Abstract

Utilizing Trudy Govier’s (1997) conception of social trust, this dissertation will provide a framework for understanding trust in healthcare relationships and highlight some of the ways that unequal power distribution and dependency, poorly defined roles, and institutions complicate trust between women and their providers. This framework will also explain how distrust, especially prejudicial distrust, leads to paternalistic attitudes on the part of providers. Paternalism limits patient autonomy because medical autonomy is constitutively relational. This means that insofar as distrust causes paternalism, it also damages autonomy. Through negative outcomes, this lack of autonomy can cause patients to distrust healthcare, which can contribute to a spiral of distrust between patients and providers. This dissertation will provide two contexts of how this distrust could play out in the clinical setting. The first conception involves lying as a response to testimonial injustice. When providers give patients a credibility deficit and distrust them to testify about their symptoms, providers may engage in the paternalistic practice of dismissing or minimizing the patient’s testimony in favor of their own assessment of the patient’s lived experience. If this practice is institutionalized, it can lead to a phenomenon known as testimonial silencing, where patients feel hopeless about their ability to convey information and distrust providers to take them seriously. This dissertation suggests that in order to overcome this silencing and reclaim autonomy in the patient-provider relationship, patients may lie to providers, not to deceive them, but in order to convey accurate information in a way that achieves perlocutionary success. The second conception deals with choice limitation in reproductive healthcare. In expanding the scope of reproductive coercion, it becomes evident that certain practices at the systematic or political level and at the clinical level should be defined as reproductive coercion. In order to explicate how reproductive choices, especially women’s choices, are restricted in multiple spheres, I argue that reproductive coercion occurs at three distinct levels of engagement with society: intimate, clinical, and systematic. By focusing on the clinical setting, the dissertation can demonstrate how paternalistic practices in healthcare, brought on by distrust in patients as decision-makers, can coerce women into certain reproductive choices that run counter to their autonomous preferences.