This book of essays focuses on the diminution of trust resulting from a perceived diminution in individual and institutional integrity as they relate to our university-based health educational and care programs. Following an introduction titled "Covenant, Leadership, and Value Formation in Academic Health Centers" (Roger J. Bulger), the first three essays treat the relationship between values expressed by institutions and those of individuals: "Medical Institutions and Their Moral Constraints" (Stephen Toulmin), "Integrity, Humaneness, and Institutions in Secular Pluralist Societies" (H. Tristram Engelhardt, Jr.), and "Institutions and the Shaping of Character" (Robert Coles). The next three essays consider the university and its role in forming and transmitting the values of expanding and conveying knowledge. They are titled: "Approaching Ethical Questions: A University Perspective" (Daniel Steiner); "Values and the Advance of Medical Science" (Donald S. Fredrickson), "Values in Teaching and Learning: A Student-Teacher Dialogue" (Kim Dunn and Ruth Ellen Bulger). Finally, how the values underlying institutional actions and policies are selected and what influence these values have on the treatment of individuals is the subject of "Hospitals as Humane Corporations" (Stanley Joel Reiser); "The Hospital-Academic Health Center Interface: The Community of Practice and the Community of Learning" (Mitchell T. Rabkin); "Determinants of the Culture and Personality of Institutions" (James G. Haughton); and "The Revival of Community and the Public Obligation of Academic Health Centers" (Lawrence W. Green). A concluding essay by Edmund D. Pellegrino is titled "Values and Academic Health Centers: A Commentary and Recommendations." References accompany some of the papers. (JB)