistemic injustice in healthcare, emphasizing the absence of robust empirical evidence, the conceptual difficulty of establishing criteria for identification, and the risk of theoretical misapplication of Miranda Fricker’s original framework. While the call for nuance and careful theoretical articulation might be worthwhile, the framing of their critique risks reinforcing precisely the patterns of epistemic exclusion that the concept of epistemic injustice is meant to expose. The implication that epistemic injustice must be operationalized and empirically validated in large-scale quantitative studies before it can be acknowledged as clinically and ethically significant may inadvertently replicate a longstanding hierarchy of knowledge in which certain forms of suffering become “real” only once translated into quantifiable data. In this response, we aim to advance the scholarly debate by questioning the argumentative basis of Nielsen et al.’s claim that fundamental scientific, conceptual, and theoretical flaws undermine the field of epistemic injustice in healthcare. We propose instead approaching epistemic injustice with social objectivity and methodological pluralism; the concept should not be dismissed for lacking quantification or standardization, but rather recognized for its complexity and significance in improving equity, care, and clinical encounters.