Marsilius-Project: "Treuhand" (Fiduciary relationships in medical ethics)

In a fiduciary relationship one party (the fiduciary) acts in the best interest of another party (the beneficiary). Today, fiduciary law governs a myriad of personal, professional and commercial relationships including e.g. the relationship between parent and child, lawyer and client, physician and patient, trustee and beneficiary, agent and principal and corporate director and corporation.

The Marsilius-Project “Treuhand” aims to identify and analyse fiduciary relationships in health care. The application of the fiduciary concept to current discussions in medical ethics can help to sharpen problems and to analyse the position and conduct of different stakeholders.

Therefore, in a first step the concept of fiduciary not only as a legal but also ethical concept must be elucidated:

  • Who are stakeholders in fiduciary relationships?
  • What are key attributes of fiduciary relationships?
  • What are fiduciary duties?

In the current state of the project the concept of an ethical fiduciary theory is applied to two topics of medical ethics:

I. The first subproject aims to substantiate the often-cited assertion that the patient-physician relationship is fiduciary in nature. Therefore, the theoretical framework for an ethical fiduciary concept regarding the patient-physician relationship must be founded. This established theory should be applied to specific contexts of the patient-physician relationship e.g. informed consent.

II. The second subproject analyses the term “data trust”. This term is used in current discussions focussing the best way of stewarding data e.g. health data. Data trust describes an independent data intermediary that mediates data between data provider and data user. In health care data trusts are discussed as an option to boost the sharing of data by providing a trustworthy structure of data management. While the usage of the term “data trust” in current discussions is limited to a technical sense, this project aims to describe the ethical foundation of data trusts. In a next step data trust as an ethical fiduciary theory should be applied to specific data trust models and be used as the foundation of a “code of conduct” for involved persons.


This project is funded by a grant of the University of Heidelberg's Marsilius Kolleg (center for advanced studies). A one-year fellowship of the Marsilius Kolleg was awarded to Prof. Dr. Eva Winkler and Prof. Dr. Stefan Geibel, Fellow-class 2019-20

  • Geibel SJ, Ludewigs S, Narchi J, Winkler EC. Ärztliche Treuhänderschaft. Essay Marsilius-Kolleg Jahresbericht 2019/2020 (Band 19, 2021), veröffentlicht am 29.03.21. https://doi.org/10.11588/fmk.2021.0.78663
  • Winkler EC. Das Konzept der Treuhand und sein Wert für die Medizinethik. Fellowbericht Marsilius-Kolleg Jahresbericht 2019/2020 (Band 19, 2021), veröffentlicht am 29.03.21. https://doi.org/10.11588/fmk.2021.0.78682
  • Ludewigs S, Narchi J, Kiefer L, Winkler EC. Ethics of the fiduciary relationship between patient and physician: the case of informed consent. Journal of Medical Ethics. https://doi.org/10.1136/jme-2022-108539

Lukas Kiefer

  • Prof. Dr. Stefan J. Geibel (Faculty of Law, Heidelberg University);
  • Ann-Cathrin Maier (Faculty of Law, Heidelberg University);
  • Sophie Ludewigs (Faculty of Law, Heidelberg University).