In his carefully crafted article, which, it is hoped, will stimulate further dialogue about this issue, David J. Doukas reviews some of the literature on this subject. He does not seem to differentiate between the family's role in decision making for competent or incompetent patients. His interest is prior to that: it is in working out a general agreement prior to the time that such an agreement may be needed. He favors a family covenant, one in which trust accumulates over time, and he offers a model of such a covenant. At first blush, the notion of covenant rather than the notion of contract seems far more suited to the medical milieu. I have no problem with the idea of covenant and trust, but I have serious reservations about its implementation....