Trust or contract: How far does the contemporary doctor-patient relationship protect and promote autonomy?

The law has intervened extensively in the last 30 years in the name of autonomy enhancement and the protection of those with reduced mental capacity. It is, however, far from clear how much this has resulted in a net increase in the substantial trust that patients feel towards healthcare professionals - indeed, the opposite might be true. This chapter considers these developments against the backdrop of Sheila McLean's contributions on the topics of consent and autonomy. It argues that a failure by law and its institutions to grasp the nuances and contours of authentic autonomy has encouraged a pseudo-contractual doctor-patient dynamic in which patient abandonment is legally sanctioned and the spectre of paternalism remains. While recognising that law cannot prescribe trust, it nonetheless suggests ways in which law's future direction of travel could be more conducive to the promotion of a genuine therapeutic partnership.