Building trust and gaining autonomy : the Trust-Autonomy Puzzle in the patient-physician relationship

This dissertation addresses The Trust-Autonomy Puzzle in the patient-physician relationship, i.e., under the assumption that patient-physician trust and patient autonomy are both valuable, how should trust and autonomy be construed so that we can have both in the patient-physician relationship? I critically examine Onora O’Neill’s solution to the puzzle. O’Neill’s solution to this puzzle is to repudiate individual autonomy and adopt Kantian principled autonomy. It implies that autonomy is no longer seen as a feature of persons, but of universalizable principles. Because Kantian principled autonomy is compatible with trust, we can have both autonomy and trust in the patient-physician relationship. I don’t think that this is the best solution available. I argue that individual autonomy should not be repudiated, and that Kantian principled autonomy is theoretically appealing but practically inadequate. Also, it is not clear what notion of trust O’Neill has in mind, so both her repudiation of individual autonomy and her defense of Kantian principled autonomy may not be well grounded. My solution to this puzzle is to adopt a revised notion of individual autonomy which means although autonomy is still a feature of persons, a person is seen as an individual who stands in a variety of interpersonal relationships with others and bears a variety of responsibilities, obligations, commitments, etc., according to those relationships. More importantly, I provide a non-reductive, robust account of interpersonal trust. According to my account, trust has a non-normative aspect, a normative aspect, and an affective aspect. Each is sufficient for at least some level of trust, but none is necessary. For full trust, all aspects may be necessary. More importantly, when trusting others, we expect (or are optimistic) that they will act autonomously according to their reflectively accepted obligations, responsibilities, commitments, etc., which amounts to respecting their autonomy. The revised notion of individual autonomy is not only compatible with my account of trust, but also an essential part of trust. In short, mutual interpersonal trust essentially involves respecting individual autonomy. As a result, we can have both patient autonomy and patient-physician trust. By building trust, we also gain autonomy.Philosoph