Defining Family

A measure both of the importance of families to our lives and of our ambivalence about them is that any discussion of the topic quickly elicits a demand for an explicit statement of what is meant by family. The most useful such account is perhaps a normative one, which identifies features of special moral significance in the clear paradigm cases. Those features can then be used to determine what counts as a family in the less clear cases. Ludwig Wittgenstein's notion of family resemblances may be pressed into service here: any social configuration that incorporates at least most of the morally significant features of, say, marital and parent-child relationships can be thought of as a family for purposes pertinent to healthcare. These features include longstanding, committed relationships; blood ties; emotional intimacy; shared histories; and shared projects that produce solidarity among family members. Other crucial features identify functions: families forge the selves of their youngest members and help maintain the selves of adults. Further, familial relationships go beyond the contractual and the voluntary; in them people incur responsibilities not of their own choosing.

Relationships within families will take on greater or lesser bioethical significance, depending on the familial question under consideration. If treatment decisions for a badly damaged neonate are at issue, family means the mother and father; if the issue at hand is pedigree testing for a genetic disorder, family means blood kinship; if the issue is determining the appropriate caregiver for a person with progressive dementia, family may mean spouse or child.

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