Families and Medical Decisions to Assume Risks for the Benefit of Others

Abstract

A sign on a highway features a crash test dummy driving and encourages drivers to slow down and drive safely by reminding them: he doesn't have anyone waiting for him at home-you do.1 The appeal to the stake family members have in each other's well-being and to the care and concern family members have toward each other is unmistakable and powerful. It should be taken more seriously in the clinical and biomedical research settings. Particularly when individuals are making decisions that will expose them to risks primarily or exclusively for the benefit of others, the decision making process should, when possible, include the family. "Family" refers to people connected by blood or marriage (and perhaps in some settings by alternative bonds) and who constitute what Lainie Friedman Ross describes as an "intimate family." Such a family is one in which "there is significant interdependence of the members and a commitment to the well-being of each other and of the group" (Ross 1998, p. 5).2 Different cultural traditions and circumstances will yield different understandings of how "far" the family extends and who counts as being part of an intimate family. None of these details are important here. This is not a sociological analysis of the family. This essay offers a philosophical argument for explicitly and proactively engaging families in certain types of decisions made in the clinical and biomedical research settings and could accommodate different understandings of the family. For individuals who exist outside of an intimate fam-1 Such a billboard was visible along highways near Doha, Qatar during a February 2012 visit. 2 Ross is addressing ethical issues in medical decision-making regarding children, and thus speaks explicitly of adults and non-emancipated minors for whom those adults are responsible. I use the term more broadly.