Trust,autonomy, and advance directives

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.This paper was presented at the Lehigh Valley Hospital Center Conference, Making Medical Decisions with and for Patients in Difficult Medical Circumstances, in 1988.The author has profited greatly in writing this paper from reading Nancy King'sMaking Sense of Advance Directives, to be published by D. Reidel, Dordrecht, The Netherlands.