Self-Trust and Reproductive Autonomy (review)

The publication of Sissela Bok's Lying: Moral Choice in Public Life (1978) and Annette Baier's "Trust and Antitrust" (1986; reprinted in Baier 1995) inaugurated fresh waves of interest in the topic of trust in two different philosophical literatures: biomedical ethics and feminist moral philosophy. Philosophical explorations of trust have until recently followed these two different paths. In bioethics, trust has been envisioned as an essential ingredient of the physician-patient relationship which has been neglected in favor of an emphasis on patient autonomy (see, e.g., Pellegrino, Veatch, and Langan 1991; Pellegrino and Thomasma 1993; O'Neill 2002). In feminist theory trust tends to be viewed as one of several relationship-based ethical concepts such as caring and empathy, which together suggest a view of moral life decidedly different from the modern tradition exemplified by Kantian rationalism and utilitarian calculation (see, e.g., Govier 1997; 1998.). Carolyn McLeod's Self-Trust and Reproductive Autonomy aims to bring these various concerns together. She succeeds by combining relational conceptions of trust and autonomy to develop her own account of self-trust and its vital, but overlooked, importance in the reproductive lives of women.

McLeod begins with an account of the nature of trust. Rather than attempt to list necessary and sufficient conditions for trust, McLeod describes a trust prototype. Central features of the trust prototype include relationality, dependence, and optimism about the competence and motives of the trusted one. McLeod emphasizes the role that ascriptions of moral integrity—which she defines as acting in a way that coincides with one's moral outlook—play in trust judgments. McLeod's take on trust is only subtly different from Baier's and Govier's, but this early chapter is valuable both for its clear discussion of the concept of trust and for the way it sets up an account of self-trust as a nonprototype case of trust. Moreover, as McLeod works her way through this thicket of conceptual issues, she introduces individual cases from her experience as a clinical bioethicist, as well as from documentary films and from studies in anthropology and sociology. The many well-drawn case discussions—focusing on miscarriage, infertility treatment, and prenatal diagnosis—helpfully inform the book's theoretical components.

McLeod next moves to a discussion of self-trust, taking care to distinguish it not only from trust itself but also from other self-regarding attitudes, such as self-confidence and self-respect. Self-trust involves optimism about one's own competence and moral integrity. Trust is relational primarily in the sense that it requires a relationship between two people, a truster and a trustee. In contrast, self-trust is relational in the sense that it requires reinforcement by others who provide truthful and respectful feedback on one's self. Unlike self-confidence or self-reliance, self-trust has a moral dimension, in that it requires living up to a moral ideal and, unlike self-respect, it implies vulnerability. It may sound strange to think of a person as vulnerable to herself, but McLeod reminds us that a host of human foibles, from weakness of the will to self-deceit, can result in betrayal of self-trust. More significantly for the central aims of the book, McLeod contends that patients are vulnerable in their self-trust to social forces as diverse as oppressive stereotypes and abuse, which can lead to distorted self-understandings.

McLeod avoids the pitfall of uncritically endorsing trust and self-trust by developing an intelligent, politically savvy account of justified self-trust, which is both reliabilist and externalist. Essentially, a person's self-trust track record, together with social feedback, determine whether self-trust in any particular situation is justified. McLeod's insight that, in trust evaluations, "we have to consider how oppression may have defined the normal conditions for reliable trusting and distrusting for members of that person's social group" (99) has special bearing on women'...