Epistemic Humility and Epistemic Confidence: Competing Ethical Forces in Clinical Medicine

Physicians often communicate diagnostic judgments with unwarranted certainty, even in the presence of significant ambiguity. While cognitive biases and institutional expectations contribute to this pattern, its ethical implications remain under-theorized. This paper explores the ethical tension between epistemic humility (acknowledging what one does not know) and epistemic confidence (performing certainty regardless of evidentiary strength). Drawing on my dual position as a decision-making scholar and a patient with complex chronic illness, I argue that epistemic humility must be reframed not merely as a virtue but as a professional obligation in clinical communication. The paper makes three contributions: (1) it conceptualizes epistemic humility as an ethical duty to distinguish clearly between knowledge, inference, and intuition in medical discourse; (2) it introduces and theorizes epistemic confidence as a socially reinforced but ethically problematic communicative norm; and (3) it uses autoethnographic insights to expose how even documented, institutionally validated diagnoses are routinely dismissed in favor of more familiar narratives. Through philosophical argument, empirical literature, and lived experience, I show how epistemic confidence under uncertainty can obscure diagnostic alternatives, undermine informed consent, and perpetuate epistemic injustice. Even after years of seeking care, patients with complex conditions routinely encounter well-meaning physicians who confidently offer alternative diagnoses, sometimes contradicting existing evidence, without acknowledging the limits of their expertise. I conclude that epistemic humility must be taught, evaluated, and institutionalized as a condition of medical legitimacy. Without it, the system rewards the illusion of confidence over the ethics of care.