Social representations of addiction and the resulting stigmatization have been widely described and studied in the literature, but their effects are no less problematic. These representations, which also occur in care settings, generate a climate of distrust which damages the therapeutic relationship, and its ethical quality. This article, combining clinical experience and an ethical stance, offers an original, innovating approach to the existence of distrust in care relationships in the area of addiction. Pragmatic approaches deriving from the human sciences and analytical philosophy provide an invitation to escape from the demanding climate of mistrust, and to take the gamble on trust so as to improve the quality of interactions between protagonists in care. In complementary fashion, a sociology of action can combat the disquiet generated by distrust through a new commitment to innovating forms of action. This "poetic" mode of action is legitimized by the reflection that backs it up, and by its presentation to peers qualified to approve it. Finally, continental moral philosophy underlines the importance of a carefully weighed commitment on the part of caregivers and addicted patients towards promises aiming to support a sincere care relationship, without damaging the therapeutic dynamic or the ethical quality by providing too many safety nets. This reflection is intended to achieve better identification of the clinical and ethical issues raised by mistrust, and inclusion of these aspects in the training of personnel and in care provision planning.

The creation in 2010 of a national ethical area on Alzheimer disease illustrates the evolution in the French context towards an institutionalization of ethical approach concerning chronic diseases and long term care. This paper presents the background of such a national area, how it works, its objectives and two concrete outputs: the charter "Alzheimer Ethics & Society 2011" and the advice "Alzheimer, ethics and society", published in September 2012.

Résumé Les concepts relatifs aux droits de l’homme caractérisent et éclairent les enjeux d’une exigence éthique dans les domaines du soin et de la recherche. Ce texte que nous avons rédigé avec Jonathan M. Mann en 1998 – quelques mois avant sa mort – tente de cerner la portée du dispositif initié en 1948 avec la Déclaration universelle des droits de l’homme du point de vue de son impact en matière de santé. Les droits de la personne tiennent pour beaucoup au respect qui lui est témoigné dans son existence même. Professeur de santé publique spécialisé dans l’épidémiologie, Jonathan M. Mann a été le premier directeur du programme sida à l’Organisation mondiale de la santé ( oms ) avant d’être le directeur du Centre François-Xavier-Bagnoud de santé publique et droits de l’homme à l’université Harvard (États-Unis).

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