{"id":4680,"date":"2025-06-20T06:42:10","date_gmt":"2025-06-20T05:42:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4680"},"modified":"2025-06-20T06:42:10","modified_gmt":"2025-06-20T05:42:10","slug":"what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/","title":{"rendered":"What Does It Mean to Provide Medicine in a World of Declining Trust?"},"content":{"rendered":"<p><em>By Crystal Lemus <\/em><\/p>\n<p>What does it really mean to \u201cprovide medicine\u201d? For many, the image is clinical\u2014white coats, prescription pads, MRI scans, and protocols. But at its philosophical core, medicine is a moral act: one human being entering into the vulnerability of another. The practice of medicine is rooted in a complex interplay between trust, knowledge, and responsibility. Today, that trust is eroding.<\/p>\n<p>During the COVID-19 pandemic, the phrase \u201cfollow the science\u201d became a cultural mantra. Yet, paradoxically, <a href=\"https:\/\/www.pewresearch.org\/science\/2022\/02\/15\/americans-trust-in-scientists-other-groups-declines\/\">public trust in scientific and medical institutions plummeted.<\/a> We now live in an era where people seek second opinions from social media influencers, where vaccination campaigns are interpreted through political lenses, and where physicians are forced to justify basic evidence-based care to increasingly skeptical patients.<\/p>\n<p>This crisis of trust is not just a sociological issue\u2014it\u2019s a philosophical one. What is the role of medicine when the public no longer agrees on what counts as a good, or even a truth?<\/p>\n<p>In ancient philosophy, medicine was considered a tekhne\u2014a craft guided not only by knowledge, but by purpose. Hippocratic ethics emphasized a shared telos: to heal, to do no harm. But healing is not just physical. The physician&#8217;s obligation has always been relational. Even Galen wrote that the success of a treatment often depends as much on the character of the physician as on the prescription itself.<\/p>\n<p>Today, algorithms aid diagnosis, artificial intelligence can parse imaging, and personalized genomics push the boundaries of precision care. These innovations are extraordinary. Yet they also shift the focus from care to calculation. If we define medicine primarily in terms of data, do we risk losing its moral dimension?<\/p>\n<p>This is not a rejection of evidence-based medicine\u2014it is a call for humility about its limits. Evidence does not exist in a vacuum. The way we interpret clinical trials, construct practice guidelines, or even design research questions is shaped by values. Choosing one outcome measure over another (e.g., mortality vs. quality of life) is a moral judgment, even if cloaked in scientific language.<\/p>\n<p>At the same time, medicine continues to operate within systems that are unequally structured. <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5915910\/\">Racial disparities in maternal health outcomes<\/a>, <a href=\"https:\/\/www.gao.gov\/products\/gao-21-93\">underfunded rural hospitals,<\/a> and <a href=\"https:\/\/nihcm.org\/publications\/the-behavioral-health-care-workforce-shortages-solutions\">mental health care shortages are not mere logistical failures<\/a>\u2014they are ethical failures. If medicine claims to be a moral enterprise, how can it tolerate such systemic inequities?<\/p>\n<p>This is where the philosophy of medicine can offer clarity. Philosophers such as <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23836135\/\">Havi Carel<\/a> argue for a \u201cphenomenology of illness,\u201d emphasizing the lived experience of the patient. Others, like <a href=\"https:\/\/www.proquest.com\/docview\/220175682?sourcetype=Scholarly%20Journals\">Tristram Engelhardt<\/a>, critique the idea that medicine can ever be morally neutral. And still others raise provocative questions: Should physicians be gatekeepers of scarce resources? Can you truly consent to care in a system shaped by economic coercion? What does autonomy mean in the face of desperation?<\/p>\n<p>These are not abstract questions. They affect how we train doctors, how we shape policy, and how we relate to patients. As we increasingly emphasize metrics\u2014patient throughput, satisfaction surveys, insurance coding\u2014we risk turning medicine into a transactional service rather than a moral calling.<\/p>\n<p>So what does it mean to \u201cprovide medicine\u201d in this context? I would argue it means this: to take seriously the philosophical dimensions of care. To recognize that behind every diagnosis is a person who may be grieving, angry, confused, or frightened. To resist the temptation to reduce health to data, and instead to anchor practice in human relationships. To remember that uncertainty is not a failure, but a feature of the moral terrain we navigate.<\/p>\n<p>If we do this\u2014if we treat medicine not just as a science or a service, but as a philosophical commitment\u2014we may begin to rebuild what has been lost: trust. Not blind faith, but earned trust. The kind that acknowledges complexity, respects disagreement, and holds space for the full humanity of both patient and provider.