Listening for That Which Is Not Said: Combating Testimonial Smothering in Clinical Ethics Consultation
Thursday, October 12, 2023
2:30 PM – 3:45 PM ET
Location: Bristol (Third Floor)
In order to facilitate patient-centered decision making about medical care, clinical ethics consultants routinely elicit testimonies of patients and their loved ones about their values, preferences, and goals. Recognizing the social factors that distort these testimonial exchanges, such as prejudicial stereotypes against marginalized communities, recent bioethics scholarship has translated the concept of testimonial injustice into the clinical encounter. Feminist scholar Kristie Dotson defines two specific practices of testimonial injustice: testimonial quieting, a failure to take a speaker’s testimony seriously due to perceived lack of credibility, and testimonial smothering, in which the speaker withholds elements of her testimony because she perceives a hearer’s inability or unwillingness to understand. But while bioethicists have extensively characterized cases of testimonial quieting—for example, in failing to treat patients as authorities on their own illnesses—testimonial smothering has yet to be theorized in the clinical space. In this paper, I will describe the phenomenon and significance of testimonial smothering using an ethics consult case study, illustrating the dangers of leaving uncovered that which is not said. I then argue that clinical ethics consultants have an obligation to recognize and combat testimonial smothering, primarily by acting as listeners willing to overcome their own situated ignorance. I conclude by describing an approach to soliciting testimony that signals both an openness to understanding and a commitment to address what one doesn’t understand. This technique may be routinely deployed by clinical ethicists in case information gathering and values exploration conversations with patients, families, and/or clinicians.