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What's trust got to do with it? Revisiting opioid contracts
1Interdisciplinary Studies Graduate Program and National Core for Neuroethics, The University of British Columbia, Vancouver, British Columbia, Canada.
Journal of Medical Ethics
|September 10, 2013
Summary
Opioid contracts may undermine patient trust and worsen care by assuming patient untrustworthiness. Cultivating epistemic humility can foster mutual trust between patients and physicians managing chronic pain.
Area of Science:
- Medical Ethics
- Public Health
- Pain Management
Background:
- Prescription opioid abuse (POA) is a significant public health issue.
- Physician concerns regarding patient 'drug seeking', abuse, and diversion of prescription opioids contribute to distrust in chronic pain management.
- Opioid contracts are used to manage physician concerns but their impact on trust is debated.
Purpose of the Study:
- To critically evaluate the role of trust and trustworthiness in opioid contracts.
- To argue that opioid contracts represent a flawed approach to patient-physician trust.
- To propose epistemic humility as a means to foster mutual trust.
Main Methods:
- Critical analysis of the concept of trust in the context of opioid contracts.
- Examination of the potential negative impacts of opioid contracts on the patient-physician relationship.
- Exploration of epistemic humility as an alternative framework.
Main Results:
- Opioid contracts can undermine patient credibility and exacerbate vulnerabilities.
- Misplaced trust can leave physicians susceptible to the harms of POA.
- Distrust between patients and physicians can destabilize the therapeutic relationship and compromise care.
Conclusions:
- Opioid contracts are a misleading appeal to patient-physician trust.
- A process of epistemic humility, valuing patients' subjective knowledge, can help cultivate mutual trust.
- Epistemic humility supports physicians' understanding of patients with chronic pain, enhancing the therapeutic alliance.
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