Beyond Prescription: Ethical Tensions in the Age of Medical Mistrust

This paper focuses on medical mistrust as a product of flawed systems, and the strain that arises between the duty to protect individual autonomy and protect the health of the greater population. It examines how behavioral science, journalistic media, social media algorithmic personalization, the commercialization of medicine, and different policies across geographical areas all shape public trust in medicine. Using this research, the paper explores how and why mistrust develops, and how this should impact the ethical responsibilities of both individuals and healthcare systems. 

Table of Contents

• Introduction

• Background

• Behavioral Science

• Media

• Stakeholders

• Values

• Ethical Considerations

• Conclusions

Introduction   

Medical mistrust is often dismissed as individual paranoia, but it is an ethical dilemma that is largely a product of government and healthcare systems that hold power over medical information, policy, and access to care. When these institutions act inconsistently, lack transparency, or appear driven by incentives which undermine patient care, trust erodes. This dynamic was more recently demonstrated and accelerated by the Covid-19 pandemic, a period marked by medical uncertainty, rapid decision-making, and ethical conflicts. Public health officials and scientists imposed strict measures and made confident assertions about a disease there was still much uncertainty about. When some of these claims proved to be false or partly incorrect, it caused a rise in public skepticism and provided the opportunity for alternative sources to gain influence and further fuel mistrust (Douthat). For instance, in the early months of 2020, mask usage was not required or recommended by the Center for Disease Control (CDC). U.S. Surgeon General Dr. Gerome Adams even tweeted that masks are “NOT effective” in preventing the spread of Covid-19 and urged the public to stop buying them. In April though, health officials switched their stance on masks, because of new evidence that asymptomatic individuals contributed substantially to the spread of the virus. More confusion followed when regulations allowed vaccinated individuals to forgo masks in certain settings in early 2021, only for mask recommendations being reinstated again in July due to the spread of the Delta variant (Netburn). These shifts in mask guidelines are only one example of the inconsistencies in public health messaging that contributed to growing medical mistrust during the pandemic. 

Public trust in healthcare, government regulation, and the pharmaceutical and insurance industries has declined, with growing skepticism surrounding vaccines, reproductive healthcare, nutrition, and pediatric medicine. While misinformation and social media have contributed to this shift, Gollust et al. (2025) found that political polarization and a fragmented media landscape has augmented these feelings. Through this project, I examine medical mistrust as an ethical issue rather than a simple lack of public and individual understanding. I will draw on empirical research on behavioral science, media studies, journalism, algorithmic personalization, and different policies across geographical areas to examine how changes in healthcare structure and biased information influence trust. I will analyze how individual autonomy should be balanced against the collective good in public health, what shifts in healthcare institutions or media could increase public trust in medicine, and how systems must adapt ethically as medical relationships become increasingly impersonal with the rise of Artificial Intelligence. Any efforts taken to rebuild public trust, I argue, must be transparent, accountable, and ethically grounded. 

Background

Medicine has evolved significantly from a model where the local physician treated people in the comfort of their own homes, managing most health needs from birth to death. This system promoted trust as doctors got to develop deep and long-term relationships with their patients, fostering trust based on familiarity, continuity, and personal knowledge of patients’ medical histories. Rather than being seen as distant scientific professionals, physicians were key and trusted members of the communities they practiced in (Malcolm). Over time, medical care has shifted into hospitals due to the development of advanced medical technology, specialized equipment, and the greater economic efficiency accompanied by this system (ChenMed). Additionally, patients increasingly began receiving treatment from multiple specialized doctors rather than a singular primary physician, like before. While this shift in medicine does allow for more nuanced physician knowledge and treatment plans, it also prevents the development of the trust-building relationships such as those that general practitioners are able to build. 

Profit has always existed in medical practice, but in recent decades its role has expanded. Medical practices and systems have increasingly consolidated both vertically through the integration of multiple stages of healthcare services, resulting in large corporations that own hospitals, insurance systems, physician practices (Clevenger), and also horizontally through the merging of hospitals or practices (Heeringa et al), leading to reduced competition, all culminating in a medical-industrial complex. This is driven in part by private equity investment, where hospitals, practices, and clinics are acquired and managed to maximize financial returns rather than prioritize patient care (Brown). As a result, hospitals are pressured to cut costs, while physicians and nurses are pushed to increase patient volume and limit time spent with patients, all to maximize efficiency and profitability for shareholders. 

