vii) That we recognize the importance of being trustworthy to the disenfranchised and
oppressed
Essential to this seventh requirement of Potter’s is the notion that in deciding to whom
one should be trustworthy it is important to recognise that many patients and clients
have already suffered the effects of trust betrayals (in some cases many times over).
Potter takes a largely feminist political stance in arguing that social and institutional
structures (in North America) tend to favour white middle-class males and that this
predominant bias does little to engender the trust of those who do not fit the existing
hegemony. Neither, to return to requirement U above, does it encourage those who are
part of the dominant class to question their assumptions about their own trustworthiness.
Hence, for Potter, anyone who is not part of the dominant group will already have
reason to be cautious about the claims to trustworthiness of authority figures. She says:
The nature of trustworthiness is nonexploitative and nondominating. As such,
exhibiting this virtue demands that, when we face conflicts with regard to whom
to sustain or break trusting relations, we take as a primary consideration those
who are already vulnerable in relation to dominant structures, in general, and to
us, in particular
(Potter 2002 p. 29).
For nurses, then, this requires the assumption that it should be the patient’s trust one
should maintain, it requires that we presume a patient’s trust should be broken when,
and only when, there are compelling reasons to do so. Betraying the trust of a patient
without a compelling reason is to exploit their position of vulnerability. The patient is,
so to speak, an easy option when conflicts of trust cannot be avoided for, generally
speaking, within the health care system it is the patient who is least likely to know what
is going on. Those working within the institutions and practices of health care have a
knowledge and understanding of the health care system, the advantages and
disadvantages of particular forms of treatment and care, and a way of evaluating service
delivery usually denied to those who are the recipients of that care. Hence patients are
already vulnerable in respect of health care professionals and institutions, and to add to
that vulnerability by betrayal(s) of trust is to compound disadvantage. For those who are
already further disadvantaged by the fact of compromised or diminished rational
capacities, betrayals of trust appear to be even more culpable.
viii) That we are committed to mutuality in intimate as well as in civic relationships
Potter’s account starts to become sketchy at this point but she seems to use the term
mutuality to mean something like a willingness to cooperate with others on the basis of
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