The Ethics and Empirics of Trust

  • Mark A. Hall
Part of the Philosophy and Medicine book series (PHME, volume 76)


I will use the occasion of discussing managed care as an excuse to develop a more general ethic of trust. One hardly needs an excuse to talk about trust, considering its foundational nature, but if justification is required, managed care provides it amply Numerous commentators have observed the many threats that managed care poses to patients’ ability to trust their physician (Anders, 1996; Mechanic, 1996; Buchanan, 2000). Managed care forces patients to leave doctors they know well, it limits their choice of their new physician, it oversees physicians’ decisions with a view to restricting care, and it rewards physicians in a manner that creates a conflict of interest. Can trust survive in such a climate, and should we care? Is managed care an unmitigated ethical disaster, or is it possible to construct an ethic of trust that is consistent with at least some forms of managed care? I hope to provide at least tentative insights into each of these questions.


Health Plan Medical Ethic Interpersonal Trust Assisted Suicide Lower Trust 
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  1. Anders, G. (1996). Health Against Wealth: HMOs and the Breakdown of Medical Trust. Boston: Houghton Mifflin.Google Scholar
  2. Anderson, A.D. Guerwitsch, D.A. (1982). ‘Therapeutic trust.’ Journal of Chronic Diseases, 35, 817–820.CrossRefGoogle Scholar
  3. Anderson, L. Dedrick, R.F. (1990). ‘Development of the trust in physician scale: A measure to assess interpersonal trust in patient physician relationships.’ Psychological Reports, 67, 1091–1100.Google Scholar
  4. Baier, A. (1986). ‘Trust and antitrust.’ Ethics, 96, 231–260.CrossRefGoogle Scholar
  5. Basmajian, J. V. (1999). ‘Debonafide effects vs. “placebo effects”.’ Proceedings of the Royal College of Physicians of Edinborough, 29, 243–244.Google Scholar
  6. Becker, L.C. (1996). ‘Trust as noncognitive security about motives.’ Ethics, 107, 43–61.CrossRefGoogle Scholar
  7. Ben Sira, Z. (1980). ‘Affective and instrumental components in the physician-patient relationship: An additional dimension of interaction theory.’ Journal of Health and Social Behavior, 21, 170–180.CrossRefGoogle Scholar
  8. Bigley, G.A. Pearce, J.L. (1998). ‘Straining for shared meaning in organization science: Problems of trust and distrust.’ Academy of Management Review, 23, 405–421.Google Scholar
  9. Boyte, W.R. (2001). ‘Casey’s legacy: Finding generosity when admitting an error in judgment.’ Health Affairs, 20 (2), 250–254.CrossRefGoogle Scholar
  10. Branch, W.T. (2000). ‘Is the therapeutic nature of the patient-physician relationship being undermined?’ Archives of Internal Medicine, 160, 2257–2260.CrossRefGoogle Scholar
  11. Buchanan, A. (2000). ‘Trust in managed care organizations.’ Kennedy Institute of Ethics Journal, 10 (3), 189–212.CrossRefGoogle Scholar
  12. Carter, M.A. (1989). Ethical Analysis of Trust in Therapeutic Relationships. Ann Arbor: University of Michigan.Google Scholar
  13. Caterinicchio, R.P. (1979). ‘Testing plausible path models of interpersonal trust in patient-physician treatment relationships.’ Science and Medicine, 13A, 81–99.Google Scholar
  14. Cook, K.S. (2001). Trust in Society. New York: Russell Sage Foundation.Google Scholar
  15. Cooter, R. (2000). ‘Do good laws make good citizens? An economic analysis of internalized norms.’ Virginia Law Review, 86 (8), 1577–1602.CrossRefGoogle Scholar
  16. Davies, H.T.O. Rundall, T.G. (2000). ‘Managing patient trust in managed care.’ The Milbank Quarterly, 78 (4), 609–624.CrossRefGoogle Scholar
  17. Evans, F.J. (1985). ‘Expectancy, therapeutic instructions, and the placebo response.’ In: L. White, B. Tursky G.E. Schwartz (Eds.), Placebo: Theory, Research, and Mechanisms (pp. 215–228 ). New York: The Guilford Press.Google Scholar
  18. Fehr, E. Gachter, S. (1998). ‘Reciprocity and economics: The economic implications of homo reciprocans.’ European Economic Review, 42, 845–859.CrossRefGoogle Scholar
