This paper explores the ways in which trust and distrust, especially among relative strangers, are connected to social identities and locations. It begins by sketching an account of interpersonal trust, emphasizing the role that socially salient identities, based in part upon cultural figurations, play in their development. It then contends that these cultural figurations both foster and result from distrust of specific social groups, including African Americans, the poor, and (some) women. Treating social roles and relations as central to moral (...) analysis enables an understanding of the injustice of some forms of social distrust which does not imply that one individual’s distrust of another is culpable in a straightforward way. The paper then develops the claim that one’s social location can affect the moral desirability of trust and distrust, concluding that social distrust can sometimes function as a kind of dissident attitude, a political stance with emancipatory potential. (shrink)

: Feminist epistemologists have found the atomistic view of knowers provided by classical epistemology woefully inadequate. An obvious alternative for feminists is Lynn Hankinson Nelson's suggestion that it is communities that know. However, I argue that Nelson's view is problematic for feminists, and I offer instead a conception of knowers as "individuals-in-communities." This conception is preferable, given the premises and goals of feminist epistemologists, because it emphasizes the relations between knowers and their communities and the relevance of these relations for (...) epistemic assessments. Furthermore, it provides a sense of epistemic agents as active reflective inquirers, capable of transforming and improving knowledge-seeking practices. (shrink)

This paper explores the ways in which trust and distrust, especially among relative strangers, are connected to social identities and locations. It begins by sketching an account of interpersonal trust, emphasizing the role that socially salient identities, based in part upon cultural figurations, play in their development. It then contends that these cultural figurations both foster and result from distrust of specific social groups, including African Americans, the poor, and (some) women. Treating social roles and relations as central to moral (...) analysis enables an understanding of the injustice of some forms of social distrust which does not imply that one individual’s distrust of another is culpable in a straightforward way. The paper then develops the claim that one’s social location can affect the moral desirability of trust and distrust, concluding that social distrust can sometimes function as a kind of dissident attitude, a political stance with emancipatory potential. (shrink)

The use of opioid contracts, which often require patients to submit to random drug screens, have become widespread amongst physicians using opioids to treat chronic pain. The main purpose of the contract is to improve care through better adherence to opioid therapy but there is little evidence as to its efficacy. The author suggests the use of opioid contracts and random drug testing destroys patients' trust which impacts health outcomes, and that physicians' motivation for their use are concerns about prosecution, (...) medication abuse and misuse, and addiction. Statistics are provided to counter fears, and evidence is offered suggesting opioid contracts are unenforceable and lack efficacy; random drug testing is often inconclusive, and a patient's trust improves adherence to treatment. (shrink)

It is common for physicians who prescribe opioids for chronic pain to have their patients sign an opioid contract in order to receive opioid therapy. A vast majority of these contracts contain a stipulation requiring patients to submit to random drug testing which screens for both licit and illicit drugs. Physicians who prescribe opioids may be concerned about prosecution and disciplinary actions; medication abuse and misuse; and addiction. Steven Passik et al. write, “…physicians still fear the risk of abuse or (...) addiction as well as the potential legal consequences of their prescribing.”Issues surrounding OC/RDT need a closer look with a focus on enforceability and efficacy of the opioid contract; accuracy and complications of drug screens and their interpretation; and the importance of trust between patient and physician. In addition, it is vital to dispel fears with facts regarding prosecutions, nonmedical use of prescription opioids, and addiction. (shrink)

Pain is one of the most frequent presenting symptoms for patients who come to a physician's office. Despite the frequency of this presentation, little consistent, systematic information is provided to medical students or physicians about the treatment of pain. In addition, relatively little information is given about the recognition and prevention of drug abuse and about how to prescribe analgesics rationally to minimize the chances for abuse. This lack of educational preparation for both pain and addiction contributes to significant fear (...) and inability on the part of health professionals to diagnose and treat both conditions. It creates a barrier of fear to prescribe adequate doses of pain medications for patients who present with both acute and chronic pain problems. Inadequate medicating can be caused by the physician's overriding worry about creating addiction in a patient. Morgan has called this problem “opiophobia.”. (shrink)

