Ethics Consultation: A Strategy for Overcoming Barriers to Trust in Healthcare

Published on: June 22, 2026

Here’s a scenario that happens every day in hospitals across the country.

A family stands huddled outside the room of their dying mother, father, sister, brother, child or friend. The patient cannot speak for themself. The clinical team has told the family that they believe further interventions will only prolong their loved one’s suffering. To the family that feels like giving up.

How to bridge the gap between the family and the medical team? And how to do it in such a way that the family feels heard and respected, the clinicians feel that they have acted in the best interests of their patient, and the institution feels protected from misunderstandings that can lead to serious conflict. In other words, how to do it in a way that earns trust?

How We Got Here

Trust – or lack thereof – is a big problem in healthcare. And for good reason.

Most people came to trust providers under conditions of limited choice and because access to competing information was scarce. For millions of others – Black, Indigenous, incarcerated, the disabled and other marginalized communities – mistrust was a rational response to decades of abuse and betrayal.

The federally funded Tuskegee Syphilis Study left Black men untreated for decades in order to study the progression of the disease. Researchers used the cells of Henrietta Lacks, a Black woman, for research without her knowledge or consent. Physicians operated on enslaved women without anesthesia.

Racial and ethnic disparities in care continue to exist today. Maternal mortality rates for Black women are catastrophically higher than for white women. The opioid epidemic exposed massive failure to protect the public. Healthcare has become a market commodity dictated more by insurers, pharmaceutical companies and shareholder returns than the needs of patients. There aren’t enough clinicians, especially in rural areas, to meet the need for care. Physicians are burned out. Patients feel rushed and unheard. And while many would like to relegate COVID-19 to the dustbin of history, its impact on trust – especially in government and its approach to healthcare – has been deep and enduring.

Trusting v. Trustworthiness

It’s natural then to ask: How do we get people to trust?

According to Inmaculada de Melo-Martín, PhD, MS, a Professor of Medical Ethics at Weill Cornell Medicine who serves on the Center’s Board of Directors, that is the wrong question.

Writing in The Hastings Center Report, Dr. de Melo-Martín draws a critical distinction between trusting and trustworthiness.

“When we ask people to trust, the emphasis is on the one who is trusting rather than the one who is trusted, on trusting rather than trustworthiness. The emphasis is particularly problematic when it involves racial and ethnic minorities.”

The right question, she argues, is not how to get people to trust but how our institutions become worthy of it. “A focus on the trustee,” she states, “rather than on the trustor, would call attention to the barriers that need to be removed for trust to exist.”

Among the barriers she cites are access to healthcare institutions, participation in clinical trials, diversity of the biomedical community, bias in healthcare professionals, providing appropriate information, conducting research on issues that are of particular importance to minority communities and, most importantly, taking people’s values seriously.

Taking Values Seriously

Dr. Melo-Martín makes the case for taking values seriously in the context of public health: “Scientific evidence is relevant to public policy decisions,” she says, “but scientific evidence alone – even reliable evidence about which there is consensus – does not dictate policy.”

Similarly, clinical evidence alone – even evidence about which there is consensus – does not dictate clinical decisions. Sometimes reasonable disagreements about what is valuable can underlie the rejection of clinical recommendations.

Clinical evidence can tell the medical team what’s happening to the patient physically, what treatments are available, and what is likely to happen depending on options chosen.

Unfortunately, when there is disagreement about a clinical decision related to values, the repercussions can be serious. Neglecting the values of stakeholders can lead to poor decisions that produce outcomes that are bad for patients and families, bad for clinicians who feel morally distressed, bad for institutions whose reputations and more are at stake, and, ultimately, bad for rebuilding and sustaining public trust.

Ethics Consultation for Trust Building

If a key barrier to trust in healthcare is failure to take people’s values seriously, then healthcare ethics consultation offers a proven way to bridge the gap.

The AMA Code of Medical Ethics defines healthcare ethics consultation as “a specialized service providing, through trained individuals or committees, analysis and advice to patients, families and clinicians to resolve uncertainty or conflict regarding value-laden, complex treatment decisions. It aims to promote respectful decision-making and improve care quality.”

A clinical ethicist is a specialty consultant brought in to assist in the care of patients in the most challenging situations. Often, these situations involve

• Patients without someone to act as their decision maker,
• patients that have reached the limits of what medicine can do but families want interventions to continue,
• and infants born prematurely whose families are struggling to decide how far they should go in approving invasive treatment.

In each of these situations, the ethicist’s role is not to impose a decision but to create the conditions under which a decision that respects the patient’s values is reached through a process all parties can trust. The ethics consultation functions not as conflict management but as a practical, proactive, justice-oriented mechanism for ensuring that every voice in a complex clinical situation is genuinely heard and weighed. Ethicists also help to build institutional culture and trustworthiness. They train clinicians, social workers, chaplains and administrators to identify and respond to ethical issues before they become crises.

An Effective Process

The Joint Commission — the nation’s leading healthcare accreditation body whose standards govern the operations of thousands of hospitals and health systems across the country — mandates that accredited organizations have a process for addressing ethical issues in patient care. The Federal government requires TJC accreditation to qualify for Medicare and Medicaid reimbursement.

Specifically, TJC requires that healthcare organizations “develop and implement a process that allows staff, patients, and families to address ethical issues or issues prone to conflict.” (Standard LD.04.02.03). It’s largely left up to organizations to determine what that process looks like, with widely varying responses to the requirement. Bioethics experts recommend, at a minimum, that organizations establish formal ethics committees, implement robust policies regarding patient rights, and conduct regular staff training to manage ethical dilemmas.

Think back to that family and medical team standing outside the hospital room of their loved one, described at the beginning of this piece, and how their experience might have been improved by an ethics consultation.

If that hospital had an effective “process” for allowing staff, patients, and families to address ethical issues or issues prone to conflict, anyone on the medical team could have asked for an ethics consultation. Likewise, any family member could have asked for a consult if they were even aware that such services exist. Ethics consultation can be especially helpful in cases that involve patients whose values are easily overlooked and for whom equity and justice has been denied.

Ethics consultations cannot get people to trust our healthcare system. But they could go a long way toward making the system more trustworthy.

 AUTHOR

Trudi Galblum, MPS, is a consultant on marketing, communications, and grantwriting for the Center for Practical Bioethics.