  19. Fogarty, L.A., Curbow, B.A., Wingard, J.R., McDonnell, K., Somerfield, M.R. (1999). ‘Can 40 seconds of compassion reduce patient anxiety?’ Journal of Clinical Oncology, 17, 371–379.Google Scholar
  20. Frankel, T. (1998). ‘Fiduciary duties.’ In: P. Newman (Ed.), The New Palgrave Dictionary of Economics and the Law (pp. 127–132 ). New York: Stockton Press.Google Scholar
  21. Frey, B.S. (1997). Not Just for the Money: An Economic Theory of Personal Motivation. Cheltenham,UK: Edward Elgar Publishing.Google Scholar
  22. Gallagher, T.H., Robert, F.St.P., Margaret, C., Bernard, L. (2001). ‘Patients’ attitudes towards cost control bonuses for managed care physicians.’ Health Affairs, 20 (2), 186–192.CrossRefGoogle Scholar
  23. Goold, S. (1998). ‘Money and trust: Relationships between patients, physicians, and health plans.’ Journal of Health Politics, Policy and Law, 23, 688–695.Google Scholar
  24. Govier, T. (1992). ‘Distrust as a practical problem.’ Journal of Social Philosophy, 23, 52–63.CrossRefGoogle Scholar
  25. Govier, T. (1993). ‘An epistemology of trust.’ International Journal of Moral And Social Studies, 2, 155–174.Google Scholar
  26. Govier, T. (1997). Social Trust and Human Communities. Montreal: McGill-Queen’s University Press.Google Scholar
  27. Govier, T. (1998). Dilemmas of Trust. Montreal: McGill-Queen’s University Press.Google Scholar
  28. Gray, B.H. (1997). ‘Trust and trustworthy care in the managed care era.’ Health Affairs, 16, 34–49.CrossRefGoogle Scholar
  29. Hall, M.A. (1994). ‘Rationing health care at the bedside.’ New York University Law Review, 69, 693–780.Google Scholar
  30. Hall, M.A. (1997). Making Medical Spending Decisions: The Law, Ethics, and Economics of Rationing Mechanisms. New York: Oxford University Press.Google Scholar
  31. Hall, M.A., Dugan, E., Zheng, B. et al. (2001). ‘Trust in physicians and medical institutions: What is it, can it be measured, and does it matter?’ Milbank Quarterly, 79, 613.CrossRefGoogle Scholar
  32. Hall, M.A., Zheng, B., Dugan, E. et al. (2002). ‘Measuring patients’ trust in their primary care providers.’ Medical Care Research Review. (in press).Google Scholar
  33. Hall, M.A., Dugan, E., Balkrishnan, R. et al. (2002). ‘How disclosing HMO physicians incentives affects trust.’ Health Affairs, 21 (2), 197.CrossRefGoogle Scholar
  34. Hardin, R. (1996). ‘Trustworthiness.’ Ethics, 107, 26–42.CrossRefGoogle Scholar
  35. Hardin, R. (2001). Trust and Trustworthiness. New York: Russell Sage.Google Scholar
  36. Hargraves, J.L. (2000). Patients Concerned About Insurer Influences. 17. Washington, D.C.: Center for Studying Health System Change. Data Bulletin.Google Scholar
  37. Hays, R.D. Ware, J.E. (1986). ‘My medical care is better than yours: Social desirability and patient satisfaction ratings.’ Medical Care, 24, 519–525.CrossRefGoogle Scholar
  38. Heimer, C.A. (2001). ‘Solving the problem of trust.’ In: K.S. Cook (Ed.), Trust in Society (pp. 40–88 ). New York: Russell Sage Foundation.Google Scholar
  39. Holmes, J.G. Rempel, J.K. (1989). ‘Trust in close relationships.’ In: C. Hendrick (Ed.), Close Relationships (pp. 187–220 ). Newbury Park: Sage Publications.Google Scholar
  40. Horsburgh, H.J.N. (1961). ‘Trust and social objectives.’ Ethics, 72, 28–40.CrossRefGoogle Scholar
  41. Jackson, R. (1996). A Philosophical Exploration of Trust. Lansing, MI: Michigan State University.Google Scholar
  42. Johns, J.L. (1996). ‘A concept analysis of trust.’ Journal of Advanced Nursing, 24, 76–83.CrossRefGoogle Scholar
  43. Kahan, D.M. (2001). ‘Trust, collective action, and law.’ Boston University Law Review, 81, 333.Google Scholar
  44. Kao, A., Green, D.C., Zaslayski, A., Koplan, J.P. Cleary, P.D. (1998). ‘The relationship between method of physician payment and patient trust.’ Journal of the American Medical Association, 280, 1708–1714.CrossRefGoogle Scholar
  45. Katz, J. (1984). The Silent World of Doctor and Patient. New York: Free Press.Google Scholar