Trust erosion related to corporization also extends to non-clinical industries such as pharmaceutical and insurance companies and their financially-driven decisions. In 2018, the pharmaceutical industry was the least-trusted healthcare sector, with only 55% of people globally trusting pharmaceutical companies (Lo). Pharmaceutical companies tend to prioritize drug profitability and market expansion. Alongside these factors, the high cost of research and development– approximately $170 million per successful drug, and rising to $515 million when you include failed research projects – contributes greatly to high medication prices (Murphy). This fuels public frustration and mistrust as they perceive these pricing practices as exploiting vulnerable patients in need of these drugs for their health.

Because insurance companies often prioritize cost control to maximize profit, people tend to mistrust coverage decisions, fearing that financial incentives outweigh medical judgement and compromise patient wellbeing. Participants in a study published in the Journal of General Internal Medicine expressed worry that such companies may choose to offer coverage for the most cost-effective treatment options to their customers, rather than those of the highest quality, for instance (Richmond et al.). These participants understood that the insurance companies have a need to reduce spending, but also believed that the companies should be more transparent about why certain coverage decisions are made.

Corporatization leads to a risk of lower physician autonomy, as corporations often have to prioritize profit over maximizing patient wellbeing. Physicians have to follow standardized rules and administrative measures rather than being able to focus solely on the patient, which will lead to worsened patient care (AMA). Loss of autonomy and increasing administrative burdens can also lead to physician burnout (Resneck Jr), which is also associated with lower quality of care, more medical errors, and leads to reduced trust. In 2021, 62.8% of physicians experienced symptoms of burnout, though that may have been elevated due to the pandemic (Resneck Jr). 

All of these developments contribute to medical mistrust, as individuals are more hesitant to trust systems they perceive as motivated primarily by profit rather than patient wellbeing. This mistrust is further intensified by the loss of long-term relationships and consistent interactions between patients and healthcare providers, which leads patients to feel as if they are being treated by an impersonal system rather than by individual, trusted clinicians. 

Behavioral Science 

To understand why medical mistrust emerges, it is important to examine behavioral science. Humans have an innate fear of taking risks, a survival mechanism that has helped us for centuries. It has also been shown that we are more afraid of new and unknown risks rather than familiar ones, even if they are equally as dangerous (Bramadat et al). This helps explain why new medical interventions are frequently met with hesitation: unfamiliarity heightens the feeling of risk, which only increases the need for trust to overcome that fear. As a result, trust becomes a key factor in determining whether individuals are willing to take risks related to choices about their health. 

Trust has been defined as “a psychological state comprising the intention to accept vulnerability based upon positive expectations of the intentions or behaviors of another” (Rousseau et al., 1998, p. 395). Therefore, when individuals have to make decisions about risks, trust is one of or even the most important factor in the conclusion they’ll ultimately come to (Bramadat et al.). People have options between who they can trust, and usually, humans prioritize stories, identity, and fear over probability or evidence-based studies (Toomey). Complex information can be confusing and burdensome to try and understand, meaning people tend to rely on intuition to make decisions instead. This makes it far more likely that individuals trust family members, people online who they resonate with, or news in the media that they connect to and understand. Furthermore, individual beliefs that have been developed from personal experiences won’t be changed, even by highly convincing statistics. 

Psychological research supports this phenomenon. In a set of experiments, social psychologists Richard Nisbett and Eugene Borgida made this observation: their students were presented with both statistical evidence and individual case examples related to bystander apathy. The statistical information didn’t meaningfully change their judgement, but hearing the stories and perspective of two specific people who failed to help in a situation had a much stronger impact on the students’ thinking, and their understanding of the situation (Kahneman). This demonstrates how trust is often placed in familiar stories and people rather than scientific data. 

