Trust, autonomy, and advance directives.

Abstract

Trust has been largely ignored in contemporary bioethical discussions and also by courts of law. The favored language of autonomy, privacy, and rights is useful but insufficient to speak to moral experience, especially the experience of persons who write advance directives, but also physicians who receive such directives. The Brophy case is analyzed for its salient features, and a more central place for the concept of trust is proposed. Let us begin with a case. Ethics is fundamentally a practical discipline, con cerned with what we should do and how we should live. So beginning con cretely may be wise. The case is that of Paul Brophy, and it is useful to ex amine because it is well known and because its most salient features are