one’s confidence in the system of health care or make a rapid initial judgement about
the trustworthiness of the nurse.
Thus confidence in the system to provide reliable and competent nurses offers a
threshold of safe care and this is important for those who find themselves in receipt of
nursing practice. It provides the basis from which trust might emerge (although this
need not be a necessary condition). Nevertheless, an account of nurse-patient
relationships based on mere reliance, rather than on trust, remains unsatisfactory
because trust and trustworthiness contribute to human flourishing in more convincing
ways than do mere reliance and confidence, and it should be said, in more satisfying
ways than do mere belief or hope. The idea of care provided without some conception
of trust and therefore in the absence of good will is not one that appeals even in acute
emergency life saving circumstances. And if one legitimate aim of nursing is, as I have
claimed, the flourishing of more-than-ordinary vulnerable persons then the dispositions
that nurses should have are those dispositions that encourage human flourishing. And
trustworthiness is one such disposition. That a nurse should be trustworthy is of
particular importance for those more-than-ordinarily vulnerable persons who, for
whatever reason, are not in a position to assess the trustworthiness of others.
Independent practical reasoning and trust
If the placing of trust hinges on the cognitive capacities of the one trusting as assumed
in a number of accounts of trust in nursing (for example, Meize-Grochowski 1984;
Johns 1996; Gilbert 1998) then those with compromised or diminished cognitive
capabilities cannot be said to trust. This idea is reflected in MacIntyre’s requirement for
independent practical reasoning if one is to trust, but as stated earlier, this is a
contingent rather than absolute requirement. Thus while it may, on occasion, be true it
cannot be generalised beyond some very limited cases. Some individuals may be unable
to hold a belief as such (for example, an unconscious person cannot hold beliefs in the
sense we usually understand people to hold, or act upon, beliefs) and therefore it is not
possible for them to trust, although others may trust on their behalf. But those who lack
a capacity (temporarily or permanently) to make an assessment of another’s good will
towards them may still be in a position to trust, even if this cannot be articulated in any
formal sense. Contra Gilbert (1998) who claims, that because trust involves choice,
what we observe in the absence of choice is hope rather than trust, Baier makes a case
for infant trust representing fundamental trust as a state of nature. She says,
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