Here, the authors present two justifications usually cited as sufficient to warrant patients‘ trust in physicians: professional status and individual merit. Whereas in ‘status trust’ professionalism is taken as a guarantor of trustworthiness, in ‘merit trust’ a physician’s trustworthiness is assessed individually. On either account, trust is justified by the physician’s professionalism. ‘Professionalism’ may be defined as ‘acting trustworthily’ in exchange for autonomy of decision-making, whereas trustworthiness refers to ‘competence’ in terms of episteme (theoretical knowledge), techne (craft or skill), and phronesis (practical knowledge or experience), and ‘commitment’ as ‘to act in a way that the truster approves’. The authors argue that although in principle trust in physicians is justified, since both professionalism and individually assessed trustworthiness grant derivative authority, the reality is different. because an increasing number of patients reject the concept of professionalism and, accordingly, find it difficult (or even impossible) to assess physicians’ trustworthiness. Hence, they no longer believe that their trust in physicians is justified.

Since to trust implies to run a risk, you may want to make sure your trust is justified before you decide to trust someone. In this chapter, the authors examine the justification of trust in the information we receive from others (epistemic trust). They stipulate that only information which is relevant to the receiver counts as testimony. Contrary to this, irrelevant information, arguments, and the provision of pieces of evidence do not count as testimony. By resorting to the concept of street-level epistemology, that is, by shifting from the truth content of a statement to the content relevance (i.e. relevance to the receiver of the information), it is possible to justify epistemic trust. Between the extreme positions of complete rejection and almost a priori acceptance of epistemic trust, the authors argue that it is responsible to grant derivative authority, i.e. to accept testimony to p if and only if we have sufficient reason to believe that p. To determine what counts as ‘sufficient reason’ they present two strategies: ‘epistemic vigilance’ and assessing the ‘epistemic trustworthiness’ of the trustee.