It is widely acknowledged that trust is a vital component of healthy individual clinical relationships. The relationship between patients (or potential patients) and healthcare institutions, however, has not been well characterized. Some authors assume a contractual model, in which an informed consumer chooses to subscribe to an insurance plan or be cared for at a provider institution. Others see the healthcare institution as merely the context or locus for individual interpersonal relationships. The literature on institutional trust in other arenas, however, suggests that individuals can and do perceive relationships with organizations as, at least in part, trust-based. Individual relationships with healthcare organizations are likely to be heavily reliant on trust because of patient vulnerability, knowledge discrepancies, and the need to allocate scarce resources. In this paper I will use the philosophical and sociological literature on institutional trust to draw conclusions about the ethics of healthcare organizations. I will argue that the individual-institution relationship in health care is trust-based and therefore, like interpersonal trust-based relationships, has moral content. Institutional trust relationships share some features of interpersonal trust relationships, namely vulnerability, power issues, and expectations of beneficence, competence and ethical behavior. Institutional trust, however, is more likely to rely on procedural fairness, openness, and participation or voice in policies and less on advocacy. Organizational behavior can increase or decrease actual trust, and (independently of its effect on actual trust) can justify, warrant, or undermine trust. Particular moral responsibilities for healthcare institutions, and patients, follow from the trust-based nature of individual-healthcare institution relationships.
Learning Objectives: After attending this session, participants will: · Know and understand the elements of trust in organizations · Be able to apply an understanding of trust to healthcare organizations · Understand the difference between a trusted and a trustworthy organization · Know and understand the moral aspects of trust-based relations · Have reflected on what organizational actions might increase or decrease the trust individuals place in them (especially patients and potential patients) · Have reflected on what organizational actions might enhance or undermine trustworthiness · Have reflected on the the elements of trusting organizations wisely
Keywords: Health Care Delivery, Bioethics
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.