Philosophical Perspectives on Trustworthiness and Open-mindedness as Professional Virtues for the Practice of Nursing: Implications for he Moral Education of Nurses

capacities including, those with learning disabilities, children, the elderly, and the
mentally ill.

Despite these shortcomings, which are by no means limited to the examples provided
within the texts identified, there continues to be an enduring tradition that recognises (at
least the rhetoric of) the importance of trust within relationships between health care
professionals and patients. Indeed, part of the critique of the rise of institutional
accountability in public service provision lies in a claim that the surveillance of audit
occurs at the expense of trust relationships between professionals and clients (see, for
example, Smith 2001, O’Neill 2002). It appears that the tradition of trust relationships
as the cornerstone of health care provision has a long history of failing to protect more-
than-ordinarily vulnerable persons. The assumption that patients ought to place their
trust in doctors, nurses and others merely because they are qualified health care
professionals is one that appears to lack any substantive foundation. Nevertheless, and
despite a significant amount of evidence that health care professionals cannot always be
trusted, there remains a willingness on the part of the general public to assume health
care professionals can be trusted. It may be that what is needed, if health care
professionals are to retain the idea that they should be trusted, is a commitment to
becoming trustworthy practitioners and this necessitates an articulation of just what
being trustworthy requires.

It should be evident from this brief overview that while the tradition of trust in health
care can be the cornerstone of effective practice it does appear to be rather more open to
abuse than many would wish it to be. In other words, the tradition of trust lacks
sufficient substance to regulate practice where practitioners, with or without deliberate
intent, assume the tradition to be self-regulating. As Kennedy notes the harms that
health care professionals do, do not necessarily arise from malevolence; harmful
practices do sometimes result from the actions of well-intentioned individuals. In
describing the failings of children’s cardiac surgery services in Bristol, Kennedy states:

It is an account of people who cared greatly about human suffering, and were
dedicated and well-motivated. Sadly, some lacked insight and their behaviour
was flawed ... Despite their manifest good intentions and long hours of

³ The three texts I have in mind here are Cohen’s 1964 What’s Wrong with Hospitals; Rob’s 1967 Sans
Everything and; Martin’s 1984 Hospitals in Trouble. Full references can be found in the reference list at
the end of this thesis. There are, of course, other influential critical texts.

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