  46. Kurtz, S.F. (2000). ‘The law of informed consent: From “doctor is right” to “patient has rights”.’ Syracuse Law Review, 50, 1243–1244.Google Scholar
  47. Lagenspetz, O. Akademi, A. (1992). ‘Legitimacy and trust.’ Philosophical Investigations, 15, 1–21.CrossRefGoogle Scholar
  48. Lake, T. (2000). ‘Do HMOs make a difference? Consumer Assessments of Health Care.’ Inquiry, 36, 411–418.Google Scholar
  49. Lewicki, R.J. McAllister, D.J. (1998). ‘Trust and distrust: New relationships and realities.’ Academy of Management Review, 23, 438–458.Google Scholar
  50. Luhmann, N. (1973). Trust and Power. Chichester: John Wiley Sons.Google Scholar
  51. Lupton, D., Donaldson, D. Lloyd, P. (1991). ‘Caveat emptor or blissful ignorance? Patients and the consumerist ethos.’ Social Science Medicine, 33, 559–568.CrossRefGoogle Scholar
  52. Lynn-McHale, D.J. Deatrick, J.A. (2000). ‘Trust between family and health care provider.’ Journal of Family Nursing, 6 (3), 210–230.CrossRefGoogle Scholar
  53. Mason, R.C.J., Clark, G., Reeves, R.B.J., Wagner, S.B. (1969). ‘Acceptance and healing.’ Journal of Religion and Health, 123–142.Google Scholar
  54. Mayer, R.C., Davis, J.H., Schoorman, F.D. (1995). ‘An integrative model of organization trust.’ Academy of Management Review, 20, 709–733.Google Scholar
  55. Mechanic, D. (1996). ‘Changing medical organization and the erosion of trust.’ Milbank Quarterly, 74, 171–189.CrossRefGoogle Scholar
  56. Mechanic, D. (1998). ‘The functions and limitations of trust in the provision of medical care.’ Journal of Health Politics, Policy and Law, 23, 661–686.Google Scholar
  57. Mechanic, D. Schlesinger, M. (1996). ‘The impact of managed care on patients’ trust in medical care and their physicians.’ Journal of the American Medical Association, 275, 1693–1697.CrossRefGoogle Scholar
  58. Mishra, A. (1996). ‘Organizational responses to crisis: The centrality of trust.’ In: R. Kramer T. Tyler (Eds.), Trust In Organizations: Frontiers of Theory and Research (pp. 261–287 ). Thousand Oaks, CA.: SAGE Publications.CrossRefGoogle Scholar
  59. Murphy, J., Chang, H., Montgomery, J., Rogers, W.H., Safran, D.G. (2000). ‘The quality of physician- patient relationships: Patients’ experiences 1996–1999.’ Journal of Family Practice, 50 (2), 123–129.Google Scholar
  60. Murray, S.L., Holmes, J.G., Griffin, D.W. (1996a). ‘The benefits of positive illusions: Idealization and the construction of satisfaction in close relationships.’ Journal of Personality and Social Psychology, 70 (1), 79–98.CrossRefGoogle Scholar
  61. Murray, S.L. Holmes, J.G. (1997). ‘A leap of faith? Positive illusions in romantic relationships.’ Personality and Social Psychology Bulletin, 23 (6), 586–604.CrossRefGoogle Scholar
  62. Murray, S. L., Holmes, J.G., Griffin. D.W. (1996b). ‘The self-fulfilling nature of positive illusions in romantic relationships: Love is not blind, but prescient.’ Journal of Personality and Social Psychology, 71 (6), 1155–1180.CrossRefGoogle Scholar
  63. Novack, D. H. (1987). ‘Clinical review: Therapeutic aspects of the clinical encounter.’ Journal of General Internal Medicine, 2, 346–355.CrossRefGoogle Scholar
  64. Parsons, T. (1951). The Social System. New York: The Free Press Of Glencoe.Google Scholar
  65. Pearson, S.D. Raeke, L.H. (2000). ‘Patients’ trust in physicians: Many theories, few measures, and little data.’ Journal of General Internal Medicine, 15, 509–513.CrossRefGoogle Scholar
  66. Pellegrino, E.D. Thomasma, D.C. (1993). ‘Fidelity to trust.’ In: E.C. Pellegrino D.C. Thomasma (Eds.), The Virtues in Medicine (pp. 65–78 ). New York: Oxford University Press.Google Scholar
  67. Pellegrino, E. D., Veatch, R.M. Langan, J.P. (1991). Ethics, Trust, and the Professions: Philosophical and Cultural Aspects. Washington, D.C.: Georgetown University Press.Google Scholar
  68. Pennebaker, J. A. (1990). Opening Up: The Healing Power of Confiding in Others. New York: Morrow. Plotkin, W.B. (1985). ‘A psychological approach to placebo: The role of faith in therapy and treatment.’ In: L. White, B. Tursky G.E. Schwartz (Eds.), Placebo: Theory, Research, and Mechanisms (pp. 237–254 ). New York: The Guilford Press.Google Scholar
