Ethical analysis of trust in therapeutic relationships

The problem of this philosophical study was to analyze the concept of trust for its nature, scope, and value, and to apply this analysis to an investigation of trust claims in therapeutic relationships between patients and practitioners. The analysis included semantic, literary, sociological, epistemological, and moral considerations. Classical philosophical texts were examined in order to determine the importance of trust as an instrumental value and as a requirement for morally desirable societies. Contemporary sociological theories regarding the function of trust were examined, as was the relationship of trust to the norm of truthfulness. Contemporary philosophical arguments which claim that trust is a value central to morality were examined. Trust was examined for its normative features, including the rationality of trust and its intrinsic value in interpersonal. relationships. The following philosophical definition of trust was provided: Trust is the' confident belief based on possibly tenuous evidence that others can be believed to act with good will. Four distinct forms of trust were identified. These were: (1) the act of entrusting or consigning to another the care or custody of one's goods or interests; (2) the rendering of a judgment regarding the trustworthy virtues of another; (3) the epistemic attitude of confidence based on the belief in the functional ability and reliability of others; (4) the attitude of assuming that or acting-as-if the word of others can be accepted as true and as if others were worthy of trust.

This philosophical conception of trust was then applied to the health care setting where an examination of two general classes of expectations regarding trust was undertaken. These expectations were of (1) technical competence and role performance of health care practitioners and (2) fiduciary obligation. Contemporary codes of ethics in medicine, psychiatry, and nursing were examined with regard to trust and claims made by practitioners regarding it. The claim that patients are obligated to trust their physicians was challenged. Trust in therapeutic relationships was seen .to be a moral value which is elevated to the status of a moral principle and defended within a theory of care.