Media 

The spread of misinformation and individual stories has been accelerated tremendously by the rise of the internet and later social media. Patients now have access to sources beyond their physicians to gain information about their health options, like google, social media, and even more recently, Artificial Intelligence.

As expressed above, anecdotes are always going to be more convincing than any expert opinion, even if flawlessly communicated. Information shared through social media – where posts show people’s faces, individuals share personal experiences in comment sections, and you can follow along specific health journeys – promotes familiarity and trust. It would be more accurate though, to say that social media can create the “semblance” of family and trust, as we do not truly know people on social media and therefore cannot actually deem them trustworthy. Still, unique communities emerge from social media where individuals are able to find support and guidance for their healthcare journeys. However, social media also facilitates the spread of misinformation, and makes it even more difficult to detect. 46% of adult social media users consume “some” and 36% consume “a lot” of false or misleading health information, while only 18% reported none or limited misinformation. About 67% of adults aren’t able to distinguish information as true or false (Stimpson & Ortega).

Additionally, only 18% of adults reported they used information from social media to make decisions regarding their health, but much of its influence may be subconscious (Stimpson & Ortega).

False and misleading information thrives largely because people are willing to consume it. People are often drawn to media that aligns more closely with their beliefs or validates their fears, rather than information that challenges them. This is a concern because it causes misinformation to spread quickly and compete with and overshadow the accurate and factual information. (Smith). It isn’t just misinformation that is harmful to public trust, but also certain ways in which information is presented through media coverage. Though reporting on side effects of medication, for instance, is necessary for transparency and patient safety, the frequent disproportionate coverage of events that are extremely rare or happen to very few people can lead individuals to overestimate the likelihood of certain risks. This only increases skepticism towards medical procedures and products, and the people involved in their administration and development (Bramadat et al.)

Moreover, demographics significantly impact what version of media individuals consume, particularly on social media. Social media platforms have algorithms that are able to make assumptions about users’ demographics, including race, age, and gender (Narayanan). Therefore, the media content that users consume is inherently biased rather than neutral. A study by Science demonstrated that social media algorithms shape social media consumption differently, specifically finding that age, race, and political affiliation impacts what content users see and engage with. This means that users are consuming different amounts and types of political media, leading to enhanced politicization. (A.M. Guess et al). By tailoring content based on demographic, social media platforms create spaces, or “echo chambers” (Nguyen) where trust is manipulated and medical issues are framed as partisan debates, where certain opinions are aligned with certain parties. This increases exposure to misinformation and only contributes to mistrust in public health institutions.

These concerns are further intensified by pseudoscientific studies, such as the 1998 Wakefield study which suggested that certain vaccines led to autism and other developmental disorders in children (Rao & Andrade). Studies like this can cause unnecessary panic, even long after the claims are refuted. Moreover, widespread practices such as “P-value hacking” reinforce this issue. “P-value hacking” is the term for researchers shaping their studies, datasets, and variables to get their p-values below 0.05. They don’t want their work to be disregarded, so they intentionally frame the final outcome with a low p-value while numerous unsuccessful tests or data that led to it remain undisclosed (Smith). The prevalence of scientific studies based on manipulated statistics contributes to public mistrust in healthcare and undermines the transparency of the scientific research process. 

As shown by the behavioral science section above, the media we consume highly impacts the trust-based and instinctive decisions that we make. As we consider this an important question arises: are you really autonomous if you're only shown one (biased) side of things on which to base your decisions? Autonomy is an especially relevant concept in healthcare, because it involves the power that individuals have in making decisions about their bodies and the quality of their lives, based on the context, knowledge, beliefs, and values that they personally have. In addition, regarding healthcare, this autonomy will inevitably impact many other stakeholders. 

Stakeholders

There are several stakeholders that should be considered when analyzing the ethical implications of medical mistrust. Firstly, patients’ choices impact themselves as individuals, but can also impact others. Moreover, healthcare providers have a responsibility to their patients’ autonomy but also to nonmaleficence, and preserving their own personal autonomy and values. Their decisions and their patients' decisions will impact their reputation and ability to practice safely and maintain trust. At a broader level, healthcare institutions and systems have a responsibility to protect public trust and patient safety, but they are also often, but not necessarily, motivated financially. Additionally, government and public health agencies have a greater responsibility to prioritize population health through laws and regulation even if it may conflict with individual autonomy at times. In countries like the US though, this is complicated as these agencies also have a responsibility to the nation’s values, such as personal liberties.