  69. Putnam, R.D. (2000). Bowling Alone: The Collapse and Revival of American Community. New York: Simon Schuster.Google Scholar
  70. Rempel, J.K., Holmes, J.G. Zanna, M.P. (1985). ‘Trust in close relationships.’ Journal of Personality and Social Psychology, 49, 95–112.CrossRefGoogle Scholar
  71. Rhodes, R. Strain, J.J. (2000). ‘Trust and transforming medical institutions.’ Cambridge Quarterly of Healthcare Ethics, 9, 205–217.CrossRefGoogle Scholar
  72. Rogers, D.E. (1994). ‘On trust: A basic building block for healing doctor-patient interactions.’ Journal of the Royal Society of Medicine, 87, 2–5.Google Scholar
  73. Rotter, J.B. (1980). ‘Interpersonal trust, trustworthiness, and gullibility.’ American Psychologist, 35, 1–7.CrossRefGoogle Scholar
  74. Rousseau, D.M., Sitkin, S.B., Burt, R.S. Camerer, C. (1998). ‘Not so different after all: A cross-discipline view of trust.’ Academy of Management Review, 23, 393–404.CrossRefGoogle Scholar
  75. Safran, D.G., Rogers, W.H., Tarlov, A.R., Inui, T., Taira, D.A., Montgomer, J.E., Ware, J.E. Slavin., C.B. (2000). ‘Organizational and fmancial characteristics of health plans: Are they related to primary care performance?’ Archives of Internal Medicine, 160, 69–76.CrossRefGoogle Scholar
  76. Safran, D.G., Taira, D.A., Rogers, W.H., Kosinski, M., Ware, J.E. Tarlov, A.R. (1998). ‘Linking primary care performance to outcomes of care.’ Journal of Family Practice, 47, 213.Google Scholar
  77. Shapiro, A.K. Shapiro, E. (1983). ‘Patient-provider relationships and the placdbo effect.’ Strategies for Health Enhancement, 25, 317–383.Google Scholar
  78. Shapiro, S. (1987). ‘The social control of impersonal trust.’ American Journal of Sociology, 93, 623.CrossRefGoogle Scholar
  79. Sherlock, R. (1986). ‘Reasonable men and sick human beings.’ American Journal of Medicine, 80, 2–4.CrossRefGoogle Scholar
  80. Sitkin, S.B., Sutcliffe, K.M. Reed, G.L. (1993). ‘Prescriptions for justice: Using social accounts to legitimate the exercise of professional control.’ Social Justice Research, 6 (1), 87–111.CrossRefGoogle Scholar
  81. Stout, L.A. Blair, M.M. (2000). Trust, Trustworthiness, and the Behavioral Foundations of Corporate Law, Social Science Electronic Publishing, Inc.Google Scholar
  82. Thom, D. H., Ribisl, K.M., Steward, A.L., Luke, D.A. The Stanford Trust Study Physicians (1999). ‘Further validation and reliability testing of the trust in physician scale.’ Medical Care, 37, 510–517.CrossRefGoogle Scholar
  83. Thomas, K. B. (1987). ‘General practice consultations: Is there any point in being positive?’ British Medical Journal Clinical Research Education, 294 (6581), 1200–1202.CrossRefGoogle Scholar
  84. Thome, S.E. Robinson, C.A. (1988). ‘Health care relationships: The chronic illness perspective.’ Research in Nursing Health, 11, 293–300.CrossRefGoogle Scholar
  85. Veatch, R.M. (2000). ‘Doctor does not know best: Why in the new century physicians must stop trying to benefit patients.’ Journal of Medicine and Philosophy, 25 (6), 701–721.CrossRefGoogle Scholar
  86. White, B.C. (1999). ‘Assisted suicide and nursing: Possibly compatible?’ Journal of Professional Nursing, 15 (3), 151–159.CrossRefGoogle Scholar
  87. Wilson, S., Morse, J.M. Penrod. J. (1998). ‘Developing reciprocal trust in the caregiving relationship.’ Qualitative Health Research, 8 (4), 446–465.CrossRefGoogle Scholar
  88. Zaner, R.M. (1991). ‘The phenomenon of trust and the patient physician relationship,’ in Pellegrino, E.D., Veatch, R.M., Langan, J.P. (eds.), Ethics, Trust, and the Professions: Philosophical and Cultural Aspects (pp. 45–65 ). Washington, D.C.: Georgetown University Press.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2002

Authors and Affiliations

  • Mark A. Hall
    • 1
  1. 1.Wake Forest UniversityWinston-SalemUSA

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