Handling mistaken trust when doctors recruit patients as research participants

June 14, 2012

Patients seem more willing to participate in biobank research than the general public. A possible explanation is the doctor-patient relationship. Patients’ trust in health care professionals might help doctors to recruit them as research participants, perhaps making the task too easy.

That trust in doctors can induce a willingness to participate in research seems threatening to the notion of well-informed autonomous decision making. Can sentiments of trust be allowed to play such a prominent role in these processes?

Rather than dismissing trust as a naïve and irrational sentiment, a new article distinguishes between adequate and mistaken trust, and argues that being trusted implies a duty to compensate for mistaken trust.

The article in Bioethics is written by Linus Johnsson at CRB, together with Gert Helgesson, Mats G. Hansson and Stefan Eriksson.

The article discusses tree forms of mistaken trust:

  1. Misplaced trust: Trusted doctors may lack relevant knowledge of biobank research (for example, about the protection of privacy).
  2. Irrational trust: Patients may be mistaken about why they trust the doctor (the doctor may actually be a form of father or mother figure for the patient).
  3. Inappropriate trust: Patients may inappropriately expect doctors always to play the role of therapists and fail to see that doctors sometimes play the role of research representatives who ask patients to contribute to the common good.

The idea in the paper, if I understand it, is that instead of dismissing trust because it might easily be mistaken in these ways, we need to acknowledge that being trusted implies a duty to handle the potentiality of mistaken trust.

Trust is not a one-sided sentiment: it creates responsibilities in the person who is trusted. If doctors take these responsibilities seriously, the relationship of trust immediately begins to look… well, more trustworthy and rational.

How can mistaken forms of trust be compensated for?

Misplaced trust in doctors can be compensated for by developing the relevant expertise (or by dispelling the illusion that one has it). Irrational trust can be compensated for by supporting the patient’s reasoning and moral agency. Inappropriate trust can be compensated for by nurturing a culture with normative expectations that doctors play more than one role; a culture where patients can expect to be asked by the doctor if they want to contribute to the common good.

If patients’ trust is seen in conjunction with these corresponding moral responsibilities of doctors, the relationship of trust can be understood as supporting the patients’ own decision making rather than undermining it.

That, at least, is how I understood this subtle philosophical treatment of trust and its role when patients are recruited by doctors as participants in biobank research.

Pär Segerdahl

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