Medical Oversight and Public Trust of Medicine: Breaches of Trust

Patient trust is central to developing a therapeutic alliance between the physician and the patient. Breaches of trust, understood as violations of a patient’s rights, confidence, and privacy, are unfortunately common in the history of medicine. In some of the most egregious historical examples, patients have been unaware, uninformed, or involuntarily forced into clinical trials, such as the gruesome research conducted in concentration camps during the Holocaust, psychosurgery in the late nineteenth century, the case of Henrietta Lacks, the Willowbrook Hepatitis Studies, and the Tuskegee Study of untreated syphilis. Some of the most common breaches of trust in modern medicine are an invasion of privacy, information withholding, lack of informed consent, and abuse of power. Current violations include, but are not limited to, systemic racism in medicine, professional misrepresentation and misuse of social media, and unethical use of healthcare technology and personalized medicine. Further, a lack of patient trust has produced COVID-19 vaccination hesitancy leading to several ethical concerns. In the context of these contemporary examples, this chapter describes several ethical challenges inherent in medical oversight and public trust in medicine. Issues pertaining to patient confidentiality, variants in the concepts of privacy, relevance for oncology, and recommendations for establishing trust are presented.