Building trustworthy relationships, a reconstruction of ethics education for the health care professions

grantor: University of TorontoThe general public distrusts professional claims to expertise and goodwill. This thesis proposes a new direction for ethics education that builds trustworthy relationships. Ethics education in the curricula of Canadian occupational therapy programmes show a concentration on rules and regulations. Assuming that there is a connection between the emphasis on regulation and distrust in professional practice this thesis examines professional relationships. It argues that the professions have taken on roles of power and control that are incompatible with professionalism. In addition, it suggests that the emphasis on regulation as a strategy for encouraging trust is misguided. An analysis of trust implies that confidence and proper trust, while related, are separate entities. Rules build confidence but they generate distrust. It is argued that proper trust is the only ethical basis for inherently unequal professional relationships where outcomes are uncertain. How is trust to be nurtured? It is claimed that respect is what matters most to people and a review of the literature outlines the different ways in which respect has been interpreted. Walzer's (1994) novel notion of the relationship between thick and thin morality suggests a new way of looking at respect that is owed to everyone and respect that is particular to individuals. This reconstruction of respect leads to consideration of a similar relationship between trust and confidence. In turn, this suggests an analogous relationship between those who hold commercial and guardian roles within the health care professions. It is argued that the relationship, so changed, respects professionalism and recognizes the need for social controls. Such radical thinking is consistent with the cultural theory of modernity described by Taylor (1995) that appreciates particularity rather than the hegemonic acultural theory that seeks culture neutrality. The professions are hardly likely to be persuaded to adopt such thinking unless it serves their purposes. The thesis concludes that a reconstruction of ethics education that includes the moral perspective of trustworthy relationships, re-interpreted for the 21st century, is essential if the professions are to survive as autonomous experts in contemporary society and be seen as trustworthy.Ed.D