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. 2023 Sep:53 Suppl 2:S33-S38.
doi: 10.1002/hast.1521.

Climates of Distrust in Medicine

Laura Specker Sullivan

Climates of Distrust in Medicine

Laura Specker Sullivan. Hastings Cent Rep. 2023 Sep.

Abstract

Trust in medicine is often conceived of on an individual level, with respect to how people rely on particular clinicians or institutions. Yet as discussions of trust during the Covid-19 pandemic highlighted, trust decisions are not always as individual or interpersonal as this conception suggests. Rather, individual instances of trusting behavior are related to social trust, which is conceived as a willingness to be vulnerable to people in general, based on a sense of shared norms. In this essay, I propose that individual and social trust are connected to each other in what can be termed a "climate of trust." I explain how masking trends during the pandemic facilitated a "climate of distrust," and I consider the role that clinicians might play in transforming climates of distrust into climates of trust.

Keywords: Covid-19; bioethics; injustice; masking; medicine; social trust.

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References

    1. This anecdote is abstracted from E. Rittenberg, “Trust, Faith, and Covid,” New England Journal of Medicine 385 (2021): 2504-5.
    1. There is considerable variation in use of the terms “distrust” and “mistrust.” For some, the two are synonyms, while, for others, “distrust” refers to a particular object of suspicion and “mistrust” is more general. Yet others define “distrust” as the expectation of harm (not the mere absence of trust) and “mistrust” as either the mere absence of trust or misplaced trust. For simplicity's sake, I will use “distrust” and forgo use of “mistrust.” In addition, “distrust” here just means the absence of trust-it does not necessarily indicate active suspicion.
    1. K. Hawley, How to Be Trustworthy (New York: Oxford University Press, 2019); R. Hardin, Trust and Trustworthiness (New York: Russell Sage Foundation, 2002); K. Jones, “Trust as an Affective Attitude,” Ethics 107, no. 1 (1996): 4-25.
    1. K. Vallier and M. Weber, eds., Social Trust (New York: Routledge Studies in Contemporary Philosophy, 2021).
    1. Eric Uslaner terms this “moralistic trust” and distinguishes it from a form of interpersonal trust he terms “strategic trust” (E. Uslaner, The Moral Foundations of Trust [Cambridge: Cambridge University Press, 2002], 15); see also F. Fukuyama, Trust: The Social Virtues and the Creation of Prosperity (New York: Simon and Schuster, 1995), 29.

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