Toward a paradigm shift: corrective trust as a pathway to mitigate biases in healthcare and beyond

ABSTRACT

In this paper, I explore the concept of corrective trust as a pathway to mitigate biases, and potentially build or restore mutual trust in relationships characterized by power imbalances, particularly within the context of healthcare. Corrective trust takes place when we actively choose to trust others when our initial mistrust or hesitation to trust is due to biases. However, existing accounts of trust as a special form of reliance present challenges to practicing corrective trust. I propose a non-reductive account that construes trust as a basic (i.e. irreducible to more basic concepts such as reliance) but complex (i.e. consists of cognitive, affective, and normative components) attitude, disentangling it from reliance and thus addressing associated challenges. This redefinition enables a deeper understanding of trust and facilitates the application of corrective trust to mitigate biases in healthcare and beyond.

KEYWORDS:

• Corrective trust
• biases
• healthcare
• trust
• reliance
• bias mitigation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In this paper, biases are defined as systematic and frequently unconscious inclinations or prejudices that impact judgments, decisions, and behaviors either in favor of or against specific individuals, groups, or ideas. These biases can arise from diverse sources such as personal experiences, cultural backgrounds, social norms, and cognitive shortcuts. They encompass social biases related to factors such as race, gender, age, ability, nationality, among others, as well as well-known cognitive biases like confirmation biases, availability biases, and motivated reasoning.

2 For an extensive survey of current accounts of trust, see McLeod (2023).

3 See McLeod (2023).

4 Coping trust is exemplified by situations where we place our trust in strangers amidst unfamiliar and potentially perilous circumstances, such as during emergencies. In such instances, we may extend trust without evidence to cope. For instance, in the aftermath of a car crash, entrusting our safety to a stranger offering assistance reflects coping trust in action.

5 Therapeutic trust happens when we place our trust in others with the expectation that this trust will facilitate the development of future trustworthiness. This form of trust is particularly prominent in familial relationships, where parents may invest trust in their children as a means of nurturing their trustworthiness, despite lacking supporting or encountering contrary evidence. Our hope for the potential for growth and improvement underpins the rationale for therapeutic trust.

6 For example, a wealthy employer may harbor unfounded suspicions toward an immigrant employee based on stereotypes, while the employee’s distrust of the employer stems from experiences of exploitation within a historically unjust system.

7 Consider a scenario where Jones, from a marginalized community, who has historically faced discrimination and economic hardship, is hesitant to trust a well-off neighbor Smith. Smith, despite having more resources and societal advantages, may also harbor mistrust due to prevailing stereotypes. In this situation, asking Jones to extend corrective trust to Smith may place an unfair burden on them. Smith, however, with greater resources and societal privilege, owes it to Jones to initiate corrective trust, recognizing the systemic injustices and their own biases at play.

8 Intersectionality adds complexity; for instance, a physician may hold power in a patient-physician relationship but be disadvantaged in other dimensions. When biases affect both parties, there’s a shared responsibility for corrective trust. Ultimately, when mistrust stems from biases, there’s a prima facie duty to extend corrective trust, though morally salient factors may undermine or override this duty, especially in situations where one party is overall more disadvantaged.

9 There are exceptions. For example, Thomas Simpson (2012) offers a genealogical account of trust which is not reductive and challenged by counterexamples. I argue that these counterexamples arise because trust cannot be analyzed in terms of sufficient and necessary conditions. Furthermore, the endeavor to analyze trust as reliance plus the condition ‘T’ is flawed. Bernd Lahno (2020) has explained the inevitability of counterexamples.

10 For an extensive survey of the existing accounts and the counterexamples they face, see McLeod (2023).

11 With few exceptions, see, for example, Nguyeu (2022).

12 For example, see Hawley (2014) and D’Cruz (2020).

13 Some may argue that this is an instance of coping trust, but I disagree. If I have evidence of the doctor’s untrustworthiness, it would be challenging and unreasonable for me to trust them even in coping with an emergency. Therefore, neither therapeutic trust nor corrective trust would be appropriate in this context, as the practical basis for trust is lacking.

14 It shows when we trust others, it is not always the case that we trust them to perform a task. Trust is primarily attitudinal rather than contractual. See Faulkner (2015) for a detailed argument.

15 According to Faulkner (2015, 427–428), trust tends to track trustworthiness, but viewing trust as “A relies on B to do something plus T” severs the link between trust and trustworthiness. As a result, the ‘analytical connection between trust and trustworthiness’ is lost. However, if trust is viewed as a basic attitude, the analytical connection between trust and trustworthiness remains intact. When A adopts an attitude of trust towards B, they aim to assess B’s overall trustworthiness. If B is not trustworthy, A should not adopt this attitude; if B is trustworthy, A should adopt this attitude. The specific task A relies on B to perform is irrelevant. Indeed, reliably assessing B’s trustworthiness is a justification condition for A’s trust.

16 This example is borrowed from Hawley (2014).

17 To resolve this conceptual issue, trust should not be viewed as a subset of reliance; instead, they intersect. Similarly, trustworthiness should not be restricted to competence alone; their relationship is also one of intersection. When we trust someone, we may rely on them even for tasks they are not competent in, or when we are uncertain about their competence, simply because we believe they will make sincere efforts to fulfill their commitments.

18 See a report from The New York Times: https://www.nytimes.com/interactive/2021/06/15/us/amazon-workers.html?smid=url-share.

19 According to my non-reductive account of trust, trust should be seen as a basic, i.e. irreducible, attitude toward persons (or institutions) rather than reliance plus some other condition T. This attitude of trust is complex because it can have both a cognitive component and an affective component. For the cognitive component, it has two parts, i.e. the non-normative part and the normative part. Accordingly, on my account, trust is seen as having three components, i.e. the non-normative cognitive component, the normative cognitive component, and the affective component. Although none is necessary for trust, each is sufficient for at least some degree of trust. However, for full trust, all components are necessary. As an essential part of my account, I propose a reliabilist account of the reasonableness of trust, i.e. trust is reasonable when it is the result of a reliable mechanism or process. For example, your trust is reasonable when it falls in the non-normative part of the cognitive component under the condition that it reliably tracks the truth regarding those non-normative beliefs. Your trust is reasonable when it falls in the normative part of the cognitive component under the condition that your normative expectation reliably tracks people’s obligations, responsibilities, commitments, etc. and the likelihood they will fulfill them and their trustworthiness. Your trust is reasonable when it falls in the affective component under the condition that your affective attitudes toward a person are not distorted by any internal or external factors. If your trust involves more than one component, the reasonableness of your trust should be evaluated in all corresponding aspects. The upshot is that the higher the degree of your trust, the more reliable processes you need in order for your trust to be reasonable. I see this as a merit of my account because it explains how the degree of our trust should vary according to our rational beliefs, affective altitudes, and normative expectations which in turn depend upon what kind of relationships we are considering.

Additional information

Notes on contributors

Ju Zhang

Ju Zhang is a postdoctoral fellow in bioethics at the Emory University Center for Ethics. Her current research focuses on developing and defending a trust-oriented model of the patient-physician relationship. Her goal is to promote reasonable patient-physician trust by modifying relevant concepts such as patient autonomy, informed consent, and justified intervention in light of her model. She intends to extend her research on patient-physician trust to nonexpert-expert trust in general and to trust between a relatively disadvantaged individual/group and a relatively advantaged individual/group. She is also interested in studying trust and cooperation among communities, societies, and nations, believing that reasonable trust is key in tackling global issues such as climate change and pandemics.