By Samia Hurst.

Many pandemic response measures, from physical distancing to confinement, rely on cooperation by members of the public for their implementation and effectiveness. In requiring such cooperation, these measures all rely on the public investing sufficient trust in scientific and/or political authorities to follow instructions and recommendations. Trust in medical and political authorities predicts compliance with vaccination recommendations for example, and it can be the main predictor. Trust must be particularly great when compliance comes at significant cost to individuals, who may refrain from seeing loved ones, place themselves in the way of harm, or lose their livelihood. It is not only trust in authorities that is required at such times. Trust that others will do their part is important as well or cooperation will be much more difficult to sustain.

Trust, however, is also particularly fragile during a pandemic. Fear can increase ingroup-outgroup bias and crystallize groups into mutual distrust. Previous experiences of discrimination understandably decrease trust at such times as well. The considerable difficulties a pandemic imposes on persons and communities can give rise to beliefs that someone must be to blame, and scapegoats are then sought within the community, or among authority figures. Constantly changing information, as data must perforce arrive in real time when a disease is new, can also sap the trust that authorities know what they are doing, or are telling the truth.

Trust is thus likely to be endangered, precisely at the time when we would need it to be at an all-time high. An understanding of trust, and of how to sustain it, is thus a crucial component of pandemic response.

According to Onora O’Neill’s influential account of trust, we give our trust when we believe that an agent will do a specific thing in a manner that is competent, reliable, and honest. Rather than being grounded in complete transparency, which is never achievable, trust rests on visibly truthful communication on the goals and actions taken as well as on the level of competence, reliability, and honesty that can be expected. The focus, then, is on trustworthiness rather than trust. According to this account, we ought to make sure that we are trustworthy: able to do that which is expected and to do it in a manner that is competent, reliable, and honest. Then, we should make it known. And because it then becomes visibly reasonable to trust such an agent, trust will follow.

So far, so good. But I would like to spotlight a less examined aspect of this account. Sustaining trust must also require that we make responsible choices as to when we do, or do not, accept trust. A central component of O’Neill’s account is that trust is based on expectations. We are aware of this when we make sometimes very specific judgments on what we trust others for. As a physician, I am like many of my colleagues surrounded by many other health professionals in my family and among my friends. I am happy to report that I would trust many of them with my life should it need saving at the hands of medicine. However, there are a few among them whom I would not entrust with a letter to mail by this evening. This is entirely normal: we have different expectations towards different people, based on our previous experiences. We do not trust individuals in a blanket manner. We trust them to do specific things.

If trust is based on expectation and how we believe they will be fulfilled, this means that we can make mistakes. As physicians, we are familiar with the basics of this. Patients not infrequently consult with unrealistic expectations. They give us their trust because they believe that we will, reliably, honestly, and competently, make them immortal for example, or at least be able to chase away death whenever it turns up. In such a case, trustworthiness cannot require us to fulfil this expectation. Instead, we ought to truthfully -and tactfully- make it clear that we cannot do so. Someone who accepts trust under such circumstances will necessarily betray it, since they will turn out to be unable to fulfill these expectations despite having accepted trust. In contrast, someone who refuses trust under such circumstances, and explains why, proves themselves more worthy of our trust: they show themselves to reliably let us know what we can, or cannot, trust them for.

During a pandemic, unrealistic expectations are very likely to occur. Hopes will arise that the illness will turn out to be nothing, that medicine will swiftly find an effective cure, that risks can be entirely switched off, that decision-makers will be all-knowing, and will make decisions devoid of any side-effects. Such expectations, if accepted, are bound to be betrayed, further endangering a possibly already fragile trust. Making responsible decisions regarding trust, then, will require identifying and acknowledging these expectations, and explaining why they cannot be fulfilled. A politically fraught exercise even at the best of times, but the mark of a responsible moral agent in difficult times.

Author: Samia Hurst

Affiliations: Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Switzerland

Competing interests: None