The concept of epistemic (specifically testimonial) injustice is the latest philosophical tool with which to try to theorise what goes wrong when mental health service users are not listened to by clinicians, and what goes right when they are. Is the tool adequate to the task? It is argued that, to be applicable at all, the concept needs some adjustment so that being disbelieved as a result of prejudice is one of a family of alternative necessary conditions for its application, rather than a necessary condition all on its own. It is then argued that even once adjusted in this way, the concept does not fit well in the area where the biggest efforts have been made to apply it so far, namely the highly sensitive case of adult patients suffering from delusions. Indeed it does not serve the interests of service users struggling for recognition to try to apply it in this context, because there is so much more to being listened to than simply being believed. However, the concept is found to apply smoothly in many cases where the service users are children, for example, in relation to children’s testimony on the efficacy of treatment. It is suggested that further research would demonstrate the usefulness of the concept in adult cases of a similar kind.

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Ideas at work in Bernard Williams’‘integrity objection’ threaten not only direct act‐utilitarianism (act‐utilitarianism considered as decision‐procedure and as test of rightness) but also indirect act‐utilitarianism (act‐utilitarianism as test of rightness only). Calculation can decide whether an action is utilitarianly right only if it takes every evaluatively relevant feature of alternatives into account. I assume, following Williams, that utilitarianism is reductionist, i.e., represents every case of an agent's valuing something as a case of having a preference. But thanks to an internal relation between an agent's values and the shape of practical deliberation, they cannot always be so represented, so there are some things agents typically value whose value to them utilitarianism necessarily misrepresents. There are therefore some actions such that calculation cannot decide whether they are utilitarianly right, and utilitarianism is incoherent as a test of rightness.

0 Consider ‘I’ as used by a given speaker and some ordinary proper name of that speaker: are these two coreferential singular terms which differ in Fregean sense? If they could be shown to be so, we might be able to explain the logical and epistemological peculiarities of ‘I’ by appeal to its special sense and yet feel no temptation to think of its reference as anything more exotic than a human being.

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