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The particular reason why care is central is that it allows us todistinguish between trust and mere reliance. I have said the twodiffer, putatively, because only the former can be betrayed. But whyis that true? Why can trust be betrayed, while mere reliance can onlybe disappointed? The answer Baier gives is that betrayal is theappropriate response to someone on whom one relied to act out ofgoodwill, as opposed to ill will, selfishness, or habit bred out ofindifference (1986, 234–5). Those who say trusting could involverelying on people to act on any of these motives cannotdistinguish trust from reliance. Examples are risk-assessmentstheorists, who, again, make trustworthiness a matter ofself-interest. Although self-interest as a motive is compatible withgoodwill toward others, it is also compatible with ill will andselfishness. The question is: how would trustworthiness be differentfrom mere reliability if trust could target any of theseattitudes?

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Institutions or groups trying to restore public trust could also usethe above method of cultivating trust. For example, the medicalprofession could try to hammer home to the public the message that mostphysicians and other medical professionals help people andcare about them. For many, such a campaign could make it impossible for themnot to think that these professionals are trustworthy. (However, for others such as Black people in the United States who have social histories of serious harm, including exploitation, by the medical profession, the result may be very different. See e.g. Almassi 2014.)

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Investigate the declining trust in the health care system from an ethical and moral position. You may use the four principles plus attention to scope model of Beauchamp and Childress or any other ethical model that you choose to address this.

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Health reform is mired in the morass of multitiered payment systems and multiple modes of access, limited by the ability to seek and to pay. Increasingly, patients are interacting with multiple entities within the system, causing more and more confusion on the part of the patient. According to recent research, patients’ trust in the system, providers, and insurers continues to decline. This may result in a decline in individual health and an increase in costs for health care.

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Likewise, it is unclear what, if any, sort of motive atrustworthy person must have. Clear conditions for trustworthinessare that the trustworthy person is competent and committed to do whats/he is trusted to do. But this person may also have to be committed ina certain way or for a certain reason (e.g. s/he cares about thetrustor). This section explains these various conditions for trust andtrustworthiness, and focuses in particular on the controversy thatsurrounds the condition about motive.