The development of a mature "bioethics of the family" is significantly complicated by controversies concerning the nature and importance of this much-vaunted, much-maligned social institution. The dramatic shifts in the demographics of American families have rendered them suspect, as have public debates that underscore the family's role in sustaining practices hostile to women's interests and that identify families or family values as a particular focus of conservative political perspectives. Families have come to seem so fragile, their configurations so arbitrary compared with what they once were, and their value so contested, that offering them a special role in bioethical deliberation may seem a dubious enterprise.
Yet neither hostility nor sentimentality does justice to the moral character of these complex and puzzling entities. Nor is the notion that families are particularly unstable in today's world altogether accurate. American families have always been somewhat fragile and subject to rapid reconfigurations. African- and European-American families in the Chesapeake colonies of Virginia and Maryland, to take only one instance, were so vulnerable to malaria and other fatal illnesses that it was not at all unusual for an adult, whether slave or free, to bury three or even four spouses, or for half-orphaned children to be reared by relatives other than the surviving parent. In the matrilineal Iroquois societies of that same period, divorce was quite common. It is true that middle-class families gained a certain solidity when they underwent a shift around 1800 to a sentimental, child-centered model of domestic life, but this was achieved through an arguably unjust gendered division of labor, in which the middle-class father was increasingly absent from home and the mother's work was narrowed principally to unpaid domestic tasks. For many poor young nineteenth-century mothers—whether black, Latina, Irish, or east European—this arrangement was not an option, and the long hours spent working outside the home left the care of their children a somewhat haphazard business. Death in childbed and other premature deaths once threatened the family's integrity as much as the divorce rate, which has risen by a steady 3 percent in every decade since the Civil War, does now. In short, there is good reason to think that stress, turmoil, and identity crises have long been a feature of American families.
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