<\/p>\n<p class=\"xmsonormal\"><b><span style=\"color: black\">Author:<\/span><\/b><span style=\"color: black\">\u00a0Crystal Lemus<\/span><\/p>\n<p class=\"xmsonormal\"><b><span style=\"color: black\">Affiliation:<\/span><\/b><span style=\"color: black\">\u00a0Lincoln Memorial University DeBusk College of Osteopathic Medicine<\/span><\/p>\n<p class=\"xmsonormal\"><b><span style=\"color: black\">Competing Interests:<\/span><\/b><span style=\"color: black\">\u00a0None declared<\/span><\/p>\n<p class=\"xmsonormal\"><b><span style=\"color: black\">Social Media Handles:<\/span><\/b><\/p>\n<p class=\"xelementtoproof\"><span style=\"color: black\">Instagram: <a href=\"https:\/\/ddec1-0-en-ctp.trendmicro.com:443\/wis\/clicktime\/v1\/query?url=https%3a%2f%2furldefense.proofpoint.com%2fv2%2furl%3fu%3dhttps%2d3A%5f%5fddec1%2d2D0%2d2Den%2d2Dctp.trendmicro.com%2d3A443%5fwis%5fclicktime%5fv1%5fquery%2d3Furl%2d3Dhttps%2d253a%2d252f%2d252fwww.instagram.com%2d252flystalcremus%2d26umid%2d3Dc190ae72%2d2Dc05f%2d2D4b13%2d2Daf12%2d2Dccdcf09e3b71%2d26rct%2d3D1749573778%2d26auth%2d3D8d3ccd473d52f326e51c0f75cb32c9541898e5d5%2d2Dafeba881a18cb8656f55b8b24e403979e0787fa5%26d%3dDwMGaQ%26c%3dEHGRkEbb0y4f%2ddFdKkQ2iQ%26r%3dlfJjeKqZ7rvLPrLw4lQl4RD9%5fmy18P950GTcRIyY9lU%26m%3dVqegqzuJ%5fRElPTgEmW6P%2dXophs%5fzXycihObcuWsQhKtNG6H680Nw%2dcb2lHGrYnIG%26s%3dnsLOro27NTXiss1hx4HACZQ0T2paXWK1%5fwtxrS5Bmlo%26e%3d&amp;umid=4f12292a-192b-4cb5-92fd-b37f0d5906dd&amp;rct=1750186999&amp;auth=8d3ccd473d52f326e51c0f75cb32c9541898e5d5-1e8f349594b6c76424c8cf28a5d7c7ca11d0c951\" target=\"_new\">@lystalcremus<\/a><\/span><\/p>\n<p class=\"xelementtoproof\"><span style=\"color: black\">Facebook: <a href=\"https:\/\/ddec1-0-en-ctp.trendmicro.com:443\/wis\/clicktime\/v1\/query?url=https%3a%2f%2furldefense.proofpoint.com%2fv2%2furl%3fu%3dhttps%2d3A%5f%5fddec1%2d2D0%2d2Den%2d2Dctp.trendmicro.com%2d3A443%5fwis%5fclicktime%5fv1%5fquery%2d3Furl%2d3Dhttps%2d253a%2d252f%2d252fwww.facebook.com%2d252fCrystal.lemus.1%2d26umid%2d3Dc190ae72%2d2Dc05f%2d2D4b13%2d2Daf12%2d2Dccdcf09e3b71%2d26rct%2d3D1749573778%2d26auth%2d3D8d3ccd473d52f326e51c0f75cb32c9541898e5d5%2d2Dcd2420c6c63bb3e261b577af641807446b2ce3e2%26d%3dDwMGaQ%26c%3dEHGRkEbb0y4f%2ddFdKkQ2iQ%26r%3dlfJjeKqZ7rvLPrLw4lQl4RD9%5fmy18P950GTcRIyY9lU%26m%3dVqegqzuJ%5fRElPTgEmW6P%2dXophs%5fzXycihObcuWsQhKtNG6H680Nw%2dcb2lHGrYnIG%26s%3dWoUEppsufqlkEy%5f5p8LS0QZKXRz%5f9Od3nsuAGecwbRU%26e%3d&amp;umid=4f12292a-192b-4cb5-92fd-b37f0d5906dd&amp;rct=1750186999&amp;auth=8d3ccd473d52f326e51c0f75cb32c9541898e5d5-befb1fa9d05b2c205bb6fcb2deab3273803dd42d\" target=\"_new\">Crystal.lemus.1<\/a><\/span><\/p>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Crystal Lemus What does it really mean to \u201cprovide medicine\u201d? For many, the image is clinical\u2014white coats, prescription pads, MRI scans, and protocols. But at its philosophical core, medicine is a moral act: one human being entering into the vulnerability of another. The practice of medicine is rooted in a complex interplay between trust, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":503,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968,8057],"tags":[],"class_list":["post-4680","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-medical-ethics"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>What Does It Mean to Provide Medicine in a World of Declining Trust? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What Does It Mean to Provide Medicine in a World of Declining Trust? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Crystal Lemus What does it really mean to \u201cprovide medicine\u201d? 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For many, the image is clinical\u2014white coats, prescription pads, MRI scans, and protocols. But at its philosophical core, medicine is a moral act: one human being entering into the vulnerability of another. The practice of medicine is rooted in a complex interplay between trust, [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2025-06-20T05:42:10+00:00","author":"owenschaefer","twitter_card":"summary_large_image","twitter_misc":{"Written by":"owenschaefer","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/"},"author":{"name":"owenschaefer","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/aed22897c55740f89c1ad1508985d1c0"},"headline":"What Does It Mean to Provide Medicine in a World of Declining Trust?","datePublished":"2025-06-20T05:42:10+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/"},"wordCount":685,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"articleSection":["clinical ethics","Medical ethics"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/06\/20\/what-does-it-mean-to-provide-medicine-in-a-world-of-declining-trust\/","name":"What Does It Mean to Provide Medicine in a World of Declining Trust? 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