Pain is one of the most frequent presenting symptoms for patients who come to a physician's office. Despite the frequency of this presentation, little consistent, systematic information is provided to medical students or physicians about the treatment of pain. In addition, relatively little information is given about the recognition and prevention of drug abuse and about how to prescribe analgesics rationally to minimize the chances for abuse. This lack of educational preparation for both pain and addiction contributes to significant fear (...) and inability on the part of health professionals to diagnose and treat both conditions. It creates a barrier of fear to prescribe adequate doses of pain medications for patients who present with both acute and chronic pain problems. Inadequate medicating can be caused by the physician's overriding worry about creating addiction in a patient. Morgan has called this problem “opiophobia.”. (shrink)

ABSTRACT Defining a nonpaternalistic yet achievable form of trust in medicine in an era of simultaneous patient empowerment and institutional control has been and remains an important task of bioethics. The ‘crisis of trust’ in medicine has been viewed mainly as the problem of getting patients to trust their health care providers, especially physicians. However, since paradigmatic cases of trust are mutual, bioethicists must pay more attention to physician trust in patients. A physician’s view of the reasonableness of trust in (...) a particular patient is affected not just by his or her relationship with that patient, but also by what is going on institutionally, professionally, legally, and politically with regard to a given treatment or intervention. Since general moral principles are insufficient in determining the moral value and reasonableness of trust in particular instances, I discuss in detail the role of trust and distrust in the specific case of treating patients with medications implicated in drug abuse. I conclude that it is important to become aware, first, of the clinical significance of physician trust and distrust in patients, and second, of the many factors which inform both of these moral attitudes. These two claims together suggest that a central, but overlooked, virtue of medical practice is reflective, context‐responsive trust in patients. (shrink)

In this paper, I claim that the doctor-patient relationship can be viewed as a vessel of trust. Nonetheless, trust within the doctor-patient relationship has been impaired by managed care. When we conceive of trust as social capital, focusing on the role that it plays in individual and social well-being, trust can be viewed as a public good and a scarce medical resource. Given this, there is a moral obligation to protect the doctor-patient relationship from the cost-containment mechanisms that compromise its (...) ability to produce trust. (shrink)

It is generally accepted that the therapeutic relationship between professionals and patients is one of trust. Nonetheless, some patient groups carry certain social vulnerabilities that can be exacerbated when they extend trust to health-care professionals. In exploring the epistemic and ethical implications of expert status, this paper examines how calls to trust may increase epistemic oppression and perpetuate the vulnerability of people with impairments. It critically evaluates the processes through which epistemic communities are formed or determined, and examines the institutional (...) structure and power relations that contribute to or sustain such self-affirming ideological communities. It also argues for a two-way collaborative approach between professionals and people with impairments that recognizes the role of local knowledge in enhancing professionals’ own understanding of their theoretical framework and promoting responsive practices and policies. (shrink)

Trust is taken to be one of the foundational values in the doctor-patient relationship, facilitating access to the benefits of health care and providing a guarantee against possible harms. Despite this foundational role, some doctors betray the trust of their patients. Trusting involves granting discretionary powers and makes the truster vulnerable to the trustee. Patients trust medical practitioners to act with goodwill and to act competently. Some patients carry pre-existing vulnerabilities, for reasons such as gender, poverty, age, ethnicity, or disability, (...) and these vulnerabilities can be exacerbated when such patients extend their trust to a doctor. Gender stereotypes reduce women's ability to challenge and thereby assess their doctor's competency. In addition, women are more likely to be distrusted by their doctors and have their experiences of medical symptoms discounted. In this paper, we analyze two extreme examples of breaches of medical trust that exploited the vulnerability of women in the health care system: the "unfortunate experiment" at the National Women's Hospital in New Zealand and the Harold Shipman murders of elderly patients in the United Kingdom, examining the potential role of gender in the outcomes with regard to trust. Major breaches of medical trust such as these typically lead to government inquiries, revisions of ethical guidelines, and substantive policy change in an effort to re-establish public and patient trust. We argue that the medical profession has an ethical obligation to put mechanisms in place to protect vulnerable patients from abuses of trust, to monitor colleagues' competence, and to be prepared to blow the whistle to protect patients who are not in a position to recognize misplaced trust. Such mechanisms will act disprosportionately to reduce harm to women as patients. (shrink)