Antipsychotic discontinuation discussed through the lens of epistemic injustice

Introduction: After decades of research to improve adherence to antipsychotic treatment for people with schizophrenia, papers and debates questioning the risk benefit ratio are now emerging. This debate remains inherently complex and emotionally charged. While all stakeholders acknowledge that there are well documented risks and benefits, these are valued differently. Challenging the legitimacy of antipsychotic long-term treatment is not only an academic issue, but a real-life dilemma of health care professionals working with people with psychosis, making ethical thinking about these issues a necessity. Methods:  In this conceptual article we suggest that the term epistemic injustice can add useful perspectives to the academic debate as well as the ethical considerations in the clinical encounter. Epistemic injustice, a term coined by the feminist philosopher Fricker, refers to a wrong done to someone as a knower or transmitter of knowledge. Epistemic means relating to knowledge. Injustice occurs when someone is unfairly judged to represent uncredible knowledge, due to unjustified prejudices. Results: Epistemic injustice can be useful term to understand why user voices are ignored, resulting in 1) the lack research on why and how people stop antipsychotic medication, resulting in absence of clinical guidelines at an organizational level, and 2) the skewed power in clinical encounters with professional “knowing what is best”.  The injustice condition is met as there is a biased priority of research supporting adherence and medication maintenance, ignoring that most people will have at least one attempt to discontinue, and therefore need to know how this can be done as safe as possible. Discussion: We argue that both epistemic humility is necessary and listening to voices with lived experience may be valuable to improve the understanding of the field.