Raymond De Vries co-director for Bioethics and Social Sciences at the University of Michigan.

Co-Director, Center for Bioethics and Social Sciences in Medicine
Professor, Department of Learning Health Sciences and the Department of Obstetrics and Gynecology
University of Michigan / Bioethics in Sociology

Raymond De Vries co-directs the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and is a Professor in the Department of Learning Health Sciences and the Department of Obstetrics and Gynecology there. He is particularly interested in the regulation of science and the production of scientific knowledge; clinical trials of genetic therapies; the export of western moral traditions to non-western societies; and the social, ethical, and policy issues associated with the medicalization of pregnancy and birth.

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Videos by Raymond De Vries

Raymond De Vries is a sociologist, and his field actually has a pretty unique take on bioethics.

The Rise of Bioethics in Response to Medical Distrust: Key Findings

Research
Contributor / Raymond De Vries
Raymond De Vries Bioethics Institutions and Context,Distrust Bioethics is particularly interesting for people who want to study trust because it arose when a much-trusted profession, medicine, lost the trust of the public.

Essentially, bioethics is the child of distrust in medicine and medical research.

The erosion of trust in medicine began in the 20th century with frightening medical experiments and frightening new technologies.

Trust in medicine was diminished when the public learned of the horrendous experiments done by the Nazis in World War II but also when they learned about experiments being done in the United States by the public health service.

The most famous of these is the Tuskegee experiment, where poor black men in Alabama who had syphilis were denied treatment for their disease by researchers who wanted to learn about the natural course of syphilis.

But the sources of this distrust in medicine and medical research is not just about the poor conduct of researchers and about new technologies.

To fully understand public distrust, we have to look at the larger picture of medicine in society.

Bumper: Tracing the Erosion of Trust in Medicine

In his book Trusting Doctors, Jonathan Imber points out that physicians in the United States began to lose their authority after World War II when they began to be valued for their technical competence rather than their personal integrity.

Another sociologist Andrew Abbott points out that the changing nature of the physician work force altered the relationships of trust between patients and physicians.

In earlier times, when physicians came from the communities where they worked, trust was automatic. But increasingly, patients are having physicians who come from different parts of the country, from different countries, from different ethnic groups.

And trusting relationships that were assumed when these parties came from the same community now had to be regulated by codes of conduct and by ethics committees.

And finally, it’s important to note that all these changes were occurring in the 1960s and 1970s in a period of great civil unrest, in a period characterized by the civil rights movement, the women’s rights movement, the gay rights movement—all of these movements began to challenge the authority of existing institutions, like religion, like law, like medicine, like family.”

Bumper: Does Bureaucracy Enhance or Undermine Trust?

The result of this increased suspicion of medicine was increased oversight in the form of research ethic committees called “institutional review boards,” or IRBs, in the United States, and clinical ethics committees.

What is gained by this formalization of trust? Looked at from the point of view of sociology, you might say that what this does is simply move trust around.

So, trust that used to exist between a patient and a physician or between a research subject and a researcher has now been shifted to trust that has to exist between a patient or research subject and an ethics committee, and that ethics committee and the researcher.

This bureaucratization of trust is a cause for much debate. On the one hand, there are people who say these committees actually facilitate research.

On the other hand, there is evidence that moving trust in this way actually prompts more devious behavior on the part of researchers as they try to evade the regulations of the research ethics committee.

Some colleagues and I did research looking at self-report of misconduct by researchers, and we discovered a significant number of researchers were willing to admit that they ignore the rules of institutional review boards.

Bumper: Bureaucracy, Trust, and Informed Consent

Perhaps the best example of the formalization of trust in medicine and medical research is the use of informed consent. Informed consent is the process of explaining what will happen to a person in the clinic or in research and then asking for their consent to participate in care or research.

This is an important tool of bioethics, one that is assumed to protect a person’s autonomy—that is, the right to say what happens to your body—but also to promote trust in medicine and medical research. But does it?

