health care that enables us to say that this or that person trusts when they are unable to
make a conscious decision to trust in particular circumstances. The person lying
unconscious following a road traffic accident or during a surgical operation fits this
description. We can imagine that the former has a general background trust in health
care professionals to respond appropriately to a road traffic accident and that the latter
has expressed a trust in health care professionals to act in her or his best interest when
anaesthetised by consenting to surgery. For others, those whose rational capacities have
never developed beyond certain infantile levels, trust may be a reflection of a ‘belief in
those on whom the person is dependent, in the sense in which Baier characterises infant
trust as the sort of trust needed if an infant is to survive.
Thus there is no necessity for a contract between equally competent persons for it to be
said that trust exists between persons. The fact is, that in any trust relationship there is
likely to be a power differential although often we may not notice this. When we trust in
an institution we are most likely to recognize that we are on the weaker end of the
power differential. Similarly when we trust in a person we allow them some power over
our affairs. As Baier notes, in allowing others this power over us we allow them to be in
a position to harm us and we accept a vulnerability. For those people whose
vulnerability is already exposed, to trust in others increases their vulnerability. And yet
it is a feature of the human condition that when we are vulnerable we have a greater
need to trust others to care for those things we value. IfI value my health, and if I find
my ability to care for my health compromised I need the help of others, and it would
seem preferable to trust rather than merely rely upon those others.
The place of trust in nursing practice
We trust, then, when we believe those in whom we are placing our trust are worthy of
that trust; that is when we believe them to be trustworthy. In Baier’s example, we trust
our enemy not to shoot us as we surrender when we believe that he has a good will
toward us. Thus our assessment of the trustworthiness of others is a matter of some
importance, and in assessing that trustworthiness we are making a judgement about their
good will toward us. On this account those who claim to be trustworthy, as nurses often
do, must not only have a good will towards patients but must also be seen to have a
good will. For it is when we believe that another has a good will towards us that we can
say we trust, rather than, say, merely hope or rely.
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