Next, pharmaceutical and biotechnology companies drive innovation in science and healthcare, motivated by both a mission to improve patient lives and the need to generate profits, which often causes much mistrust. Similarly, insurance companies are typically financially motivated, and are a major source of mistrust. They set coverage and pricing policies that strongly impact access to care. Another equally important stakeholder is the media, which influences public understanding and opinion on healthcare, and can distort perception through misinformation or biased coverage, undermining trust in medical institutions. Ultimately, these issues affect the general public, and no one in society is left out of this ethical dilemma. Everybody benefits from collective health protections and initiatives, but can also bear the consequences of autonomous choices like disease spread, overwhelmed hospitals, or higher healthcare costs. 

Values

Several values and ethical principles are central to the ethical dilemma of medical mistrust. Autonomy emphasizes the importance of respecting an individual’s right to make choices about their health based on their beliefs. The way a patient exercises their autonomy will depend on their personal beliefs, fears, values, and perception of risk. This value is complicated when individual medical decisions affect others. Furthermore, beneficence highlights the duty of healthcare institutions, governments, and healthcare providers to protect the health of the general public. This value supports public health campaigns and guidelines to protect societies, but it also assumes that institutions know what is best for the public and will infringe some individual autonomy to achieve general health objectives. On the other hand, nonmaleficence describes the duty of healthcare institutions, governments, and healthcare providers to prevent harmful medical choices, as well as not cause harm through dishonesty or profit-driven care. Justice is relevant because access to healthcare should be fair, people should be treated equitably, and vulnerable populations should be protected. It is also an important value to consider because medical mistrust does not impact all groups equally. Communities with who have experienced discrimination or lower access to care have greater reason to mistrust healthcare systems. Transparency is a crucial value since trust should be earned in an honest way. It protects autonomy because the public should have full context and correct and unbiased scientific information on which to base their decisions. One last value is accountability, which connects many of these values. Both individuals and institutions must take accountability for the consequences of their decisions. This ensures institutions’ power is exercised transparently and justly, and that individuals realize their autonomous decisions will likely affect others. 

Ethical Considerations

Utilitarianism vs Right-based ethics

Right-based ethics is an ethical framework that prioritizes protection of the moral rights of individuals, which others are also morally required to respect (Düwell et al.). Additionally, those rights can not be overridden even for the greater good. When it comes to healthcare, these rights may include autonomy, informed consent, refusal to certain treatments or medications, privacy, and access to care. So, from this framework and based on these individual rights, it would be most ethical to allow individuals to have strong control over their healthcare choices. This may include patients having the ability to refuse vaccines or other medications they are against, choosing alternative forms of care and medicine, and making decisions free of coercion or government intervention.

 This right to autonomy is not unfettered though, and our freedom of choice also depends on how they intersect with the freedom of choice that others have, and the duty that we have to others. When an individual’s healthcare decision, like vaccine refusal, increases certain risks for vulnerable people around them, their personal freedom begins to constrain someone else’s. So, right-based ethics doesn’t simply justify doing as one pleases based on the right to autonomy, and it must also account for the coexisting rights of others in a society.

 This relates directly to Immanuel Kant’s deontology, a framework which focuses on moral duties, based on reason rather than outcomes (Kranak). In the case of mistrust, this may include the duty to not harm others and also treat them as ends in themselves. Kant’s Categorical Imperative argues that when making ethical decisions, we must consider if it is possible for our choices to be universally followed (Kranak). If everyone was mistrustful of medicine, public health systems would collapse and everybody’s health would be negatively impacted. Therefore, from a deontological lens, medical mistrust is not ethically justified.

