Epistemic Justice and Integrated Care: Navigating the ethical dilemmas of partnering and not partnering with people with lived experience

Background: Integrated care increasingly recognises that people with lived experience are essential partners in designing, developing, governing, and monitoring health and social care systems. However, inclusion alone does not guarantee justice or equality. When poorly designed or under-resourced, participation can reproduce inequities or limit the quality improvement that integrated care seeks to achieve. Exclusion, in turn, increases research waste and weakens accountability.

This workshop explores epistemic justice, the fairness of whose knowledge counts, who is heard, and under what conditions. Drawing on Fricker’s theory (1) and the EMERGES framework (2), it focuses on recurring ethical dilemmas in co-production, such as how legitimacy is earned, voices are represented, power is shared, and partnerships are sustained. By linking these dilemmas to the IFIC 9 Pillars of Integrated Care, the workshop examines how credibility, recognition, and fairness unfold across the pillars. Participants will be invited to reflect on practical ways to embed epistemic justice within integrated-care practices.

TARGET AUDIENCE: The session welcomes people with lived experience, researchers, educators, practitioners, policymakers, and system leaders engaged in co-production, governance, or health equity. No prior expertise is required: only curiosity, reflection, and openness to dialogue. Participation from underrepresented or neglected communities is particularly encouraged.

Approach: The workshop is co-designed and co-led by people with lived experience, researchers, practitioners, and educators, modelling equity and partnership in action. It will be dialogical, participatory, and trauma-aware, creating a reflective and inclusive learning environment.

- Welcome and safety (0-10 min): introduction to the purpose, guiding principles, and ground rules for respectful dialogue.

- Framing the dilemmas (10-20 min): a short interactive overview of key epistemic-justice tensions and their relevance to integrated care.

- Small-group discussions (20-55 min): participants form mixed groups of three to four will explore short ethical scenarios (e.g., legitimacy, power-sharing, sustainability). Using a reflection checklist, they identify barriers and enabling conditions.

- Sharing and building ideas (55-75 min): each group will summarise insights, clustering reflections around the 9 Pillars to identify common challenges and opportunities.

- Collective synthesis (75-85 min): themes will be mapped to co-create emerging “guardrails” for equitable partnership.

- Closing reflection (85-90 min): participants will share takeaways and discuss continuing dialogue through the IFIC network.

Facilitation will be grounded in dialogue and shared inquiry, using scenario-based reflection rather than instruction. Participants can expect an open, collaborative atmosphere focused on mutual learning and practical reflection.

EXPECTED OUTCOMES: Deepened understanding of ethical tensions in lived-experience involvement. Practical insights and shared language to advance equitable practice. Contributions to a reflective framework linking epistemic justice to the 9 Pillars of Integrated Care. Strengthened international connections to sustain ongoing learning.

Rather than offering fixed answers, the workshop will provide a space for shared understanding: a collective step toward more just, inclusive, and people-centred integrated care for all.

REFERENCES :1. Fricker M. Epistemic Injustice: Power and the Ethics of Knowing. Oxford University Press; 2007.

2. Gupta V, et al. Understanding the Identity of Lived Experience Researchers and Providers: A Conceptual Framework and Systematic Narrative Review. Research Involvement and Engagement. 2023;9(1).