There’s an irony here that the use of informed consent can actually promote distrust. How does that happen? Let me give you an example.

Studies have shown that more police on the street creates more fear of crime than it diminishes, because people start to ask, “Why are there so many police around? There must be more crime in my neighborhood.”

Informed consent works in a similar way. When given to a patient or a research subject, the natural response is, “Is there some reason I should distrust you?”
How trust shapes the medical field by Raymond De Vries.

How Trust Shapes the Medical Field: A Sociologist’s Perspective

Foundations
Contributor / Raymond De Vries
Raymond De Vries Bioethics Trust and Networks,Generalized Trust Trust is central to the work of bioethics. In fact, you might say bioethics is a trust check on medicine and medical research, offering advice on morally fraught issues, giving voice to patients’ moral concerns, and solving bioethical problems.

I’m a sociologist, and my field actually has a pretty unique take on bioethics. We’re less interested in finding out what’s morally right and more interested in what this new way of being moral means.

So, we want to ask, who decides what’s a moral question? Who’s empowered to solve these moral questions? Who gets to say what’s right and what’s wrong?

Bumper: What Makes the Sociological Perspective Unique

Peter Berger identifies three essential features of the sociological perspective.

First of all, sociology is a relativizing discipline; that is, we’re always interested in how ideas and behavior are situated in their social context, in their historical period, in the culture and the society in which they occur.

Secondly, sociology is a debunking discipline; that is, it never accepts the taken-for-granted explanation of the way things are.

Finally, sociology is an unrespectable discipline.

So, rather than looking for explanations of society from the powerful (from leaders, from managers), we look for stories that come from the dispossessed (from followers, from the people who are being managed).

For example, a physician’s view of trust will be much different than a patient’s view of trust

It’s important to get both of those perspectives when you’re trying to understand trust.

Bumper: Questioning the Impact of Industrialization on Trust

Sociological views of trust, then, are naturally skeptical about taken-for-granted explanations of trust. Let me illustrate.

"Sociology as a discipline was born in the 17th, 18th, and 19th centuries, and it was a period marked by rapid social change."

Industrialization, urbanization, secularization, the rise of mass democracy—all these things were changing the way people lived together.

And the early sociologists were interested in finding out how these changes were affecting the way people related to each other.

Now, the easy answer to that question was to see that these rapid changes were diminishing trust and diminishing relationships between people.

"Ferdinant Tönnies looked at these changes and lamented the disappearance of small, close, friendly, trusting societies that he referred to in German as “gemeinschaft” societies, into larger impersonal societies that he referred to as “gessellschaft” societies.

He saw these as threatening the very foundations of trust.

But Emile Durkheim, one of the founders of sociology, challenged this view. He didn’t see these changes as bringing the end of solidarity but the shift from one form of solidarity into another one.

This new form of solidarity, which he called “organic solidarity,” which was based on interdependence of people in a society characterized by division of labor. So, with the division of labor, people had to depend on each other in new ways.

Bumper: Questioning the Role of Trust in Modern Society

Let’s fast-forward about 100 years to the work of Anthony Giddens, a sociologist from the United Kingdom.

Like Durkheim, he challenged taken-for-granted ideas about the sources of trust. For example, many people think citizens in modern society are less trusting than in the good old days when people lived in small communities.

But Giddens points out that every moment of our everyday lives is characterized by trust. Every day, in innumerable ways, we have to exercise trust in our daily lives.

Well, when you go to work, when you live in your home, you are trusting an architect who designed the buildings that you’re living and working in. You’re trusting that these buildings will stay standing, that they’ll provide you with a comfortable and safe place to live.

So, Giddens makes this same point that what might look like impersonal society actually rests on a foundation of trust.

What’s interesting for us is to take a look at how this perspective, how this thinking about trust from a skeptical, contextual point of view, can be applied to looking at the field of bioethics and how trust operates in bioethics.