How Trust Shapes the Medical Field: A Sociologist's Perspective
Foundations
CONTRIBUTOR / Raymond De Vries
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
The simple act of walking into your home each day is a profound act of trust in an inconspicuously high-stakes situation. Doing so demonstrates that you trust the architect who designed your home and that the roof won’t come crashing down on you. And, much like historic societies who relied on strong interdependence as a necessary means of survival, modern life still requires a great deal of reliance on others. Though we may not be as community-oriented as societies of the past, our lives still involve high amounts of trust in other people--their competency, their integrity and so forth--regarding each and every aspect of our lives.
Transcript
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.