Yes, we have a right to medical autonomy, but if everyone prioritized themselves and that right above their duties to others, deontology tells us we have failed to uphold our moral obligations to the wellbeing of our societies. This conclusion holds even if mistrust didn’t cause any direct harm, because deontology only deals with duties, not consequences. 

Another important consideration is that both rights-based ethics and deontology rely on the assumption that decisions are based on information that is rational. Yet, epistemology distinguishes knowledge from mere belief by arguing that knowledge requires more than a belief that happens to be true. Rather, a belief must be formed and acquired in the right way, through reasoning and supporting evidence, to be considered justified knowledge (Truncellito). This means that personal beliefs, if formed through misinformation or faulty reasoning, do not qualify as knowledge. Because right-based ethics and deontology require rationality as the basis for legitimate decision making, medical choices based on misinformation wouldn’t meet this standard, making it more difficult to argue those choices are fully autonomous. If medical mistrust isn’t grounded in justified knowledge, prioritizing individual autonomy over collective health would be more difficult to defend. 

A Utilitarian ethical approach holds that the most ethical decision is that which results in the greatest good for the greatest number of people. From a utilitarian perspective, medical mistrust is a problem to be minimized in order to allow healthcare to benefit the most people, in the most beneficial way possible. It can justify overriding personal beliefs, fears, and discomfort through mandates, restrictions, and pressures. Though it may be unrealistic to prevent mistrust from spreading, a utilitarian approach would argue that mistrust must be limited as much as possible, to preventable harm for the majority of the population. The considerations regarding epistemology and justified knowledge apply equally to utilitarianism, as the framework assumes that we can know which choice is most beneficial ahead of time, which is hardly the reality when considering healthcare decisions. 

Utilitarian, deontological, and right-based ethical frameworks can potentially coexist, but in regards to medical mistrust, they often conflict. While utilitarianism would support the use of mandates or pressure to suppress medical mistrust, a right-based perspective would view that as an abuse of individual freedom of choice. Deontology would similarly reject coercion as a response to medical mistrust, but for a different reason: it treats individuals as means to an end, rather than as ends in themselves. Because they prioritize different and often conflicting values, it is rare that these frameworks would realistically be able to coexist in our societies. This raises the dilemma: Should our societies prioritize collective health outcomes or protect individual autonomy even when the consequences are harmful or less beneficial?

The tension between utilitarianism, right-based ethics, and deontology also raises a deeper tension between the concepts of negative freedom and positive freedom. Negative freedom emphasizes a lack of obstacles (Carter) and in this case government interference, pressure, or coercion. On the other hand, positive freedom exists more often when individuals are part of a collective system (Carter) which helps them achieve conditions necessary for a healthy life. Should we seek to provide negative freedom in healthcare where there are little or no laws or regulations about the healthcare choices individuals can make, or positive freedom, where autonomy can be limited slightly more so systems can provide access to care and take public health measures to protect people from harm?  

To illustrate the different sides of this ethical tension, we can compare the healthcare systems in Western Europe versus American healthcare systems. Mistrust exists in both contexts, but it is shaped differently due to contrasting cultural and political values. The United States is a nation that historically places great emphasis on personal freedoms, individualism, and limited government intervention, which aligns more closely with negative libertyAZSQ  and prioritizing individual autonomy for health decisions. In contrast, Western Europeans tend to value the state’s responsibility to protect public welfare, reflecting a greater focus on a positive liberty approach regarding healthcare. 58% of Americans in a survey report by the Pew Research Center believed the freedom to pursue life’s goals without state interference was more important than the state guaranteeing nobody is in need. On the other hand, countries including Britain, Germany, France, and Spain ranged from 30-38% who believed the same, with the majority believing the opposite (Pew Research Center). In addition, research by Trust Across America shows that many European countries ranked significantly higher on the 2019 Country Trust Index than the U.S. This suggests that healthcare systems with a stronger government role and an emphasis on collective goals, may promote more public trust in healthcare, even though they may place slightly greater limits on individual autonomy. 

