title: How to Retain the Trust of Patients and Families When We Will Not Provide the Treatment They Want.
abstract: How might clinicians best try to retain the trust of patients and family members after clinicians oppose giving a treatment? If clinicians can maintain the trust of patients and families in these situations, this may soften what may be the greatest possible loss--the death of a loved one. I discuss what clinicians seeking to retain trust should not do--namely impose their values and reason wrongly--and introduce strategies that clinicians may use to reduce both. I present five principles that clinicians can follow to try to retain trust, with examples that illustrate each. I suggest specific interventions that clinicians can make, especially when they anticipate that a patient and/or family may, in time, want a treatment that is futile.
authors.affiliation: Programs in Medical Ethics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814 USA. edmund.howe@uhuhs.edu.
authors.forename: Edmund G
authors.initials: EG
authors.lastname: Howe
mesh_terms: D002755:Choice Behavior / Q000941:ethics; D003142:Communication; D003657:Decision Making / Q000941:ethics*; D034462:Dissent and Disputes; D004644:Emotions; D004645:Empathy; D026689:Ethical Analysis; D028663:Ethical Theory; D026822:Ethicists / Q000523:psychology / Q000592:standards; D033061:Ethics Consultation / Q000941:ethics / Q000592:standards; D005190:Family / Q000523:psychology; D005239:Fear; D015276:Health Care Rationing / Q000941:ethics; D006801:Humans; D008149:Love; D018447:Medical Futility / Q000941:ethics / Q000523:psychology; D009014:Morals; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D011368:Professional-Family Relations / Q000941:ethics*; D012927:Social Control, Informal; D035502:Trust / Q000523:psychology; D014342:Truth Disclosure / Q000941:ethics*; D035501:Uncertainty; D028761:Withholding Treatment / Q000941:ethics*