Appropriating empowerment: Precision Medicine’s proclivity to epistemic injustice

Precision medicine (PM) encompasses various emerging, data-intensive healthcare and biomedical research initiatives aimed at tailoring care to individual patient characteristics. While “precision” primarily denotes an epistemological shift in how biomedical research is approached and care delivered, the conviction that PM empowers patients in clinical decision-making is central to its vision as it is taken up across policy contexts. In this paper, I critically assess these promises by drawing on recent engagements in agential epistemic injustice (Lackey 2020; Medina 2022). I suggest that the social, cultural, and epistemological conditions in which the epistemic practice of precision care unfolds are conducive to epistemic injustice. Despite PM’s explicit aims to address longstanding criticisms regarding the disease-centric nature of contemporary biomedical care practices by including person-centered, non-biomedical features in clinical consideration, exploring its underlying logic suggests its epistemic economy is stacked against patients’ epistemic interests. As such, despite its laudable aim of patient empowerment, the exacerbated risk of epistemic injustice might truncate patients’ (epistemic) agency, further disempowering them in clinical decision-making. To conclude, I suggest that the reliance on “empowerment”- and “person-centered care”-rhetoric dominating PM discourse is a case of epistemic appropriation (Davis 2018), further discouraging engagement with social, experiential, and phenomenological dimensions of illness, defanging critics of raising those concerns, and impeding the realization of epistemic justice in healthcare.