I. Trust and Autonomy

Onora O’Neill notes in her book, Autonomy and Trust in Bioethics, that trust in the medical professions has been decreasing in recent years, even though “we might expect the increasing attention paid to individual rights and to autonomy to have increased public trust in the ways in which medicine is practiced and regulated.”1 Instead, “the loss of trust is a constant refrain in the claims of campaigning groups in the press.”2 She argues that this is dangerous insofar as the decline of trust in their doctors affects the ability of the patients to make autonomous decisions about their own health. Although concern about the loss of trust is widely shared, there is disagreement about what type of trust is necessary to the doctor-patient relationship. Annette Baier’s conception of trust as necessarily involving an element of good will on the part of the trusted party, has been influential in characterizing the medical relationship. On the other hand, Allen Buchanan contends that Baier’s concept of trust is not necessary for the medical relationship; rather, he suggests that a form of mere reliance, implying nothing about good will on the part of the doctor, is sufficient for the well-functioning of the doctor-patient relationship, especially in the modern world of managed care organizations.3 Recognizing that managed care organizations are replacing the traditional doctor-patient relationships as sources of medical care, Buchanan argue