Fundamentals of Medical Ethics — Medical Expertise: Balancing Science, Values, and Trust

This Perspective examines the evolving crisis of medical expertise and trust in the U.S., especially highlighted by the Covid-19 pandemic. Drawing on historical events from the rise of cultural medical authority in the 19th century, through mid-20th century scientific advancements, and activist-driven critiques of the 1960s–1990s the author explores how marginalized communities and social movements challenged paternalistic practices and unethical research. Contemporary skepticism, amplified by misinformation and political polarization, has exposed weaknesses in conventional physician–patient communication. The article argues for a shift toward understanding patients’ values, integrating shared decision-making, and acknowledging historical injustices to rebuild trust. Strategies include eliciting patients’ beliefs, recognizing valid concerns, and replacing misinformation with respectful dialogue reframing expertise as a relational and ethically grounded tool rather than simply scientific authority.

This Perspective examines the evolving crisis of medical expertise and trust in the U.S., especially highlighted by the Covid-19 pandemic. Drawing on historical events from the rise of cultural medical authority in the 19th century, through mid-20th century scientific advancements, and activist-driven critiques of the 1960s–1990s the author explores how marginalized communities and social movements challenged paternalistic practices and unethical research. Contemporary skepticism, amplified by misinformation and political polarization, has exposed weaknesses in conventional physician–patient communication. The article argues for a shift toward understanding patients’ values, integrating shared decision-making, and acknowledging historical injustices to rebuild trust. Strategies include eliciting patients’ beliefs, recognizing valid concerns, and replacing misinformation with respectful dialogue reframing expertise as a relational and ethically grounded tool rather than simply scientific authority.