Integrating the Ethics of Trust into Bioethics: Examining the Prospects and Challenges

Trust is considered foundational to the doctor-patient relationship and plays a central role in shaping patient-provider interactions across a range of temporal and institutional scales. Yet, despite its importance, most bioethical frameworks do not explicitly engage with the ethics of trust or provide a systematic account of how to integrate considerations of trust into ethical decision-making. I argue that an important reason for this omission is that considerations of trust feature differently in our decision-making than other kinds of considerations (e.g., beneficence or autonomy), meaning that they cannot be integrated into bioethical frameworks the same way as other considerations. More specifically, because trust is a feature of a relationship that can be gained or lost, the ethics of trust requires a special focus on how our decisions will affect our relationships with other people rather than how they will affect those people per se. This shift in focus adds a layer of complexity to the ethics of trust that is not well-handled by traditional bioethical frameworks. Accordingly, I propose an alternative, multi-level approach to integrating trust into bioethics that introduces trust as a higher-order regulatory parameter in ethical decision-making. In this role, considerations of trust would serve as a unifying basis for negotiating conflicts in first-order values and for developing decision architectures for healthcare providers. I conclude by discussing some examples of how this might work in practice, focusing in particular on how this proposal might help inform responses to the emerging crisis of trust in healthcare.