Another important aspect to consider is that healthcare systems in Western Europe are less profit-motivated since they are greatly government-controlled, while American systems tend to be more commodified. The relationship between physicians and patients becomes more of that between consumer and provider, which decreases trust levels as discussed above (Huang et al). Doctors in Europe tend to be paid less than American doctors because of the nature of the systems, which implies that their patients may see them as less profit-driven and therefore more trustworthy. However, greater government intervention can certainly also generate mistrust, if individuals prioritize individual autonomy over healthcare decisions. Additionally, a healthcare system that functions efficiently and promotes trust in one country won’t necessarily do so in another. Factors including population size, cultural norms, resource availability, and economic circumstances all shape the success of healthcare systems and the trust they promote. 

While excessive mistrust can undermine public health greatly, some skepticism can certainly be considered beneficial to individual patients and also healthcare systems. Research in social psychology has found that when people are less trusting, it pushes them to think more critically and evaluate situations with heightened caution, because they are less likely to simply accept what they are told (Weir). Regarding healthcare, a certain degree of mistrust can lead individuals to notice discrepancies or errors in their care and take steps to advocate for their health (Hostetter & Klein). Additionally, having individuals question the decisions that are made by healthcare institutions and professionals may increase the pressure on them to maintain high standards of care, meticulous research practices, and act with as much transparency as possible when dealing with new or controversial treatments. In this way, mistrust can prevent medical authorities from abusing their influence in situations of uncertainty. While this perspective has not been studied widely, it is an interesting and important question to consider, and could be a valuable area for further research. 

Conclusions

In my view, medical mistrust should not be dismissed as a product of ignorance, but rather framed as a major ethical concern. Baseline skepticism is a normal human characteristic, especially in situations involving risk. However ,mistrust is largely shaped by inconsistent communication, lack of transparency, profit-driven enterprises, and politicized and biased media, rather than simply an individual failure to understand science. The debate surrounding medical mistrust is ultimately centered on the tension between individual autonomy and the collective good, raising questions about whether personal freedom can ever be limited to prevent widespread harm. The ethical frameworks of utilitarianism - which emphasizes the outcome that benefits the majority - right based ethics - which prioritizes individual choice - and deontology - which argues our duty to consider our societies and treat everyone as ends in themselves - demonstrate this clash. 

One common response to medical mistrust is coercion, which can be effective in increasing adherence to regulations, yet presents ethical limitations. I believe that the usage of coercion and dishonesty is an immoral way of seeking out trust and the greater good. Coercion infringes on an individual’s freedom and autonomy to make informed decisions about their healthcare choices (Navin). The ultimate goal should be to guide individuals to develop morality to help them make choices that are autonomous but also consider everyone else in their societies.

For trust in public health to be sustainable, adherence shouldn’t be enforced and instead ethical, effective, and legitimate systems need to be built. Transparency from healthcare systems, governments, and media is crucial to maximizing trust. This includes avoiding coercive or dishonest methods as stated above, reducing polarization in sources (including by making social media algorithms less biased), creating shared standards of evidence, and making medical reasoning more coherent and accessible. Furthermore, I feel that both individuals and institutions should be held accountable for the consequences of healthcare-related decisions. Institutions such as government public health agencies, hospitals, pharmaceutical companies, and insurance providers hold immense power over medical information, policy, and access to care and, as a result, have a responsibility for transparency and nonmaleficence. Yet, that does necessarily mean that these institutions will comply with their responsibilities. The right set of incentives and regulations will need to be developed so that they uphold this set of values. Just as institutions have this duty to create policy and standards to protect public trust, individuals have an equal responsibility to follow those rules. Individuals also remain accountable for how their autonomous health choices will affect the rest of the population. Therefore, public health laws should be written and justified in ways that appeal to individuals with diverse moral values and opinions (Navin). In order to do so, I believe that legitimate health policies must be crafted in ethical principles of nonmaleficence and justice, though these principles can conflict when balancing individual freedoms with the well-being of a broader population. This would help ensure that compliance to these policies is based on moral legitimacy rather than imposed pressures. Essentially, I believe policies should motivate people to adhere to public health guidelines and initiatives because they feel it is the morally correct action, rather than because they fear punishment for failing to comply. 

