Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

Trust is frequently discussed with reference to the professional–patient relationship. However, trust is less explored in relation to the ways in which understanding of, and responses to, questions of ethics are discussed by both the “public” and “experts.” Public engagement activity in healthcare ethics may invoke “trust” in analysing a moral question or problem but less frequently conceives of trust as integral to “public engagement” itself. This paper explores the relationship between trust and the ways in which questions of healthcare (...) ethics are identified and negotiated by both “experts” and the public. Drawing on two examples from the author’s “public engagement” work—a radio programme for the British Broadcasting Corporation and work with a playwright and theatre—the paper interrogates the ways in which “public engagement” is often characterized. The author argues that the common approach to public engagement in questions of ethics is unhelpfully constrained by a systemic disposition which continues to privilege the professional or expert voice at the expense of meaningful exchange and dialogue. By creating space for novel interactions between the “expert” and the “public,” authentic engagement is achieved that enables not only the participants to flourish but also contributes to trust itself. (shrink)

In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and practice. Our (...) data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and “the system” underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents—and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust—as arising from the internalization of countering views, which facilitates nuance. (shrink)

In this article, we investigate the role of scientific and patient narratives on perceptions of the medical debate around gestational diabetes testing. Among medical scientists, we show that the narrative surrounding GDM testing affirms that future research and data will lead to medical consensus. We call this narrative trajectory the “deferred quest.” For patients, however, diagnosis and their subsequent discovery that biomedicine does not speak in one voice ruptures their trust in medical authority. This new distrust creates space for patients (...) to develop a Frankian quest narrative where they become the protagonist in their story. Additionally, across these different narratives, we observe how character is constructed and employed to negotiate trust. We conclude that healthcare providers should assess the narrative trajectory adopted by patients after diagnosis. Also, we suggest that providers acknowledge the lack of medical consensus to their patients. This veracity would foster women’s sense of trust in their provider as well as allow women to be active interlocutors in a debate that ultimately plays out in their deliberation about their body, pregnancy, and risk. (shrink)

“Highly personal and original... McKibben goes beyond Marshall McLuhan’s theory that the medium is the message.” ——The New York Times Imagine watching an entire day’s worth of television on every single channel. Acclaimed environmental writer and culture critic Bill McKibben subjected himself to this sensory overload in an experiment to verify whether we are truly better informed than previous generations. Bombarded with newscasts and fluff pieces, game shows and talk shows, ads and infomercials, televangelist pleas and Brady Bunch episodes, McKibben (...) processed twenty-four hours of programming on all ninety-three Fairfax, Virginia, cable stations. Then, as a counterpoint, he spent a day atop a quiet and remote mountain in the Adirondacks, exploring the unmediated man and making small yet vital discoveries about himself and the world around him. As relevant now as it was when originally written in 1992–and with new material from the author on the impact of the Internet age–this witty and astute book is certain to change the way you look at television and perceive media as a whole. “By turns humorous, wise, and troubling... a penetrating critique of technological society.”–Cleveland Plain Dealer “Masterful... a unique, bizarre portrait of our life and times.” –Los Angeles Times “Do yourself a favor: Put down the remote and pick up this book.” –Houston Chronicle. (shrink)

A study how patients and practitioners transform ordinary clinical interchange into a story-line.

The U.S. scientific community has long led the world in research on such areas as public health, environmental science, and issues affecting quality of life. These scientists have produced landmark studies on the dangers of DDT, tobacco smoke, acid rain, and global warming. But at the same time, a small yet potent subset of this community leads the world in vehement denial of these dangers. -/- Merchants of Doubt tells the story of how a loose-knit group of high-level scientists and (...) scientific advisers, with deep connections in politics and industry, ran effective campaigns to mislead the public and deny well-established scientific knowledge over four decades. Remarkably, the same individuals surface repeatedly-some of the same figures who have claimed that the science of global warming is "not settled" denied the truth of studies linking smoking to lung cancer, coal smoke to acid rain, and CFCs to the ozone hole. "Doubt is our product," wrote one tobacco executive. These "experts" supplied it. -/- Naomi Oreskes and Erik M. Conway, historians of science, roll back the rug on this dark corner of the American scientific community, showing how ideology and corporate interests, aided by a too-compliant media, have skewed public understanding of some of the most pressing issues of our era. (shrink)

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.