Sissela Bok's1 and Torbjörn Tännsjö's2 writings on trust and informed consent were sources of inspiration for my article.3 It is gratifying to have a chance to respond to their thoughtful comments.

Bok concurs with my scepticism that the ‘trust-promotion argument for informed consent’ can successfully generate commonsense morality's full set of informed consent norms. But she finds that argument even more wanting, perhaps so wanting as to be unworthy of critical attention. What she seems to find particularly objectionable is the fact that the argument treats all social trust as valuable. For Bok, misplaced trust in health practitioners who are deceitful or violate patients’ other rights lacks any value whatsoever. There isn't even a pro tanto duty (a defeasible presumption) in favour of promoting it.

My own inclination is to say that nearly all trust has some social value, if only thanks to its tendency to promote social stability (which Bok seems to dismiss) or its tendency to promote medical adherence (the value of which she may have to acknowledge). But often, trust also tends to generate bad outcomes, and in many cases of misplaced trust, that tendency will make its value negative on balance. Still, in my view, …