Though coercion can raise ethical concerns by greatly restricting individual autonomy, gentle nudging, which ultimately preserves individual choice while guiding behavior through incentives and other strategies, could pave ways for public trust to be earned rather demanded (Steele). These methods would allow for a great deal of autonomy, yet encourage the public to take actions for the collective good. While it could be argued that because such approaches still influence individuals they could be considered as an infringement on informed decision-making, in my view they differ from coercion in that individuals conserve their ability to reject the suggested options. While this may not be the ideal conclusion to optimizing both autonomy and the greater good in medical mistrust, a practical compromise must be reached. 

One strategy that I’ve considered which could prove effective for nudging is that of choice architecture. Government and healthcare systems should aim to learn how to structure the choices they present in a way that reduces harm without coercion. Choice architecture has already been used to diminish the issue that is drug compliance, by constructing dosage schedules that make it more psychologically straightforward to remember to take medications (Thaler et al). Choice architecture is also reflected in organ donation systems:

the usage of organ donation opt-out instead of opt-in systems equally respects personal autonomy, but greatly increases the number of organ donors. Most individuals in opt-in nations do not opt to become donors, while most in opt-out systems don’t opt to become non-donors; people tend to adhere to the default option (Beraldo et Karpus). 

As mentioned, corporatization is an enormous contributor to the weakening of public trust in healthcare. I believe we should consider preventing vertical integration, such as the same holding company owning multiple levels involved in patient care. For instance, an insurance company owning practices or hospital systems allows it to control patient care in ways that cut costs and prioritizes profit over patient wellbeing. Vertical integration, with the right structure, can be ethical and promote trust, if the company is not profit-motivated, such as Intermountain Healthcare for instance (Intermountain Healthcare). Standardizing healthcare prices is another factor which could aid in preventing monopolies and promoting public trust, because it reduces skepticism about overcharging (Brown). Governments should contemplate nudging healthcare companies to become non-profit and patient-prioritizing, in new ways, on top of the current tax exemptions. This is certainly possible, as shown by Blue Cross Blue Shields, whose majority of entities act as non-profits and reinvest surplus revenue instead of distributing it to shareholders (Wilson). Additionally, having board members who are clinicians or patient representatives would bring more emphasis to patient-needs and provide balance in a profit-focused environment (Brown). Ultimately, I would argue that the most impactful shifts would be those that are both widespread and visible to the public, so they may achieve the greatest change in perception and trust. It is certainly important for companies to make meaningful changes internally as well, such as increasing representation on their boards, yet strategies such as standardizing healthcare pricing, or even a system such as outcome-based pricing will be the most effective in rebuilding trust in healthcare systems. For instance, the pharmaceutical company Novartis entered into outcome-based contracts with a few insurance companies in 2016, providing reimbursements on the medication Entresto if it didn’t have the intended results for patients (González). Yet, this concept raises extremely complicated and separate ethical considerations: How should the value placed on certain health outcomes be determined, especially in regards to quantity and quality of life, especially when every patient’s situation is individual and unique?

Looking ahead, with the rise of AI’s involvement in healthcare, there is the risk of further depersonalization and bias, which would only accelerate mistrust. AI is also democratizing access to information, and initially, this only aids in the spread of misinformation. Yet, we could also harness AI’s potential to ultimately decrease mistrust. AI models are already being designed specifically to detect medical misinformation on social media, such as a theoretical model named MISSCI, which explains the reasoning behind detected false claims (Hess).

Ultimately, medical mistrust reveals a deeper ethical failure not of individuals, but of systems who expect trust without consistently earning it. While individual autonomy must be protected, personal decisions affect the entire population and our shared resources. Therefore, I believe that ethical healthcare systems must justify their authority through transparency, fair policies, and moral legitimacy. Trust cannot be forced through coercion or dishonesty, it must arise from institutions that consistently keep the public’s interest in mind. Simultaneously, individuals remain morally responsible for recognizing how their autonomous choices will impact those around them. Medical mistrust therefore, is neither something to be ignored nor something to be suppressed. It is an issue that demands ethically grounded and transparent systems which promote informed and responsible decision-making.  

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